Additional benefit of using a risk based selection for prostate biopsy: an analysis of biopsy complications in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC).

To investigate biopsy complications and hospital admissions that could be reduced by the use of ERSPC risk calculators (RC).

All biopsies in the Rotterdam section of the ERSPC from 1993 to 2015 were included. Biopsy complications and hospital admission data were prospectively recorded in questionnaires that were completed 2 weeks after biopsy. The ERSPC RC3 and RC4 were applied to men attending the first and subsequent rounds of screening, respectively. Applying the predefined RC3/4 probability cut-offs for prostate cancer(PCa) risk of ≥12.5% and high grade PCa(HGPCa) risk ≥3%, we assessed the the number of complications, admissions and costs that could be reduced by avoiding biopsies in men below these cut-offs.

10747 biopsies with complete questionnaires were included. A total of 7294(67.9%) complications, 3.9% (424/10747) post-biopsy fever, and 0.9%(92/10747) hospital admissions were recorded. Fever rate has been static over the years, but hospital admissions had tripled from 0.6%(1993-1996) to 2.1%(2009-2015). Among 7704 biopsies which fit the criteria of RC3 or 4, 35.8%(2757/7704) biopsies, 37.4%(1972/5268) complications, 39.4%(128/325) fever, and 42.3%(30/71) admissions could have been avoided by using one of the RCs. More complications could have been avoided in the case of RC4 or more recent biopsies(2009-2015). 35.9% of the total cost of biopsies and complication treatment could be saved.

A significant proportion of biopsy complications, hospital admissions, and costs could be reduced if biopsy decisions were based on ERSPC risk calculators instead of PSA only, and this effect was most prominent in more recent biopsies and in men with repeated biopsies or screening. This article is protected by copyright. All rights reserved.

BJU international. 2017 May 12 [Epub ahead of print]

Peter K F Chiu, Arnout R Alberts, Lionne D F Venderbos, Chris H Bangma, Monique J Roobol

Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.