Rate Of Prostate Biopsy Research Articles

Initial experience and cancer detection rates of office-based transperineal magnetic resonance imaging-ultrasound fusion prostate biopsy under local anesthesia.

We aimed to demonstrate feasibility and cancer detection rates of office-based ultrasound-guided transperineal magnetic resonance imaging-ultrasound (MRI-US) fusion (TFB) prostate biopsy under local anesthesia. With institutional review board approval, records of men undergoing TFB in the office setting under local anesthesia were reviewed. Baseline patient characteristics, MRI findings, cancer detection rates, and complications were recorded. The PrecisionPoint Transperineal Access System (Perineologic, Cumberland, MD, U.S.), along with UroNav 3.0 image-fusion system (Invivo International, Best, The Netherlands) were used for all procedures. Following biopsy, men were surveyed to assess patient experience. Between January 2019 and February 2020, 200 TFBs were performed, of which 141 (71%) were positive for prostate cancer, with 117 (83%) Gleason grade group 2 or higher. A total of 259 of 265 MRI lesions were biopsied, with 127 (49%) positive overall. Prostate Imaging-Reporting and Data System (PI-RADS) 4-5 lesions were positive for prostate cancer in 59% of cases. The mean procedural time was 20 minutes, with a patient enter-to-exit room time of 54 minutes. There were no septic complications, no patients required post-procedure hospital admission, and all procedures were successfully completed. Seventy-five percent of patients surveyed reported complete resolution of pain at three days following the procedure. Office-based TFB represents a viable approach to prostate cancer detection following prostate MRI. Larger-scale assessment is needed to categorize cancer detection rates more accurately by PI-RADs subset, patient selection factors, complication rate, and cost relative to TFB under anesthesia.

Impact of COVID-19 on the incidence of prostate cancer among White and Black Veterans.

29 Background: Early-stage prostate cancer (PCa) is typically detected on prostate-specific antigen (PSA) screening and subsequent prostate biopsy, healthcare interventions that are considered routine elective procedures. The COVID-19 pandemic disrupted routine healthcare screenings and interventions. We sought to determine whether delayed screening and diagnostic workup of PCa was associated with increased rates of incident PCa, high-grade Gleason, and metastatic disease at diagnosis. Methods: We used the Corporate Data Warehouse of the Veterans Health Administration to collect PSA, prostate biopsy, PCa diagnosis, Gleason score, and metastasis information of White and Black Veterans aged 40 years or older newly diagnosed with PCa from January 2019 through June 2021. For each month, we calculated rates of PSA, prostate biopsy, and incident PCa per 100,000 men and plotted monthly rates by race. We performed descriptive analyses to compare age at first PSA, age at diagnosis, baseline PSA, Gleason scores, and metastasis pre- and post-January 2020, the month in which the U.S. declared COVID-19 a public health emergency. Results: The decrease in the rate of PSA screening immediately after January 2020 was similar in both White and Black Veterans (7% vs. 6%). However, the magnitude of reduction in the rate of prostate biopsy and the rate diagnosis of incident PCa were five times larger among Black Veterans compared to White Veterans (11% vs. 2% for both biopsy and diagnosis rates). Among the 17,771 White and 9,610 Black Veterans with incident PCa, the rate of Gleason of 4+3 or greater and the rate of metastatic disease at diagnosis increased three months after the pandemic in both race groups with comparable magnitude (2-3% increase in high-grade Gleason, 1% increase in metastatic disease). Conclusions: Utilization patterns indicated that while the decrease in PSA screening after the pandemic was similar in White and Black Veterans, reductions in prostate biopsy and diagnosis of incident PCa were five times greater in Blacks than Whites. Further research including risk-adjusted modeling is needed to determine whether Black Veterans were disproportionately affected by the pandemic-related disruptions in PSA screening and diagnostic workup of prostate cancer.[Table: see text]

Impact of birth season on second-to-fourth digit ratio, prostate volume, and prostate cancer.

