Variations in prostate biopsy practice: A quantitative questionnaire-based study

Abstract

original research E732Cite as: Can Urol Assoc J 2013;7(11-12):e732-9. http://dx.doi.org/10.5489/cuaj.372 Published online November 8, 2013. AbstractBackground: The ambivalent results of recent large randomized prostate cancer studies have added a significant layer of uncertainty for clinicians and patients contemplating investigation of early disease. This uncertainty and lack of prescriptive recommendations from professional organizations has led to significant variation in practice in North America. The purpose of this study was to determine the extent of variation in biopsy recommendations by urologists and to discern factors predictive for these recommendations. Methods: An anonymous, cross-sectional, self-report questionnaire was sent to all active members of the Canadian Urological Association practicing in Ontario. The survey consisted of demographic data and 10 closed-ended questions designed to capture biopsy preferences in ambiguous clinical situations. Respondent preferences for recommending a prostate biopsy were compared to a guideline-informed study standard. Descriptive and correlative statistics were used to analyze the responses. Results: The response rate to the survey was 74%. The responses showed considerable variability in recommendations for or against biopsy. While most of the urologists concurred with the research team's study standard recommendations, only 4 scenarios had over 80% concurrence and 1 scenario, which centered on the utility of free PSA, had only had 42% concurrence. None of the respondent's descriptors were associated with trends to recommend biopsy other than the number of biopsies performed per year (p = 0.04). Interpretation: This self-report survey investigating prostate biopsy thresholds identifies considerable variation in practicing urologists in Ontario. The drivers of biopsy recommendations in these relatively ambiguous clinical situations appeared to be age, suspicious rectal examinations, and total PSA.

Prostate Biopsy in the Elderly: Histologic Findings and Treatment Necessity

“…As well the US Preventive Services Task Force (USPSTF) has recommended against routine PSA screening for prostate cancer and claimed upper limit of age as 75 in an earlier version (Moyer, 2012). However, this lack of clear guidance on this point is well reflected by the treatment practices of urologists which show a great variance (Lipinski et al, 2013;Situmorang et al, 2013;Verim et al, 2013). In our practice, PSA analysis in the elderly depends mainly on either physical examination and/or lower urinary tract symptom driven suggestion, or patient's own will as a continuum of yearly PSA screening.…”