Alerts reduce prostate cancer overtesting

Point-of-care alerts reduced unnecessary prostate-specific antigen testing in men older than 75.
*Secondary analysis of cluster randomized trial; Level 2.

Citation

Duong N, Lee JY, Peprah Y, et al. Changing Clinician Behavior in Geriatrics: Point-of-Care Alerts for Prostate-Specific Antigen Screening. Am J Prev Med. 2026;71(1):108305.

Background

Routine prostate-specific antigen screening in older men can cause overdiagnosis, overtreatment, anxiety, and treatment harms. Guidelines recommend against routine screening in this age group, yet clinician practice varies.

Patients

338 clinicians in 59 primary care practices; patients were men aged 76 years or older. Exclusions included prior prostate cancer, androgenic drug use, or no eligible clinician visit.

Intervention

Brief online education plus an electronic health record alert when ordering prostate-specific antigen testing.

Control

Brief online education alone.

Outcome

Clinician-level annual overtesting rate: proportion of eligible older male patients receiving prostate-specific antigen testing in the prior 12 months.

Follow-up Period

18 months.

Results

Outcome Effect
Overtesting rate, overall 12.1 fewer tests per 100 patients versus control (95% CI, 7.5 to 16.7)
Female clinicians 15.6 fewer tests per 100 patients (95% CI, 9.4 to 21.9)
Male clinicians 6.9 fewer tests per 100 patients (95% CI, 2.2 to 11.6)
Graduated in 2000 or later 17.4 fewer tests per 100 patients (95% CI, 9.5 to 25.3)
Graduated before 2000 7.8 fewer tests per 100 patients (95% CI, 3.4 to 12.3)
Clinicians triggering alerts Decreased 0.6 percentage points per month (95% CI, 0.3 to 0.8)

The analysis compared clinicians by assigned practice group and used weighting to reduce bias from missing follow-up data.

Limitations

This was a secondary analysis and was not originally powered for subgroup differences. It used one health system, so results may not generalize. Pandemic disruption required excluding several months. Clinician reasons for overriding alerts were often missing.

Funding

NIH National Institute on Aging; unrelated Omron support disclosed.

Clinical Application

Use point-of-care alerts to reduce low-value prostate testing in men older than 75, while addressing persistent ordering and patient requests.