Prostate biopsy rates fall as transrectal ultrasound rates rise

The epidemiologic confusion wrought by the introduction of the PSA test in the 1990s appears to have settled down, according to a study of biopsy patterns. Biopsy rates have fallen dramatically, and the incidence of prostate cancer has stabilized.

"Doctors now are selecting more appropriate patients for biopsy, as evidenced by the observation that the biopsy rates are falling while the incidence of prostate cancer detection has remained stable since 1995. We are getting better at what we do, and we are using the technology more appropriately," lead author David F. Penson, MD, MPH, of the University of Southern California Norris Cancer Center, Los Angeles, told Urology Times.

He and colleagues from the Urologic Diseases in America Project queried the 1.3 million national Medicare public use files to determine the rate of biopsies per 100,000 men and the percentage guided by transrectal ultrasound during 1992, 1995, 1998, and 2001.

They found that the number of biopsies fell 44.6%, from 2,893 per 100,000 men in 1992 to 1,602 in 2001. Biopsy rates by racial group reversed. In 1992, the Caucasian biopsy rate exceeded that for African-Americans: 2,963 per 100,000 and 2,676 per 100,000, respectively. Nine years later, the rate for Caucasians was 1,597 per 100,000, compared with 1,733 for African-Americans.

From 1992 to 2001, the percentage of TRUS-guided biopsies nearly doubled from 36.9% of all biopsies to 67.9%. Significant differences in biopsy rates and TRUS application rates by region also were observed.

The next step will look at detection rates and possibly the nature of the biopsy procedure, Dr. Penson said.