In our recent manuscript, “Intra-Practice Urologist-Level Variation in Targeted Fusion Biopsy Outcomes,” we evaluated variation in cancer detection rates for 5 fusion biopsy providers in a high-volume single center. We found no significant differences in the detection of clinically significant prostate cancer across the providers. However, there was a statistically significant difference in clinically significant prostate cancer detection across the providers when biopsying PI-RADS 4 lesions. Such differences are potentially due to variations in sampling strategies and segmentation where there is wide variation in cancer detection rates, compared to PIRADS 3 and 5 lesions where the pre-test probabilities of detecting cancer can be much lower or higher, respectively.
A limitation of our study was that we were not able to control for variability in the 13 different radiologists who interpreted prostate MRI. Nevertheless, this heterogeneity reflects real-world practice in a high-volume center.
Our work demonstrates that urologists at the same center perform similarly in overall cancer detection with fusion biopsy, but there is room for standardization and quality improvement to address subtle variations at the lesion level. Continued improvement in fusion prostate biopsy will rely on a multidisciplinary approach to address the complex interplay of variations in such a highly technical procedure.
Written by: Apoorv Dhir, MD & Arvin George, MD
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
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