Prostate-specific antigen test result interpretation when combined with risk factors for recommendation of biopsy: a survey of urologist’s practice patterns

Abstract

Recent data have suggested historical cutoff levels for prostate cancer (PC) screening using a prostate-specific antigen (PSA) level≤4ng/ml may no longer be appropriate with cancer detected at lower levels, particularly in younger men. Our aim was to conduct a contemporary survey of urologist's practice patterns toward PC detection, specifically focusing on factors determining the decision to recommend ultrasound-guided biopsy (TRUS-BX). Three hundred and sixty active urologists from the Canadian Urological Association were requested to complete an online questionnaire focusing on scenarios of varying age, family history, ethnicity and PSA. Urologists indicated when to TRUS-BX. Of 360 urologists, 125 (35%) completed the questionnaire. Sixty-seven percent indicated men should be screened for PC aged 50-60 with 27% preferring 40-50years. Seventy-seven percent would continue screening >75. Considering a 65-year-old man with no risk factors and a normal digital rectal exam 56% would offer TRUS-BX at PSA 4.5; 35% at 3.5 and 10% at 2.5ng/ml. Considering a similar 45-year-old man, 94% would at PSA 4.5; 77% at 3.5 and 33% at 2.5ng/ml. On multivariate analysis, offering TRUS-BX appears driven significantly (P<0.0001) more by younger age and higher PSA (OR 4.3-20.6 and 4.4-34.9, respectively) rather than family history or ethnicity (OR 3.3 and 1.8, respectively). Age and PSA appear the driving factors in obtaining TRUS-BX. Also, a significant proportion of urologists would still not offer TRUS-BX at the traditional PSA cutoff of 4ng/ml for men with no risk factors. Further studies are required to ascertain whether this relates to a lack of dissemination of studies into practice.