Introduction: At present, there are limited data investigating predictors of delay and failure to initiate urologic assessment in men referred for evaluation of an elevated PSA. Since only 50% of age-appropriate American men receive PSA screening, it is vital to identify factors that may prevent continued work up. This study aimed to evaluate predictors of timely urologic evaluation among men referred for initial elevated PSA in a diverse, high-risk, urban community. Methods: We conducted a retrospective cohort study of all men ages 50+ referred to urology within our healthcare network between January 2018 and December 2021 for initial elevated PSA. Time to initial urologic evaluation was categorized as timely (within 4 months of referral), late (after 4 months), or absent (no urology evaluation). Demographic and clinical variables were abstracted. A multivariable multinomial logistic regression model controlling for age, referral year, household income, distance-to-care, and PSA at referral was conducted to identify predictors of timely vs. late vs. absent urologic evaluation. Results: 1335 men met inclusion criteria; 589 (44.1%), 210 (15.7%), and 536 (40.1%), had timely, late, and absent urologic evaluation, respectively. The majority were non-Hispanic Black (46.7%), English-speaking (84.0%), and married (54.6%). Median time to initial urologic evaluation differed significantly between timely and late groups (16 vs. 210 days, P<0.001). Multivariable logistic regression (Table 1) revealed the following to be significant predictors of timely urologic evaluation: non-Hispanic Black (OR=1.59, P=0.03), Hispanic (OR=2.07, P=0.001), Spanish-speaking (OR=1.44, P=0.03), or former-smokers (OR=1.31, P=0.04). Conclusions: In our diverse community, men who are non-Hispanic White or English-speaking have a decreased odds of timely urologic evaluation after a referral for elevated PSA in our diverse patient population. Our study underscores cohorts that may benefit from implementation of institutional safeguards to facilitate and ensure appropriate follow-up upon referral for elevated PSA. SOURCE OF Funding: None