PurposeThe second-to-fourth digit ratio (digit ratio), which is determined in utero, is associated with exposure to visible sunlight during early pregnancy and the season of birth. The digit ratio is also associated with benign prostatic hyperplasia (BPH) and prostate cancer. This suggests that BPH and prostate cancer may be related to the birth season. Therefore, this study aimed to determine whether prostate volume and prostate cancer were related to the birth season.Materials and MethodsA total of 858 male patients with lower urinary tract symptoms were enrolled. The right digit ratio was measured, and the month of birth was surveyed. Serum prostate-specific antigen (PSA) levels were measured, and prostate volumes were measured by transrectal ultrasonography. Patients with suspected prostate cancer underwent prostate biopsy.ResultsThe mean age, digit ratio, prostate volume, and serum PSA level of 858 patients were 61.6 years, 0.947, 36.2 mL, and 4.24 ng/mL, respectively. Age, serum PSA levels, prostate biopsy rates, and cancer detection rates did not differ significantly according to the birth season. However, compared with the summer birth group, the winter birth group had lower digit ratios (0.951±0.040 vs. 0.941±0.040; p=0.014), larger prostate volumes (33.4±14.9 mL vs. 38.2±20.7 mL; p=0.008), and more prostate cancer (5.3% vs. 11.3%; p=0.031). Multivariate analysis showed that birth season independently predicted prostate cancer.ConclusionsThe relationships of birth season with prostate volume and prostate cancer may be due to differences in the amount of light exposure during early pregnancy.

Prostate cancer detection rate in men undergoing transperineal template-guided saturation and targeted prostate biopsy.

ObjectivesTo compare prostate cancer (PCa) detection rate of transperineal template‐guided saturation prostate biopsy (SBx) and multiparametric magnetic resonance imaging (mpMRI)/transrectal ultrasound fusion guided targeted biopsy (TBx).Materials and MethodsWe prospectively enrolled 392 men who underwent SBx and TBx in case of suspicious lesions from November 2016 to October 2019. Triggers for a biopsy were an elevated prostate‐specific antigen (PSA) and/or positive digital rectal examination and only treatment naïve patients without a previous diagnosis of PCa were included. Study inclusion occurred before biopsy and a prebiopsy mpMRI was available in all men. SBx were taken from 20 different locations according to the modified Barzell zones. The primary endpoint was the detection rate of clinically significant PCa (csPCa) and insignificant PCa (ciPCa) by SBx and/or TBx by comparing the two methods alone and in combination. Additional TBx were taken for any prostate imaging–reporting and data system (PI‐RADS) lesion ≥3 seen on the mpMRI. csPCa was defined as any Gleason score ≥7 and ciPCa as Gleason score 6.ResultsA total of 392 men with a median age of 64 years (interquartile range [IQR]: 58–69), a median PSA of 7.0 ng/ml (IQR: 4.8–10.1) were enrolled. Overall, PCa was found in 200 (51%) of all biopsied men, with 158 (79%) being csPCa and 42 (21%) ciPCa. A total of 268 (68%) men with a suspicious mpMRI and underwent a combined TBx and SBx, of whom csPCa was found in 139 (52%). In this subgroup, 116/139 (83%) csPCa would have been detected by TBx alone, and an additional 23 (17%) were found by SBx. Men with a negative mpMRI (PI‐RADS < 3, n = 124, 32%) were found to have csPCa in 19 (15%) cases. In patients with a negative mpMRI in combination with a PSA density <0.1 ng/ml2, only 8% (3/36) had csPCa. If only TBx would have been performed and all men with a negative mpMRI would not have been biopsed, 42/158 (27%) of csPCa would have been missed, and 38/42 (90%) ciPCa would have not been detected. On multivariable analysis, significant predictors of csPCa were increasing PSA (odds ratio, OR: 1.07 [95% confidence interval, CI: 1.03–1.11]), increasing age (OR: 1.07 [95% CI: 1.03–1.11]), PI‐RADS score ≥ 3 (OR: 6.49 [95% CI: 3.55–11.89]), and smaller prostate volume (OR: 0.96 [95% CI: 0.95 –0.97] (p < 0.05 for all parameters).ConclusionIn comparison to SBx, TBx alone detects csPCa in only ¾ of all men with a positive mpMRI lesion. Thus, systematic biopsies in addition to TBx have to be considered at least in some who undergo a prostate biopsy. In men with a negative mpMRI, SBx still detects 15% csPCa, but similarly overdetecting ciPCa. According to our results, low PSA density and negative mpMRI findings could be used to decide which men can safely avoid biopsy.

