PURPOSE: To determine if the USPSTF recommendation against PSA screening was associated with a change in biopsy and cancer detection rates.
MATERIALS AND METHODS: We conducted a time series analysis (10/2008-06/2013) of prostate biopsies performed at University Health Network (Toronto). Biopsies for active surveillance or solely targeting MRI-detected lesions were excluded. Interventional auto-regressive integrated moving average (ARIMA) models with step functions were used to examine changes in the number of biopsies performed and cancers detected per month. Low risk PC (LRPC) was defined as no Gleason pattern ≥4, ≤ 3 cores involved or ≤ 1/3 of total number of cores involved, and no core with >50% cancer involvement. Intermediate-to-high grade PC (I-HGPC) was defined as Gleason 7-10.
RESULTS: A total of 3408 biopsies were performed and 1601 (47.0%) PCs were detected (LRPC=563 (16.5%); I-HGPC=914 (26.8%)). The median number of biopsies per month decreased from 58.0 (IQR=54.5-63.0) before recommendations to 35.5 (IQR=27.0-41.0) afterward (p=0.003), while median number of patients undergoing their first-time biopsies decreased from 42.5 (IQR=37.5-45.5) to 24.0 (IQR=19.0-32.5, p=0.025). The median number of LRPCs detected per month decreased from 8.5 (IQR=6.5-10.5) to 5.5 (IQR=4.0-7.0, p=0.012), while the median number of I-HGPCs per month decreased from 17.5 (IQR=14.5-21.5) to 10.0 (IQR=9.0-12.0, p< 0.001).
CONCLUSIONS: Following the USPSTF recommendation, the number of biopsies performed (total and first-time biopsies), based on referrals from our catchment area, have decreased. This is likely due to decreased use of PSA-screening. Although encouraging that fewer low risk PCs are being diagnosed, the sudden decrease in the detection rate of Gleason 7-10 PCs is concerning.
Bhindi B, Mamdani M, Kulkarni GS, Finelli A, Hamilton RJ, Trachtenberg J, Zlotta AR, Evans A, van der Kwast TH, Toi A, Fleshner NE. Are you the author?
Institution(s): See publishing journal.
Reference: J Urol. 2014 Dec 3. pii: S0022-5347(14)05037-X.