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