Prostate Biopsy Rates Fall Following Guideline Updates

The proportion of biopsied men who have complications from the procedure rose from 14% to 18% from 2005 to 2014.
The proportion of biopsied men who have complications from the procedure rose from 14% to 18% from 2005 to 2014.

Prostate biopsy rates have fallen following the updated American Urological Association (AUA) guidelines and US Preventive Services Task Force (USPSTF) recommendations, a new study confirms. Although biopsy complication rates have decreased as well, the proportion of men experiencing them has risen.

“Taken together, these findings support a reduction in the morbidity of biopsy following publication of revised PSA screening guidelines but highlight the continued need to reduce the relative morbidity of biopsy,” lead investigator R. Jeffrey Karnes, MD, of Mayo Clinic in Rochester, MN, and colleagues wrote in European Urology, published online ahead of print.

Dr Karnes and his team analyzed prostate biopsy and 30-day complication rates using US claims data from 2005 to 2014 for 5,279,315 commercially insured men older than 40. Of these, 104,584 underwent prostate biopsy.

Interrupted time-series analysis allowed the investigators to quantify the impact of the major publications addressing PSA screening. From 2005 to 2014, biopsy rates fell 33% from 64.1 to 42.8 per 100,000 persons per month, with immediate reductions following the 2008 and 2012 USPSTF recommendations and 2013 AUA guidelines. This rate decrease is larger than previous reports, suggesting that thresholds for urology referral and/or performance of biopsy may have changed.

Likewise, complication rates decreased 10% from 8.7 to 7.8 per 100,000 persons per month, with notable decreases following the 2012 USPSTF recommendations.

Despite the absolute reduction in 30-day complication rate, the proportion of biopsied men who experienced complications rose from 14% to 18%, driven by non-sepsis infections. Previous studies have also found increases in infectious complications. Further analysis of the current study revealed that prior fluoroquinolone use increased the odds of complications by 27% and anticoagulant use by 14%. Advanced age above 70 years also increased the chances by 25% of complications perhaps due to more comorbidities in this population.

“Accordingly, if health policy aims to reduce the morbidity of PSA screening related to biopsy, further efforts should focus on improving patient selection and periprocedural processes of care,” Dr Karnes and colleagues suggested. They noted that men who have previously taken fluoroquinolone may benefit from pre-biopsy rectal swabs. For men with comorbidities such as peripheral vascular disease or cancer, clinicians might reconsider biopsy.

The study's retrospective design may reflect changes in policy or practice over time that were not assessed, which is a limitation. The researchers also cited lack of a control group and the uncertain influences of imaging, biopsy approach, indication for anticoagulation, and other factors.

Source

  1. Gershman B, Van Houten HK, Herrin J, et al. Impact of Prostate-specific Antigen (PSA) Screening Trials and Revised PSA Screening Guidelines on Rates of Prostate Biopsy and Postbiopsy Complications. Eur Urol. doi: 10.1016/j.eururo.2016.03.015.
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