You have accessJournal of UrologyProstate Cancer: Detection & Screening (V)1 Apr 20132216 THE ASSOCIATION OF THE DIAGNOSTIC OUTCOME OF THE TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY WITH THE OPERATOR EXPERIENCE: IMPLICATIONS FOR TRAINING Sergey Tadtayev, Adam Hussein, Lewis Carpenter, Nikhil Vasdev, and Gregory Boustead Sergey TadtayevSergey Tadtayev Stevenage, United Kingdom More articles by this author , Adam HusseinAdam Hussein Stevenage, United Kingdom More articles by this author , Lewis CarpenterLewis Carpenter Hatfield, United Kingdom More articles by this author , Nikhil VasdevNikhil Vasdev Stevenage, United Kingdom More articles by this author , and Gregory BousteadGregory Boustead Stevenage, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2125AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is established that a number of factors influence the diagnostic outcome of the transrectal ultrasound-guided (TRUS) prostate biopsy, however the there is a paucity of data on the effect of the operator experience. The aim of this study was to investigate the association of the level of operator experience with the diagnostic outcome of the TRUS biopsy: cancer detection rate (CDR) and Gleason grade of the detected cancers. We also evaluated the learning curve of the least experienced operators. METHODS We conducted a review of 690 consecutive patients who underwent their first TRUS biopsy in a single institution over a 24 months period. Biopsies were undertaken by 7 consultants, 11 senior trainees practicing TRUS > 1 year and 9 junior trainees who started their TRUS training during the study period. Logistic regression was used for statistical analysis. RESULTS The analysis of the whole cohort has demonstrated that TRUS biopsies performed by more experienced operators were more likely to be positive, yet a lower proportion of cancers found by the least experienced operators was of Gleason 6 grade (Juniors vs Seniors OR 0.41, p=0.006, CI 0.22-0.77, Juniors vs Consultants OR 0.34, p=0.001, CI 0.18-0.65). However, upon stratification by serum PSA (<10 ng/mL vs ≥ 10 ng/mL), the difference in the positive biopsy outcome between the least and more experienced operators has only reached statistical significance in < 10 ng/mL group. We could not identify an evidence of a learning curve amongst the juniors. CONCLUSIONS We have demonstrated that in the patient cohort with the serum PSA < 10 ng/mL the more experienced operators had more positive biopsies, which is likely due to superior prostate sampling as suggested by a higher proportion of Gleason 6 cancers found by these operators. Junior trainees should focus their TRUS biopsy practice on the patient group with high PSA values in order not to jeopardise the diagnostic outcome of the biopsies in patients with PSA in the “grey zone” < 10 ng/mL. Patient/biopsy characteristics Consultants Senior trainees Junior trainees Whole cohort Number of patients (%) 225 (32.60%) 316 (45.79%) 149 (21.61%) Median age, years, (IQR) 68 (14) 68 (13) 67 (11) Median PSA, ng/mL, (IQR) 8.5 (9.9) 8.45 (8.25) 8.8 (9.5) Median prostate volume, cm2 46 47.5 40 Mean number of cores 12.21 12.54 12.38 CDR,% 64% 59.49% 46.98% Gleason 7 and above,% 64.58% 67.55% 81.42% PSA < 10 ng/mL Number of patients (%) 130 (32.17%) 187 (46.28%) 87 (21.55%) Median age, years 64.5 66 65 Median PSA, ng/mL 6.1 6.3 6.7 CDR,% 50% 50.26% 29.88% PSA ≥ 10 ng/mL Number of patients (%) 95 (33.21%) 129 (45.10%) 62 (21.69%) Median age, years 74 72 71 Median PSA, ng/mL 17 20.4 18.05 CDR,% 83.16% 72.86% 70.96% Group Operators Odds Ratio p 95% confidence intervals Whole cohort Junior vs Senior trainees 1.90 0.003 1.24-2.92 Juniors vs Consultants 2.41 <0.001 1.53-3.80 PSA < 10 ng/mL Junior vs Senior trainees 2.37 0.002 1.38-4.07 Juniors vs Consultants 2.35 0.004 1.32-4.16 PSA ≥ 10 ng/mL Junior vs Senior trainees 1.10 0.784 0.56-2.15 Juniors vs Consultants 2.02 0.073 0.94-4.35 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e908-e909 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sergey Tadtayev Stevenage, United Kingdom More articles by this author Adam Hussein Stevenage, United Kingdom More articles by this author Lewis Carpenter Hatfield, United Kingdom More articles by this author Nikhil Vasdev Stevenage, United Kingdom More articles by this author Gregory Boustead Stevenage, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...