Data confirm value of 10- to 12-core prostate biopsy

Orlando, FL-Increased adoption of the practice of obtaining 10- to 12-core biopsy specimens of the prostate has resulted in increased detection of prostate cancer across the United States, a recent large study shows.

“Increased cancer detection rate correlated significantly with increased numbers of specimens examined,” said the study’s first author, Carl A. Olsson, MD, chief medical officer of Integrated Medical Professionals, LLC, New York.

The study, which was presented at the Genitourinary Cancers Symposium in Orlando, FL, included more than 4.2 million specimens collected from approximately 440,000 biopsies. Data were collected from an annual mean of 1,756.7 urologists in 765.6 practices in the U.S. Biopsy rates and core sampling patterns were assessed in patients whose biopsies were submitted to either a national reference library (NRL) or laboratory integrated into a urology group practice (UPL).

The association between rates of positive biopsies and number of specimens per biopsy was analyzed. Analysis was confined to standard needle biopsy and standard anatomic pathology sampling. Saturation biopsies were not included. For each year studied, positive biopsy rate and number of specimens per biopsy were recorded for both NRL and UPL, separately and combined.

From 2005-2011, the average rate of positive biopsies was 40.3%, and the rate was similar at NRL and UPL. In 2005, the positive biopsy rate was 38.2% and the number of specimens per biopsy was 7.9; by 2011, the positive biopsy rate was 42.6% and the number of specimens per biopsy was 10.7.

Steepest increase between 2005-2008

The steepest increase in the number of specimens obtained occurred between 2005 and 2008, which was during the development of core sampling regimens.

“The transition point was in 2008, suggesting that urologists were responding to published literature and guidelines recommending increased prostate sampling. Physicians utilizing UPL adopted these changes earlier than those using the NRL,” Dr. Olsson indicated in the poster.

“This data, which represents the work product of over 2,000 urologists, indicates that physicians modified their clinical patterns to reflect best practices as suggested by the peer-reviewed literature,” said principal author Deepak A. Kapoor, MD, chairman and CEO of Integrated Medical Professionals. “The fact that there was no difference in either positive biopsy rate or specimen vials submitted across sites of service definitively demonstrates that appropriate medical necessity, not physician ownership, determines utilization of services.”

Regardless of where the biopsies were obtained, no significant difference was observed in the number of specimens obtained per biopsy.

“Segregation of prostate biopsy cores into 10-12 unique vials per biopsy has been adopted by urologists across sites of service, and it appears to be the de facto national standard of care,” Dr. Olsson and colleagues wrote in their poster.

The Genitourinary Cancers Symposium was co-sponsored by the American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Urologic Oncology.UT