Prostate Bx: Urologists may be getting more selective

Editor's note: This article has been updated since its original publication to include additional study data and commentary from the author/presenter.

Charleston, SC-The rate of prostate biopsy declined steadily and significantly over a contemporary 10-year period, results of a retrospective longitudinal review of data from the Veterans Health Administration (VHA) show.

The decreasing trend occurred despite an increase in PSA screening, and was most precipitous in non-African-American men and those older than 60 years of age, reported researchers from the Medical University of South Carolina, Charleston.

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“Overdiagnosis and overtreatment of prostate cancer is a primary concern in urology today, and in response to this issue, the major focus has been on limiting PSA screening. We were interested in examining patterns of utilization of prostate biopsy, which is a screening intervention point within the urologist’s control,” said co-author Ryan S. Levey, MD, urology resident at the Medical University of South Carolina, who worked on the study with Sandip Prasad, MD, and colleagues.

“Since we did not find the same degree of change in PSA screening, we believe our study suggests that urologists may be practicing more judicious use of prostate biopsy with the goal of identifying those men who may benefit most from diagnosis and treatment of prostate cancer. Importantly, however, longitudinal follow-up is needed to determine whether the decline in prostate biopsy alters cancer-specific outcomes and survival,” Dr. Levey told Urology Times.

For the study, the authors analyzed data for men aged 40 to 80 years seen at more than 120 hospitals and 600 outlying clinics of the VHA system. All patients had at least one PSA value between 2003 and 2012. Once a patient was biopsied, he was removed from the study population. The dynamic cohort encompassed over 24 million eligible patient-years. It included more than 250,000 men per year and a total of nearly 174,000 biopsies.

Overall, there was a 4.7% annual increase in the number of men who had PSA screening, leading to the inclusion of 3 million men by the end of the study period.

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14% decline observed

An autoregressive, ecological parametric model was used to evaluate trends for prostate biopsy with a focus on effects of age (<60 vs. ≥60 years) and race/ethnicity (non-African-American vs. African-American). The biopsy rate per month at the start of the study was 130 per 100,000 men, and by the end, it had decreased by 14%. The average rate of decline per month was 0.24 per 100,000 men overall, 0.40 per 100,000 men in the cohort older than 60 years of age, and 0.26 per 100,000 men among Caucasians.

Dr. Levey said that the large sample size was a major strength of the study. In addition, he noted that findings from a VHA population can be fairly well generalized to the national population.

“Nevertheless, additional research is needed to determine if these trends exist outside for populations outside the VHA where financial incentives and referral practices differ,” he said.

“Meanwhile, we feel that with such a large number of men included in our study, there is more to learn by mining the data we have at hand,” he said.

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