EAU 2019: Trends in Prostate Biopsy Criteria and Outcomes from 2010 to Present: The Columbia Experience
All biopsies performed between 2010 and 2017 at Columbia University were analyzed. Patients with a PSA>50 and biopsies of patients on active surveillance were excluded from the analyses.
A total of 818 prostate biopsies were performed during this timeframe. Use of MRI fusion started from 0% in 2010 and increased to 43% in 2017. The average age remained similar through the years (65.2 vs. 66.4, p=0.22). However the average PSA and average PSA density increased significantly through the years from 5.72 to 8.16 ng/ml, p=0.001, and from 0.12 to 0.19, p=0.001, respectively. There was a significant decrease in the diagnosis of grade group 1 disease (21.2% vs. 12.3%, p=0.05) and increase in clinically significant disease diagnosis (>= Gleason grade group 2) from 21.2% to 40.4%, p=0.001. Although not statistically significant, there was also an increase in the Gleason grade group 4 incidence from 5.1% to 13%, p=0.29, and a decrease in the negative prostate biopsy rate, from 57.6% to 47.3%, p=0.09.
In conclusion, significant changes have been noted through the years since the change in screening guidelines in 2012. The authors rightfully comment that although the decrease in overdiagnosis is encouraging, the long-term effects of the new screening practices on metastasis and mortality are still unclear.
Presented by: Christopher Haas, MD, Columbia University, College of Physicians and Surgeons, Columbia University
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.