688 Cancellation Rate of Prostate Template Biopsy: Are There Any Merits to Implementing Pre-Operative Bowel Preparations?

Abstract Introduction The aim of this quality improvement project was to analyse the cancellation rates of the template biopsy done at the George Eliot Hospital. The focus was mainly on those due to poor bowel prep whereby manual evacuations have failed. Locally we have sometimes noted the failure rate of transperineal prostate biopsy as a result of the poor quality of the ultrasound due to inadequately evacuated rectum. Unfortunately, there are very limited studies which have looked into this issue hence the significance of this problem is not universally acknowledged. Method Retrospective review of all the template biopsies that were planned from April 2019 to April 2020 using the operation notes and local theatre management software. Results There was a total of 105 planned template biopsies from April 2019 to April 2020. 72 cases were attempted and within this, 7 of these cases required manual evacuations in which 3 resulted in abandonment of procedure. There were 33 cases which were cancelled due various other reasons. Conclusions The results showed that the failure rates due to poor bowel prep were not significant (4%). Based on these findings we have decided not to proceed with the implementation of pre-operative bowel prep with phosphate enema as we felt that the potential benefits were not enough for it be initiated as a routine practice. We aim to address the other reasons identified for cancellations.

A Prospective Study Comparing Cancer Detection Rates of Transperineal Prostate Biopsies Performed by Junior Urologists versus a Senior Consultant in a Real-World Setting

Introduction: Prostate biopsy (PB) is a typical daily practice method for the diagnosis of prostate cancer (PCa). This study aimed to compare the PCa detection rates and peri- and postoperative complications of PB among 3 residents and a consultant. Patients and Methods: A total of 343 patients who underwent PB between August 2018 and July 2019 were involved in this study. Residents were systematically trained for 2 weeks by a consultant for performing systematic biopsy (SB) and targeted biopsy (TB). And then, 3 residents and the consultant performed PB independently every quarter due to routine rotation in daily practice. The peri- and postoperative data were collected from a prospectively maintained database (www.pc-follow.cn). The primary outcome and secondary outcome were to compare the PCa detection rates and complications between the residents and consultant, respectively. Results: There was no significant difference between the residents and consultant in terms of overall PCa detection rates of SB and TB or further stratified by prostate-specific antigen value and prostate imaging reporting and data system (PI-RADS) scores. We found the consultant had more TB cores (175 cores vs. 86–114 cores, p = 0.043) and shorter procedural time (mean 16 min vs. 19.7–20.1 min, p < 0.001) versus the residents. The complication rate for the consultant was 6.7% and 5%–8.2% for the residents, respectively (p = 0.875). Conclusions: The residents could get similar PCa detection and complication rates compared with that of the consultant after a 2-week training. However, the residents still need more cases to shorten the time of the biopsy procedure.

Prostate Cancer Screening and Incidence among Aging Persons Living with HIV.

The risk of prostate cancer among persons living with human immunodeficiency virus (PWH) is not well understood and may be obscured by different opportunities for detection. We identified 123,472 (37,819 PWH and 85,653 comparators) men enrolled in the Veterans Aging Cohort Study, a prospective national cohort of PWH and demographically matched, uninfected comparators in 2000-2015. We calculated rates of prostate specific antigen (PSA) testing by human immunodeficiency virus (HIV) status and fit multivariable Poisson models comparing the rates of PSA testing, prostate biopsy, and cancer incidence. The mean age at enrollment was 52 years. Rates of PSA testing were lower in PWH versus uninfected comparators (0.58 versus 0.63 tests per person-year). Adjusted rates of PSA screening and prostate biopsy were lower among PWH (incidence rate ratio [IRR] 0.87, 95% CI 0.75-0.84 and IRR 0.79 95% CI 0.74-0.83, respectively). The crude IRR for prostate cancer was lower in PWH versus controls (IRR 0.90, 95% CI 0.83-0.97). However, in a multivariable model adjusting for PSA testing, cancer incidence was similar by HIV status (IRR=0.93, 95% CI 0.86-1.01, p=0.08). Among patients who received a prostate biopsy, incidence of prostate cancer did not differ significantly by HIV status (IRR 1.06, 95% CI 0.98-1.15, p=0.15). Among incident cancers, there were significant differences in the distributions of Gleason grade (p=0.05), but not cancer stage (p=0.14) by HIV status. When accounting for less PSA testing among PWH, the incidence of prostate cancer was similar by HIV status. These findings suggest that less screening contributed to lower observed incidence of prostate cancer in PWH.

