PD19-07 PROSTATE BIOPSY TRENDS IN RELATION TO U.S. PREVENTATIVE TASK FORCE RECOMMENDATIONS AGAINST ROUTINE PSA-BASED SCREENING: A TIME-SERIES ANALYSIS

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening I1 Apr 2014PD19-07 PROSTATE BIOPSY TRENDS IN RELATION TO U.S. PREVENTATIVE TASK FORCE RECOMMENDATIONS AGAINST ROUTINE PSA-BASED SCREENING: A TIME-SERIES ANALYSIS Bimal Bhindi, Muhammad Mamdani, Girish S. Kulkarni, Antonio Finelli, Robert J. Hamilton, John Trachtenberg, Alexandre R. Zlotta, Ants Toi, Andrew Evans, Theodorus van der Kwast, and Neil E. Fleshner Bimal BhindiBimal Bhindi More articles by this author , Muhammad MamdaniMuhammad Mamdani More articles by this author , Girish S. KulkarniGirish S. Kulkarni More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Robert J. HamiltonRobert J. Hamilton More articles by this author , John TrachtenbergJohn Trachtenberg More articles by this author , Alexandre R. ZlottaAlexandre R. Zlotta More articles by this author , Ants ToiAnts Toi More articles by this author , Andrew EvansAndrew Evans More articles by this author , Theodorus van der KwastTheodorus van der Kwast More articles by this author , and Neil E. FleshnerNeil E. Fleshner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1526AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives In May 2012, the U.S. Preventative Task Force (USPTF) released recommendations against routine Prostate-Specific-Antigen (PSA) screening for prostate cancer (PC). In the context of a single-payer healthcare system, the objective of our study was to examine how this event has impacted our institutional biopsy rate and cancer detection using a time-series analysis. Methods We examined the University Health Network (UHN, Toronto) BioBank database for prostate biopsies done from Oct 2008 to Jun 2013. The BioBank approaches all patients undergoing prostate biopsy at UHN and has a 94.7% consent rate for inclusion. Biopsies for active surveillance or solely targeting MRI-detected lesions were excluded. Low risk PC (LRPC) was defined as no Gleason pattern ≥4, ≤3 cores involved or ≤1/3 of total number of cores involved, and no core with >50% cancer involvement. High grade PC (HGPC) was defined as Gleason 7-10. A time-series analysis using interventional auto-regressive integrated moving average (ARIMA) models with step intervention functions were conducted to examine the effect of the recommendations on number of biopsies performed and cancer detection per month. Results Within the study period, 3397 biopsies were performed and 1591 (46.8%) PCs were detected (LRPC = 558 (31.3%); HGPC = 909 (26.8%)). The median for biopsies per month decreased from 65.5 (IQR=58-78) before the USPTF recommendations to 31 (IQR=24-38) afterward (p=0.003), while median number of patients undergoing their first-time biopsies decreased from 45 (IQR=41.5-58.5) to 24 (IQR=20-32, p=0.022). The median PSA of men undergoing biopsy did not change significantly after recommendations (p=0.76). The median number of LRPCs detected per month decreased from 10 (IQR=8-14) to 5 (IQR=4-6, p=0.005), while the median number of HGPCs detected per month also decreased from 17 (IQR=15.5-21) to 9 (IQR=8-11, p<0.001). Conclusions Since the USPTF recommendations, the number of biopsies (total and first-time biopsies) performed at UHN, based on referrals from our catchment area, has decreased. This is likely due to decreased PSA-screening and referral by general practitioners. Although encouraging that less low risk (often clinically insignificant) PCs are being diagnosed, the magnitude of sudden decrease in detection rate of Gleason 7-10 PCs is concerning. It is unclear to what extent selective screening is taking place. Unfortunately, men with “missed PCs” cannot be directly studied. Long-term population based studies are needed to assess the repercussions. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e548 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Bimal Bhindi More articles by this author Muhammad Mamdani More articles by this author Girish S. Kulkarni More articles by this author Antonio Finelli More articles by this author Robert J. Hamilton More articles by this author John Trachtenberg More articles by this author Alexandre R. Zlotta More articles by this author Ants Toi More articles by this author Andrew Evans More articles by this author Theodorus van der Kwast More articles by this author Neil E. Fleshner More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...