Effect of training and individual operator's expertise on prostate cancer detection through prostate biopsy: Implications for the current quantitative training evaluation system

Abstract

Purpose This study was conducted to evaluate the relevance of training and experience to gaining expertise in prostate biopsy based on an assessment of outcomes from the performance of urology residents. Materials and Methods We retrospectively reviewed the medical records of 10,299 patients who underwent prostate biopsy by 50 operators under a unified urology residency program. The number of prostate biopsies performed by an operator for each patient was used as an indicator of operator experience. Residents were grouped into quartiles according to cancer detection rates in the first 50 and the last 50 procedures. Results Among 10,299 patients (median age, 67.5 years; median prostate-specific antigen [PSA], 7.04 ng/mL), the overall prostate cancer detection rate and that for patients with PSA <10.0 ng/mL were 37.0% and 25.9%, respectively. Operator experience was a significant predictor for cancer detection in patients with PSA <10.0 ng/mL. Cancer detection rates and the proportion of more advanced prostate cancers were higher in the last 50 cases than in the first 50 cases. Detection rates varied significantly among operator; residents with higher detection rates at training initiation showed even higher detection rates after additional training. Conclusions Training that adds to the cumulative experience of a trainee appears to play a meaningful role in improving cancer detection rates. The level of skill required to achieve mastery for independent practice may be assessed from the accuracy results of prostate biopsy procedures, and trainees with poor rates will require more technical training to improve precision.

Understanding tumor localization in multiparametric MRI of the prostate—effectiveness of 3D printed models

“…This result could be explained by the fact that biopsies are performed most frequently at this level of training in our clinic. As Lee and Mager et al have already shown, there is a learning curve of 40-50 targeted biopsies, after which the detection rate is sufficient and sometimes even higher than the expert standard of the institution (9,17). This is likely a practice effect, which makes those who perform many biopsies at the time of the survey perform better.…”

“…Even in radical prostatectomy, a detailed understanding of the tumor localization in mpMRI as well as a high quality prostate biopsy is essential for safe resection margins and nerve sparing ( 10 , 16 ). However, achieving a comprehensive understanding of mpMRI is still a major challenge for many urologists worldwide ( 4 , 5 ) and requires a high level of experience ( 4 , 7 , 9 , 17 ). After implementation of mpMRI and targeted prostate biopsies into the EAU-guidelines as the gold standard diagnostic for prostate cancer ( 3 ) the demand for targeted prostate biopsies has increased drastically.…”