PD50-01 PROSTERIA: A CLAIMS-BASED STUDY OF DEMOGRAPHIC AND TEMPORAL TRENDS IN FREQUENT PROSTATE SPECIFIC ANTIGEN TESTING

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 Sep 2021PD50-01 PROSTERIA: A CLAIMS-BASED STUDY OF DEMOGRAPHIC AND TEMPORAL TRENDS IN FREQUENT PROSTATE SPECIFIC ANTIGEN TESTING Dylan Peterson, Shufeng Li, Hriday Bhambhvani, James Brooks, and Michael Eisenberg Dylan PetersonDylan Peterson More articles by this author , Shufeng LiShufeng Li More articles by this author , Hriday BhambhvaniHriday Bhambhvani More articles by this author , James BrooksJames Brooks More articles by this author , and Michael EisenbergMichael Eisenberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002072.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While there is disagreement between professional medical organizations about which patients should undergo Prostate Specific Antigen (PSA) screening, there are no guidelines that recommend PSA screening more often than annually. Despite this, there are patients who have their PSA tested more frequently, which we have termed “Prosteria”. We aimed to characterize patient demographic and temporal trends of frequent PSA testing. METHODS: Adult men with at least three PSA tests and two or more years of continuous insurance enrollment in the Optum De-identified Clinformatics® Data Mart were included in this study. Men were censored at the end of their insurance enrollment or 30 days prior to a diagnosis of prostate cancer, prostatitis, or UTI. PSA tests were excluded if they occurred within 30 days of a prior PSA test. “High frequency PSA testing” was defined as an average of one or more PSA tests every 9 months. Multivariable logistic regression evaluated associations between demographic features and PSA testing frequency. RESULTS: 9,547,876 PSA tests obtained between January 2003 and June 2019 on 1,996,472 men were included. While 55% of men were tested less than annually, 19% of men underwent high frequency testing. The distribution of time between PSA tests was notable for spikes around 90, 180, and 365 days. Patients were less likely to undergo high frequency testing if they were White (OR: 0.73, 95% CI: [0.72, 0.73]), educated (OR: 0.91, 95% CI: [0.91, 0.92]), and younger (OR: 0.98 per year, 95% CI: [0.97-0.98]). However, a U-shaped distribution was observed with men aged 55-65 being less likely to undergo high frequency testing than younger or older men. Of men with PSA levels available, men with high frequency testing had higher average PSA values (1.99 (SD: 1.94) vs 1.31 (SD: 1.30); p < 0.001). Over the study period, the proportion of patients getting high frequency testing increased at a rate of 1.17% per year (figure). CONCLUSIONS: In this large cohort study, high-frequency PSA testing was common, increasing over time, and significantly associated with demographic characteristics. Future work will investigate variations between ordering providers based on geographic region and specialty, as well as the impact of screening frequency on rates of prostate biopsy, cancer detection and treatment. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e851-e851 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dylan Peterson More articles by this author Shufeng Li More articles by this author Hriday Bhambhvani More articles by this author James Brooks More articles by this author Michael Eisenberg More articles by this author Expand All Advertisement Loading ...

Trends in the Uptake of Diagnostic Multi-Parametric MRI of the Prostate With Federal Funding: Australia Population Data

In recent years, there has been an expanding role for multi-parametric Magnetic Resonance Imaging (mpMRI) in the workup of prostate cancer. There is growing evidence suggesting the utilization of mpMRI increases clinically significant prostate cancer detection and reduces prostate biopsy rates.1 Furthermore, there are suggestions that mpMRI may help guide the management of patients with prostate cancer.2,3 In keeping with this, the European Association of Urology prostate cancer guidelines now strongly recommend that mpMRI should be performed prior to biopsy.

