EAU 2019: Trends in Prostate Biopsy Criteria and Outcomes from 2010 to Present: The Columbia Experience

Barcelona, Spain (UroToday.com) PSA screening has decreased significantly since the US Preventative services task force guidelines in 2012. In this study, the authors aimed to evaluate trends in biopsy criteria and outcomes in an urban tertiary care center following the implementation of the screening guidelines in 2012.

All biopsies performed between 2010 and 2017 at Columbia University were analyzed. Patients with a PSA>50 and biopsies of patients on active surveillance were excluded from the analyses.

A total of 818 prostate biopsies were performed during this timeframe. Use of MRI fusion started from 0% in 2010 and increased to 43% in 2017. The average age remained similar through the years (65.2 vs. 66.4, p=0.22). However the average PSA and average PSA density increased significantly through the years from 5.72 to 8.16 ng/ml, p=0.001, and from 0.12 to 0.19, p=0.001, respectively. There was a significant decrease in the diagnosis of grade group 1 disease (21.2% vs. 12.3%, p=0.05) and increase in clinically significant disease diagnosis (>= Gleason grade group 2) from 21.2% to 40.4%, p=0.001. Although not statistically significant, there was also an increase in the Gleason grade group 4 incidence from 5.1% to 13%, p=0.29, and a decrease in the negative prostate biopsy rate, from 57.6% to 47.3%, p=0.09.

In conclusion, significant changes have been noted through the years since the change in screening guidelines in 2012. The authors rightfully comment that although the decrease in overdiagnosis is encouraging, the long-term effects of the new screening practices on metastasis and mortality are still unclear.

Presented by: Christopher Haas, MD, Columbia University, College of Physicians and Surgeons, Columbia University

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.