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Too Few or Too Many Prostate Biopsies? Results from an Academic Center
Benjamin J King, Brian H Irwin, Thomas D Trainer, Mark K Plante, Samuel J Trotter, Scott D Perrapato
University of Vermont College of Medicine, Burlington, VT
Introduction:
Given the variability in indications for and cancer detection rates from trans-rectal ultrasound(TRUS)-guided biopsy, we evaluated the prostate cancer(PCa) detection rate in males undergoing 12-core needle biopsies at a single academic center. We then identified the proportion of men with PCa who met the criteria for active surveillance(AS).
Materials & Methods:
A retrospective analysis of 603 consecutive patients undergoing TRUS-guided biopsies after meeting standard-of-care criteria including at least one of the following: abnormal digital rectal exam, PSA>4ng/mL, PSA velocity >0.7ng/mL and/or positive family history in 1st degree relative were identified within an IRB-approved pathologic database. Klotz and Nam criteria(PSA≤10ng/ml, clinical stage T1-T2a, Gleason score≤6,<3 cores involved,<50% of a single core involved) were used as determinants for AS candidacy. AS candidacy and PCa detection rates were calculated.
Results:
Two-hundred eighty-five of the 603(47.3%) prostate biopsies resulted in a diagnosis of PCa with 75(26.3%) of those patients meeting Klotz and Nam criteria for AS. The remaining 73.7% of PCa diagnoses were classified as intermediate/high-risk cases.
Conclusions:
The cancer detection rate at our center of 47.3% is well-above the rate reported in the PLCO screening trial of 36.8% as well as the rates seen in other large-scale PCa screening trials. Given the fact that favorable-risk PCa nationally represents ~50-60% of new diagnoses, further research should be done to clarify strict biopsy indications in order to help eliminate the variability in PCa detection rates between centers. With appropriate biopsy indications, we may see increased detection of intermediate/high-risk PCa as seen in this study.
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