Five-alpha reductase inhibitors in men undergoing active surveillance for prostate cancer: impact on treatment and reclassification after 6years follow-up.

To evaluate the impact of 5-alpha reductase inhibitors (5-ARIs) on definitive treatment (DT) and pathological progression (PP) in patients on active surveillance (AS) for prostate cancer. We identified 361 consecutive patients, from an IRB-approved database, on AS for prostate cancer with minimum 2years follow-up. Patients were grouped into two cohorts, those using 5-ARIs (5-ARI; n = 119) or not using 5-ARIs (no 5-ARI; n = 242). Primary and secondary endpoints were treatment-free survival (TFS) and PP-free survival (PPFS), which were evaluated by Kaplan-Meier analysis. Univariate and multivariable cox regression analysis were used to identify predictors for PP and DT. A p value < 0.05 was considered statistically significant. Baseline characteristics and the prostate biopsy rate were similar between the two groups. Median (range) follow-up was 5.7 (2.0-17.2) years. Five-year and 10-year TFS was 92% and 59% for the 5-ARI group versus 80% and 51% for the no 5-ARI group (p = 0.005), respectively. Five-year and 10-year PPFS was 77% and 41% for the 5-ARI group versus 70% and 32% for the no 5-ARI group (p = 0.04), respectively. Independent predictors for treatment and PP were not taking 5-ARIs (p = 0.005; p = 0.02), entry PSA > 2.5ng/mL (p = 0.03; p = 0.01) and Gleason pattern 4 on initial biopsy (p < 0.001; p < 0.001), respectively. The main limitation is the retrospective study design. 5-ARIs reduces reclassification and cross-over to treatment in men on active surveillance for prostate cancer. Further, taking 5-ARIs was an independent predictor for prostate cancer progression and definitive treatment.

Funding of prostate magnetic resonance imaging leads to fewer biopsies and potential savings to health systems in the management of prostate cancer.

To assess the impact of the introduction of multiparametric magnetic resonance imaging of the prostate (mpMRIp) on the number of prostate biopsies performed in Australia. Australian Medicare published statistics from 1 July 2007 to 30 June 2019 were obtained from publically available databases for prostate-specific antigen (PSA) testing, prostate biopsy, and mpMRIp. Analysis was divided into three time periods broadly based on availability of mpMRI to the Australian public: 2007-2012 (no mpMRIp), 2012-2018 (mpMRIp available, privately funded), and 2018-2019 (mpMRIp available with Medicare funding). Introduction of mpMRIp was hypothesised to reduce the number of prostate biopsies performed. PSA testing numbers were used as a control. The economics model, proposed by the Medical Services Advisory Committee (MSAC), was analysed for cost savings. Accounting for variations in PSA testing, the introduction of mpMRIp from 2012 coincided with a reduction in the number of prostate biopsies by an average of 354.7/month (95% CI 175, 534.4; P<0.001). Whilst the number of mpMRIp performed for the initial 12months was underestimated by the MSAC at 38470 vs 20149 (+$8.3million Australian dollars), we estimate the annual savings from reduced number biopsies and biopsy-associated complications to be $13.2 ± 9.6million. Availability of mpMRIp in Australia has correlated with a significant reduction in prostate biopsy rates, with an estimated annual saving of $13.2 ± 9.6million. Government funding of this diagnostic service has the potential to improve health equity and save on health expenditure.

Establishing a novel prediction model for improving the positive rate of prostate biopsy.

