Intra-Practice Urologist-Level Variation in Targeted Fusion Biopsy Outcomes.

To examine the extent to which the urologist performing biopsy contributes to variation in prostate cancer detection during fusion-guided prostate biopsy.

All men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry who underwent fusion biopsy at Michigan Medicine from August 2017 to March 2019 were included.

The primary outcomes were clinically significant cancer detection rate (defined as Gleason Grade ≥ 2) in targeted cores and clinically significant cancer detection on targeted cores stratified by PI-RADS score. Bivariate and multivariable logistic regression analyses were performed.

A total of 1,133 fusion biopsies performed by five providers were included. When adjusting for patient age, PSA, race, family history, prostate volume, clinical stage, and PI-RADS score, there was no significant difference in targeted clinically significant cancer detection rates across providers (range = 38.5-46.9%, adjusted p-value = 0.575). Clinically significant cancer detection rates ranged from 11.1-16.7% in PI-RADS 3 (unadjusted p = 0.838), from 24.6-43.4% in PI-RADS 4 (adjusted p = 0.003), and from 69.4-78.8% in PI-RADS 5 (adjusted p = 0.766) lesions.

There was a statistically significant difference in clinically significant prostate cancer detection in PI-RADS 4 lesions across providers. These findings suggest that even among experienced providers, variation at the urologist level may contribute to differences in clinically significant cancer detection rates within PI-RADS 4 lesions. However, the relative impact of biopsy technique, radiologist interpretation, and MR acquisition protocol requires further study.

Urology. 2023 Apr 28 [Epub ahead of print]

Apoorv Dhir, Chad S Ellimoottil, Ji Qi, Alex Zhu, Robert S Wang, Jeffrey S Montgomery, Simpa S Salami, John T Wei, Prasad R Shankar, Matthew S Davenport, Nicole E Curci, John D Millet, Chen-Yu Wu, Anna Johnson, David C Miller, Arvin K George

Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor., Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor; Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor., Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor; Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor., Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor., Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor. Electronic address: .

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