MP20-10 TEMPORAL TRENDS IN PROSTATE BIOPSY CRITERIA AND OUTCOMES FROM 2012-PRESENT

Abstract

INTRODUCTION AND OBJECTIVE: In 2012, the United States Preventive Services Task Force (USPSTF) issued guidelines discouraging screening for prostate cancer using prostate specific antigen (PSA). We evaluated trends in our biopsy practices during this time period, with the hypothesis that criteria for biopsy became increasingly stringent, and there was a shift in diagnosis from low risk to higher risk disease. METHODS: We queried our institution’s electronic medical record for transrectal ultrasound-guided prostate biopsies (CPT code 55700) from 2012-2017. Patient and biopsy parameters (age, PSA, standard vs. MRI fusion biopsy, Grade Group [GG]), were recorded. Biopsies for PSA >50 ng/mL or those done for surveillance were excluded. Chi-square correlation assessed differences between % clinically significant prostate cancer (csPCa, defined as GG ≥ 2) and %GG1 diagnosis between 2012 and 2017. Multivariate logistic regression assessed predictors of csPCa as well as clinically insignificant prostate cancer (GG1). RESULTS: A total of 1,031 prostate biopsies were reviewed, and 927 were retained as initial diagnostic biopsies. Overall, PSA increased 0.35 ng/mL/year. The %csPCa increased from 20% in 2012 to 43% in 2017 (p < 0.001) while the %GG1 decreased from 23% to 11% (p = 0.004). On multivariable logistic regression, year was a significant independent predictor of csPCa (OR 1.13, p = 0.016). Year was also an independent predictor of GG1 disease with a 14% decreased odds of GG1 diagnosis with each additional year (OR 0.86, p=0.013). CONCLUSIONS: In the post-2012 era, there has been migration in prostate biopsy outcomes from low risk to higher risk disease. Rising PSA for biopsied patients during this time reflects more stringent criteria for biopsy. While less diagnosis of low grade disease (“overdiagnosis”) is a desirable outcome, increased detection of high grade disease is potentially worrisome. The effects of these shifts on prostate cancer mortality and advanced disease will become evident over time.Source of Funding: None.