BackgroundAt present, prostate-specific antigen (PSA) is the primary evaluation index for judging the necessity of prostate cancer (PCa) biopsy. However, there is a high false-positive rate and a low predictive value due to many interference factors. In this study, we tried to find a novel prediction model that could improve the positive rate of prostate biopsy and reduce unnecessary biopsy.MethodsWe retrospectively studied 237 patients, including their age, body mass index (BMI), PSA, prostate volume (PV), prostate imaging-reporting and data system (PI-RADS) v2 score, neutrophil-lymphocyte ratio (NLR), biopsy Gleason score (BGS), and other information. The univariate and multivariate logistic analyses were used to screen out indicators related to PCa. After establishing a prediction formula model, we used receiver operating characteristic (ROC) curves to assess its prediction performance.ResultsOur study found that age, PSA, PI-RADS v2 score, and diabetes significantly correlated with PCa. Based on multivariate logistic regression analysis results, we created the following prediction formula: Y = 2.599 × PI-RADS v2 score + 1.766 × diabetes + 0.052 × age + 1.005 × PSAD – 9.119. ROC curves showed the formula’s threshold was 0.3543. The composite formula had an excellent capacity to detect PCa with the area under the curve (AUC) of 0.91. In addition, the composite formula also achieved significantly better sensitivity, specificity, and diagnostic accuracy than PSA, PSA density (PSAD), and PI-RADS v2 score alone.ConclusionsOur predictive formula predicted performance better than PSA, PSAD, and PI-RADS v2 score. It can thus contribute to the diagnosis of PCa and be used as an indicator for prostate biopsy, thereby reducing unnecessary biopsy.

Fifteen-year analysis of prostate biopsies in Western Australia including recent impact of multiparametric magnetic resonance imaging.

The number of men undergoing prostate biopsy and subsequent cancer detection rates has changed significantly over the past 15 years. We aim to evaluate changes in the diagnostic pathway of prostate cancer between 2003 and 2018. A total of 13 844 Western Australian biopsy-naive men were assessed to determine trends in age, prostate-specific antigen levels, number of core samples, positive cores and tumour grade (Gleason) between 2003 and 2018. Further, in 2018, the impact of pre-biopsy multiparametric magnetic resonance imaging (mpMRI) was also assessed. Between 2003 and 2012, the number of men undergoing biopsy increased from 1445 to 3100. During this time, the prostate cancer detection rate (%) remained unchanged. However, in 2018, 2042 men underwent prostate biopsy (reduction of 34.1%) and the detection rate increased to 72.6%. The incidence of low-grade cancer (Gleason score <7) increased from 28.1% in 2003 to 36.2% in 2012, but it decreased significantly to 15.1% by 2018. High-grade cancer (Gleason score >7) declined from 21.3% in 2003 to 15.2% in 2012 but then increased to 35.7% in 2018. The use of mpMRI in 2018 improved the detection rate of high-grade cancer. However, its specificity remains low (29.7%) and a considerable proportion of low Prostate Imaging Reporting and Data System score lesions was later diagnosed with cancer unsuitable for active surveillance. In recent years, there has been a significant increase in the diagnosis high-grade cancer and a reduction in cancer suitable for active surveillance. mpMRI identifies high-grade tumours but is not a reliable alternative to prostate biopsy.

Chronic oral anticoagluation and risk of prostate cancer: Evidence of detection bias.

Warfarin treatment has been associated with lower risks of prostate cancer, without a specified biological mechanism. Our study tested the hypothesis that reluctance to perform prostate biopsies in men who are anticoagulated results in lower rates of diagnosed prostate cancer, leading to an apparent protective effect. Rates of prostate biopsies have decreased from 2000 to 2015, allowing calendar time to be used as the intervention. In a national population-based sample of elderly men, our study compared trends in prostate cancer incidence between 17,815 men treated with chronic oral anticoagulation for prosthetic heart valve thromboprophylaxis and a general population comparison group of 356,300 men. Cancer events were based on administrative claims. Among men enrolled in 2000-2001 and followed through 2015, prostate cancer incidence was substantially lower in the anticoagulation group (adjusted incidence rate ratio [IRR] 0.70; 95% confidence interval [CI] 0.62-0.80). Incidence decreased over time in the general population group to approach that of the anticoagulation group among men enrolled in 2008-2010 (IRR 0.86; 95% CI 0.71-1.04). Rates of prostate biopsies also decreased over time in the general population group to match the rate in the anticoagulation group. These results indicate that the apparent protective effect of warfarin treatment on the risk of prostate cancer is likely the result of detection bias from lower rates of biopsies among men who are anticoagulated.

