According to research and local data, there is a need to improve urology referrals 
for prostate examinations.  Identified barriers to proper urology referrals include 
contradictory guidelines, confusing decision-making aids, and providers’ knowledge 
deficit.  A Delphi panel consisting of four multidisciplinary physicians from internal 
medicine, radiation oncology, surgical pathology, and urology in the Los Angeles area 
were recruited to obtain consensus feedback.  The Delphi panel ranked existing Prostate
Specific Antigen (PSA) screening guidelines in this order:  American Urological 
Association’s guideline first, American Cancer Society second, and American Society of 
Clinical Oncology third.  They agreed on the importance of PSA value interpretation 
staying consistent with current urological practices today and emphasized the importance 
of identifying risk factors for prostate cancer.  Although only one of four physicians on 
the panel used a tool for calculating life expectancy, all agreed on PSA screening in the 
50-59 age group, and two of four also included age groups 40-49, 60-69, and 70-79.  
Future implications include pilot testing this updated PSA testing tool, which 
incorporates user-centered design with local primary care providers (PCPs) as a reliable 
decision-making aid to help improve urology referrals for prostate examinations thereby 
saving cost, time, and lives.