Prostate biopsy rates fall; TRUS rates rise

Biopsy rates, which had soared early in the 1990s with the introduction of the PSA assay, have fallen dramatically and the incidence of prostate cancer has stabilized, according to a study from the University of Southern California, Los Angeles.

"Doctors 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," David F. Penson, MD, MPH, associate professor at the USC Norris Cancer Center, told Urology Times.

Dr. Penson and his colleagues sifted through 1.3 million Medicare records to determine biopsy rates and TRUS utilization during 1992, 1995, 1998, and 2001.Changes recorded by Dr. Penson during the 9-year period were substantial. The number of biopsies conducted on men fell from 2,893 per 100,000 in 1992 to 1,602 in 2001, a decline of 44.6%. Biopsy rates by racial group reversed during the years measured. In 1992, the Caucasian biopsy rate exceeded that for African-Americans: 2,963 per 100,000 for Caucasians and 2,676 per 100,000 for African-Americans. Nine years later, the African-American rate exceeded the Caucasian rate: 1,594 per 100,000 for Caucasians compared with 1,733 per 100,000 for African-Americans.

The percentage of biopsies taken under the guidance of transrectal ultrasonography nearly doubled. In 1991, 36.9% of all biopsies used TRUS. This percentage rose to 67.9% by 2001.