Relationship of prostate specific antigen related variables and MRI+ MRS examination with prostate biopsy

Objective To evaluate relationship of prostate specific antigen(PSA)related variables and MRI+ MRS examination with results of prostate biopsy. Methods A total of 1227 patients aged(66.1±7.7)years(range, 55-90 years)undergoing prostate biopsy in our hospital from May 2014 to September 2018 were retrospectively analyzed.Two hundred forty-two patients with serum prostate-specific antigen(PSA)in the grey zone(total PSA=4-10 μg/L) , and having indications for prostate biopsy were selected.According to results of transrectal ultrasound-guided prostatic biopsy, patients were divided into prostate cancer group and benign prostate hyperplasia group.The levels of total PSA(tPSA), free PSA/tPSA ratios(f/t PSA), prostate specific antigen density(PSAD), (f/t)PSA/PSAD, prostate volume(PV)and other relevant data, as well as MRI+ MRS test findings were statistically analyzed. Results The positive cancer rate of prostate biopsy was 26.0%(63/242)in patients with total PSA in the grey , including 56 cases of adenocarcinoma, 3 cases of mucinous adenocarcinoma, and 4 cases of stromal sarcoma.Negative prostate biopsy results were found in 179 cases.Two hundred sixteen patients underwent MRI+ MRS test before prostate biopsy, among which 81 were positive and 135 were negative.There were significant differences in PSAD, (f/t)PSA/PSAD, PV and MRI+ MRS test findings(P=0.001, 0.002, 0.045 and 0.001)and there was no significant difference in tPSA and free/total PSA ratios(P>0.05)between prostate cancer group and benign prostate hyperplasia group. Conclusions The positive cancer rate of prostate biopsy in patients with total PSA in zone is 26.0%.The PSAD, (f/t)PSA/PSAD, prostate volume and MRI+ MRS examination are very useful for whether or not to perform prostate biopsy, which can be used to guide prostate biopsy in patients with total PSA in gray . Key words: Prostate; Punctures; Prostatic neoplasms

Assessment of men's risk thresholds to proceed with prostate biopsy for the early detection of prostate cancer.

To delineate the range of "risk thresholds" for prostate biopsy to determine how improved prostate cancer (CaP) risk prediction tools may impact shared decision-making (SDM). We conducted a cross-sectional survey study involving men 45-75years old attending a multispecialty urology clinic. Data included demographics, personal and family prostate cancer history, and prostate biopsy history. Respondents were presented with a summary of the details, risks, and benefits of prostate biopsy, then asked to indicate the specific risk threshold (% chance) of high-grade CaP at which they would proceed with prostate biopsy. Of a total of 103 respondents, 18 men (17%) had a personal history of CaP, and 31 (30%) had undergone prostate biopsy. The median risk threshold to proceed with prostate biopsy was 25% (interquartile range 10-50%). Risk thresholds did not vary by race, education, or employment. Personal history of CaP or prostate biopsy was significantly associated with lower mean risk thresholds (19% vs. 32% [P = 0.02] and 23% vs. 33% [P = 0.04], respectively). In the lowest versus highest risk threshold quartiles, there were significantly higher rates of CaP (36% vs. 1%, P = 0.01) and prior prostate biopsy (46% vs. 17%, P < 0.01). Men have a wide range of risk thresholds for high-grade CaP to proceed with prostate biopsy. Men with a prior history of CaP or biopsy reported lower risk thresholds, which may reflect their greater concern for this disease. The extent to which refined risk prediction tools will improve SDM warrants further study.

Transperineal Prostate Biopsies Using Local Anesthesia: Experience with 1,287 Patients. Prostate Cancer Detection Rate, Complications and Patient Tolerability.

