Standardized prostate cancer incidence and mortality rates following initial non‐malignant biopsy result

Abstract

Objectives To compare the incidence of subsequent prostate cancer diagnosis and death following an initial non‐malignant systematic transrectal ultrasonography (TRUS) biopsy with that in an age‐ and calendar‐year matched population over a 20‐year period. Subjects and Methods This population‐based analysis compared a cohort of all men with initial non‐malignant TRUS biopsy in Denmark between 1995 and 2016 (N = 37 231) with the Danish population matched by age and calendar year, obtained from the NORDCAN 9.1 database. Age‐ and calendar year‐corrected standardized prostate cancer incidence (SIR) and prostate cancer‐specific mortality ratios (SMRs) were calculated and heterogeneity among age groups was assessed with the Cochran's Q test. Results The median time to censoring was 11 years, and 4434 men were followed for more than 15 years. The corrected SIR was 5.2 (95% confidence interval [CI] 5.1–5.4) and the corrected SMR was 0.74 (95% CI 0.67–0.81). Estimates differed among age groups (P < 0.001 for both), with a higher SIR and SMR among younger men. Conclusion Men with non‐malignant TRUS biopsy have a much higher incidence of prostate cancer but a risk of prostate cancer death below the population average. This underlines that the oncological risk of cancers missed in the initial TRUS biopsy is low. Accordingly, attempts to increase the sensitivity of initial biopsy are unjustified. Moreover, current follow‐up after non‐malignant biopsy is likely to be overaggressive, particularly in men over the age of 60 years.

MRI-Targeted Prostate Biopsy Introduces Grade Inflation and Overtreatment

“…Furthermore, there is abundant literature showing that up to 30% of men with clinical suspicion of PCa but with negative systematic biopsy de facto harbour high-grade prostate cancer [26]. If these are clinically significant, one would expect PCa mortality during extended follow-up [23].…”

“…Indirect evidence for grade inflation also comes from registry studies in which men with negative systematic biopsies have been followed for decades with negligible PCaspecific mortality [23][24][25]. Furthermore, there is abundant literature showing that up to 30% of men with clinical suspicion of PCa but with negative systematic biopsy de facto harbour high-grade prostate cancer [26].…”

Danish Prostate Registry (DanProst) – an Updated Version of the Danish Prostate Cancer Registry, Methodology, and Early Results

“…Following an update in 2018, the most recent version of DaPCaR includes a population of 153,373 unique men with a histological assessment of the prostate from 1995 to 2016. So far, this registry has resulted in several publications describing different epidemiological aspects of prostate cancer diagnosis and outcomes [4][5][6][7][8][9][10][11][12][13]. The two versions of DaPCaR were laborious to use as most data had to be manually imputed with no regular updates.…”