PMD6 - Real-World Data Analysis of Confirmatory Biopsy Utilization in Suspected Prostate Cancer Patients

Abstract

As the US healthcare system transitions away from volume-based delivery to one that is focused on quality and value, there is a continued focus on understanding the drivers of cost, especially in oncology. Over one million prostate biopsies are performed annually, with many newly diagnosed cases being patients who may never die of the disease. Potential cost savings exist in identifying patients for which biopsy is unnecessary. In this study, we quantify the use of biopsy procedure in the diagnosis of prostate cancer. We utilized a chart pull survey methodology to identify 1,000 patients who had undergone traditional sextant prostate biopsy for suspected prostate cancer. Patient chart surveys were collected from 11 community urology sites varying in practice size and geographic representation from across the US. Patients were separated into research cohorts by whether they had received molecular testing prior to biopsy. Our research found that among the 1,000 patients who received a prostate biopsy, the most common reason for biopsy was elevated prostate-specific antigen (PSA), followed by abnormal digital rectal exam (DRE). Only 80 patients (8%) received a molecular test (4Kscore, PHI, PCA3, SelectMDx) prior to biopsy. Among the 1,000 patients who received a biopsy, 530 (53%) were confirmed to have prostate cancer. Among the 80 patients who had molecular testing prior to biopsy, 41 (51%) were confirmed to have prostate cancer. This result represents no significant difference in the rate of patients confirmed to have prostate cancer following biopsy (p=0.74), with or without prior molecular testing. Our results demonstrated that use of molecular testing did not improve the rate of prostate cancer confirmation through biopsy. They also highlighted the need for more accurate biomarkers for molecular testing to determine which patients should be biopsied among those suspected of having prostate cancer.