ORLANDO, FL, USA (UroToday.com) - This study represented the largest U.S. sampling of prostate biopsies analyzed for positive biopsy rates and core-sampling patterns. Saturation biopsies were not included. From 2005-2011, data from 437 937 patients representing 765 urology practices (mean average of 1 756 urologists) were collected from both the national reference laboratory and pathology laboratories as part of urology group practices (LUGPA members). A mean positive biopsy rate of 40.3% was the same for both lab sources. The investigators concluded during this six year period, “There was a national trend of increased sampling in prostate biopsy from 7.9 to 10.7 (v/bx) resulting in an increased cancer detection rate in the U.S. – 38.2% to 42.6%. Results suggest urologists in large group practices have adopted a de facto national standard of care by segregating the prostate biopsy cores into 10-12 unique v/bx.
“We conducted this study to look at prostate biopsies as a general pattern throughout the United States. In order to do that, we looked at both a national reference laboratory, where urologists who are in private practice send their samples for review, and we looked at a group of large urology group practices, which contain their own pathology laboratories,” said Carl A. Olsson, MD, Integrated Medical Professionals, New York.
“What we found was that over a period of seven years, and as time went on, there was a gradual increase in the use of further sampling. There was also an increase in further sampling of the prostate on both sides (both in the urology laboratories as well as in the national reference laboratories). The interesting thing was that the percentages of biopsies that were positive rose over time. In a linear fashion, this shows that increasing the sampling did detect significantly more cancers than the lower sampling rate did in the original year of the study. There was an increased cancer detection rate from 38% to 43% over the time period of the study. The results indicate a (trend) of doing additional sampling per biopsy whether he or she be in a large urology group or in a small urology group.”
Listen to Carl A. Olsson, MD discuss the study
Deepak Kapoor, MD, president, Large Urology Group Practice Association, and Integrated Medical Professionals, New York, and an author on this study, added, “Our data has three distinctly different messages, each one of which affects a different target audience. For the practicing urologist, this is the largest study that's ever been done on positive-biopsy rate and correlating the positive-biopsy rate with the number of specimens that were sent (to the database). Our data includes more than 4.5 million biopsy specimens, representing more than 400 000 patients, representing the work product of over a third of the urologists in the country. This demonstrates, conclusively that an extended sextant biopsy regimen of 10 to 12 cores is what is necessary for the optimum yield in prostate cancer detection.
Listen to Deepak Kapoor, MD discuss the study
The second message, which affects a different target audience is a health policy message. What we've seen nationally is that there's been a fundamental change in the paradigm of health care, from the mom-and-pop private practice to integration into large, single- and multi-specialty groups, as well as the absorption of practices into hospitals. There have been articles in the press that have suggested that the incentives for groups that incorporate certain ancillary services are inappropriate, and they may be going ahead and performing services for financial motives rather than clinical reasons. What our data shows is that the prostate cancer-positive biopsy rate is exactly the same regardless of whether physicians own and operate the laboratories or whether they send the specimen to a lab with which they don't operate. The second thing is that there's no statistically significant difference between the number of specimens that are sent. So from a health policy standpoint it's actually very important because we've seen in many metro areas that hospitals have acquired so many practices that they have actually secured a near monopoly on services.”
Dr. Kapoor goes on to explain that alternatively the patient should retain the ability to go to a local community-based urology practice. “In my view, patient care is improved when patients have choice…since the utilization rate and the positive-biopsy rate and the utilization (in this study) are identical across (all) sites-of-service (this should alleviate any concerns that the biopsy might not be clinically motivated). The patient should have absolute confidence that the clinician is recommending the biopsy for what is right for the patient, not for what's right for the doctor's pocketbook.”
In his view, by decentralizing multi-disciplinary urology services through an outpatient facility, care can be more cost-effectively delivered. “Our goal is to overcome the logical barriers -- location, parking, access to novel and new therapies -- so that the patients have good access to continuity of care. Dr. Kapoor underscored this view by recalling his recent guest appearance on an Hispanic radio station, “We talked about current healthcare utilization trends among Hispanic Americans. This community prefers to go to an outpatient facility before they ever consider going to a hospital-based facility. At the end of the day, our patients talk with their feet. They have to be comfortable coming into the facility and as physicians we to be ready to talk to them about PSAs, biopsies, and when and why to utilize these tests to detect prostate cancer.”
Presented by Carl A. Olsson, Deepak A. Kapoor, Savvas E. Mendrinos, Ann E. Anderson, and David G. Bostwick at the 2013 Genitourinary Cancers Symposium - February 14 - 16, 2013 - Rosen Shingle Creek - Orlando, Florida USA
Professionals, PLLC; Columbia University Medical Center, North Hills, NY; Integrated Medical Professionals, PLLC, Melville, NY; Integrated Medical Professionals, PLLC, Garden City, NY; Bostwick Laboratories, Uniondale, NY
Written and prepared by Karen Roberts, medical writer for UroToday.com