AUA 2017: Population-Level Cancer Detection and Patterns of Care Following MRI-Guided Prostate Biopsy

Boston, MA (UroToday.com) Dr. Liu and colleagues from Emory University in Atlanta, GA presented their population-level analysis of cancer detection following MRI-guided prostate biopsy this morning at the 2017 AUA Annual meeting in Boston. With the rapid uptake in MRI-guided biopsies over the past number of years, studies have typically been limited to large centers of excellence and/or multi-institutional collaborations. As such, this is the first population-based study assessing utilization of MRI-guided biopsies.

The authors used the MarketScan Commercial Claims database from 2009-2013, which captured US men with private health insurance who underwent a prostate biopsy without a prior history of prostate cancer diagnosis (n=210,894). Men were considered to have undergone an MRI guided biopsy if their MRI was within 3 months of prostate biopsy. There were 1,378 men that underwent an MRI-guided biopsy, 740 men that underwent a transperineal biopsy, and 208,776 men that underwent conventional transrectal-ultrasound guided (TRUS) biopsy. Among the cohort, a new prostate cancer diagnosis was most common after TRUS-biopsy (36.4%), compared to those undergoing MRI-guided biopsy (28.9%) or transperineal biopsy (29.3%) (p<0.001). In a subgroup analysis, patients with a prior negative prostate biopsy were less likely to have a new prostate cancer diagnosis (20.5% vs 37.7% biopsy-naive, p<0.001), and among these patients those who underwent an MRI-guided biopsy were at no greater likelihood of being diagnosed with prostate cancer (OR 1.12 vs TRUS-Bx, 95%CI 0.88-1.43). Interestingly, among prostate biopsy-naïve men, an MRI-guided prostate biopsy was associated with a lower odds of prostate cancer detection (OR 0.81 vs TRUS-Bx, 95%CI 0.71-0.93). The strength of this study includes the large sample size allowing comparisons between biopsy approaches. Limitations of the study include a lack of pathological data and a relatively small sample size for men undergoing MRI-guided biopsy, likely secondary to the time period of study corresponding to early adoption of MRI-guided techniques.

Certainly MRI-guided prostate biopsy has assisted with active surveillance protocols and further delineating prostate anatomy, particularly in patients with a negative biopsy and rising PSA. This population level work is informative and hypothesis generating. As the authors conclude, these findings merit further investigation, taking tumor and provider factors into account.

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Presented By: Wen Liu, Emory University, Atlanta, GA, USA

Co-Authors: Dattatraya Patil, David Howard, Renee Moore, Heqiong Wang, Martin Sanda, Christopher Filson

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA
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