We report our experience with transperineal prostate biopsy as well as the cancer diagnosis rate, complications and patient tolerability in 1,287 consecutive patients at risk for prostate cancer. Beginning in October 2016 transperineal prostate biopsy was performed using local anesthesia in all patients undergoing prostate biopsy. Data on prebiopsy characteristics and results, including the cancer detection rate, complications and patient tolerability scores, were collected retrospectively from patient records. The cancer detection rate of transperineal prostate biopsy was 49.8% (641 of 1,287 patients). Clinically significant prostate cancer was detected in 385 patients and 62 (9.7%) had exclusively anterior zone pathology findings. Urinary retention developed in 20 patients (1.6%) following transperineal prostate biopsy, requiring temporary catheterization. In 4 patients (0.3%) lower urinary tract symptoms were suggestive of infection but only 1 had a positive urine culture. The only hospital admission was for a patient with persistent hypotension after biopsy. Patients tolerated transperineal prostate biopsy reasonably well and generally reported only mild levels of discomfort on a pain visual analogue scale. Infiltration of the anesthesia was rated more painful than the biopsy. Transperineal prostate biopsy with the patient under local anesthesia is a feasible alternative to transrectal biopsy in the detection of prostate cancer. Transperineal prostate biopsy has an acceptable cancer detection rate with additional detection of anterior zone cancers. It is a safer alternative in patients due to the low risk of complications, in particular urosepsis, and it is well tolerated. Transperineal prostate biopsy using local anesthesia could be considered a standard modality for the initial diagnosis of prostate cancer.

Prostate Cancer Detection Rates of Standard Transrectal Prostate Biopsy and MR-guided Fusion Transrectal Prostate Biopsy

Prostate Cancer Detection Rates of Standard Transrectal Prostate Biopsy and MR-guided Fusion Transrectal Prostate Biopsy

AUTHOR REPLY

The ascendance of prostate magnetic resonance imaging (MRI) coincided with a popular reckoning about years of overdiagnosis and overtreatment of low-grade prostate cancer. 1 Bhindi B Mamdani M Kulkarni GS et al. Impact of the U.S. Preventive Services Task Force recommendations against prostate specific antigen screening on prostate biopsy and cancer detection rates. J Urol. 2015; 193: 1519-1524 Crossref PubMed Scopus (87) Google Scholar Prostate MRI has been heralded as a solution to improve accuracy when diagnosing and staging prostate cancer with 2 primary advantages: (1) detecting occult, high-grade cancer in men who would otherwise be missed, allowing timely treatment, and (2) ruling out aggressive disease in men with ostensibly low-risk cancers allowing greater confidence in avoiding treatment. Studies supporting the performance of prostate MRI in identifying clinically significant cancers have been performed under best-case circumstances—largely in high-volume centers of imaging excellence, and by experts using state-of-the-art equipment. 2 Siddiqui MM Rais-Bahrami S Turkbey B et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA. 2015; 313: 390-397 Crossref PubMed Scopus (1136) Google Scholar Therefore, it is important to begin to evaluate the assumption that MRI will lead to better clinical outcomes in the “real world.”

Impact of Accountable Care Organizations on Prostate Cancer Screening & Biopsies in the United States

PurposeAccountable care organizations (ACOs) are designed to financially incentivize efficiency and reduce low-value care. To determine if ACOs impacted prostate cancer screening patterns, we analyzed trends in prostate-specific antigen (PSA) screening and prostate biopsies by ACO and non-ACO providers. Materials & MethodsUsing a random 20% sample of Medicare claims, we selected men aged 66 years and older. In 2014, beneficiaries were attributed to ACO and non-ACO providers using a modified MSSP algorithm. Beneficiaries treated by these same providers in 2010 served as the control population. Inverse-probability weighting and difference-in-differences analyses were utilized to compare trends in PSA screening and prostate biopsies in 2010 and 2014. Analyses were stratified by age groups: 1) 66-69 years and 2) ≥70 years. ResultsOf beneficiaries treated by ACO and non-ACO providers, PSA screening rates were 62.4% and 60.5% in 2010 vs. 55.9% and 54.4% in 2014 in men aged 66-69, respectively (p=0.3). Prostate biopsy rates were 2.5% and 2.3% in 2010 vs. 1.7% and 1.6% in 2014, respectively (p=0.6). In men aged ≥70, PSA screening rates were 54.3% and 54.2% in 2010 vs. 46.0% and 46.4% in 2014, respectively (p=0.2). Similarly, prostate biopsy rates were 1.8% and 1.7% in 2010 vs. 1.1% and 1.1% in 2014, respectively (p=0.7). ConclusionsThough decreasing utilization of low-value services is a fundamental goal of ACOs, PSA screening and prostate biopsy trends were similar for ACO and non-ACO providers across all age groups in the study years. This suggests that ACO implementation did not have an impact on PSA screening or prostate biopsies usage.