PURPOSE: There remains significant controversy around the optimal criteria for recommending prostate biopsy.
To examine this issue further, urologists in the Michigan Urological Surgery Improvement Collaborative (MUSIC) assessed statewide prostate biopsy practice patterns and variation in prostate cancer (PCa) detection.
METHODS: MUSIC is a statewide physician-led collaborative designed to improve prostate cancer care. From 3/2012 through 6/2013, 17 MUSIC practices collected standardized clinical and pathological data for 3,015 men undergoing first-time prostate biopsy. We examined pathologic biopsy outcomes according to patient characteristics and across MUSIC practices.
RESULTS: The overall cancer detection rate was 52%, with significant variability across MUSIC practices (range: 43% to 70%, p< 0.0001). 27% of all patients biopsied were > 69 years, ranging from 19% to 36% at individual practices. Men with a PSA < 4 ng/ml were 26% of the study population (range: 10% to 37%). Detection rates in patients > 69 years ranged from 42% to 86% for individual practices (p=0.0008). For patients with PSA < 4 (n=793), cancer detection rates ranged from 22% to 58% across individual practices (p=0.0065). The predicted probability of cancer detection varied significantly across MUSIC practices (p< 0.0001), even after adjusting for patient age, PSA, prostate size, family history and DRE findings.
CONCLUSIONS: While overall detection rates are higher than previously reported, cancer yield for prostate biopsy varies widely across urology practices in Michigan. These data serve as a foundation for our efforts to understand and improve patient selection for prostate biopsy.
Written by:
Riedinger CB, Womble PR, Linsell SM, Ye Z, Montie JE, Miller DC, Lane BR. Are you the author?
Michigan State University College of Human Medicine, Grand Rapids, MI; Department of Urology, University of Michigan Medical School, Ann Arbor, MI; Michigan State University College of Human Medicine, Grand Rapids, MI; Spectrum Health Hospital System, Grand Rapids, MI.
Reference: J Urol. 2014 Feb 25. pii: S0022-5347(14)00346-2.
doi: 10.1016/j.juro.2014.02.088
PubMed Abstract
PMID: 24582538
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