BETHESDA, MD USA (UroToday.com) - A study presented by Ryan Levey from the Medical University of South Carolina provides some evidence that urologists may have changed the way they approach prostate cancer diagnosis in response to concerns regarding overdiagnosis and overtreatment of indolent disease. Using the Veterans Health Administration (VHA) data, this group looked at trends in prostate biopsy utilization between 2003 and 2012. Men age 40 to 80-years-old were included in the cohort if they had at least one PSA drawn between 2003 and 2012. They were subsequently removed from the eligible study population if they underwent a prostate biopsy. This resulted in over 250 000 patients included in the study in any given year, and over 24 million patient-years utilized in the analysis.
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In total over 190 000 biopsies were performed during the study period. The rate of prostate biopsy was found to decrease annually over the past decade. In 2003, the rate of biopsy was 130 per every 100 000 men, per month; by 2011 this decreased by 14%, or by an average rate of 0.24 fewer biopsies per 100 000 men, per month. The largest declines in biopsy rate were seen in patients over 60-years-old (0.40 fewer biopsies per 100 000 men, per month) and in Caucasians (0.26 fewer biopsies per 100 000, per month). In contrast, smaller rates of decline in biopsies performed were seen in African-American men (0.19 fewer biopsies per 100 000, per month) and in men younger than 60 (0.16 fewer biopsies per 100 000, per month).
These results suggest that urologists may be becoming more judicious regarding selection of patients for prostate biopsy, given the rates of men with elevated risk for prostate cancer (i.e., African-Americans) and those most likely to benefit from prostate cancer treatment (i.e., younger patients) experienced a slower decline in prostate biopsy rate, while those less likely to benefit from treatment (i.e., older patients) experienced the highest rate of decline.
Further research will help to elucidate whether this trend is also seen outside of the VHA. It would also be interesting to see how these trends change over time and whether there is any geographical variation with regards to these trends.
Ryan Levey,1 Gowtham Rao,2 Azza Shoaibi,3 Kathlyn Haddock,2 and Sandip Prasad4
1Department of Urology, Medical University of South Carolina (Charleston, SC USA); 2J.B. Dorn Veterans Affairs Medical Center (Columbia, SC USA); 3Department of Epidemiology and Biostatistics, School of Public Health, University of South Carolina (Columbia, SC USA); 4Department of Urology, Medical University of South Carolina (Charleston, SC USA), Ralph H. Johnson Veterans Affairs Medical Center (Charleston, SC USA)
Timothy Ito, MD* from the 2014 Winter Meeting of the Society of Urologic Oncology (SUO) "Defining Excellence in Urologic Oncology" - December 3 - 5, 2014 - Bethesda, MD USA
*Fox Chase Cancer Center, Philadelphia, PA USA