Negative influence of changing biopsy practice patterns on the predictive value of prostate‐specific antigen for cancer detection on prostate biopsy

• Published in: Cancer 2008-04, Vol.112 (8), p.1718-1725
• Main Authors: Schwartz, Michael J., Hwang, David H., Hung, Andrew J., Han, Jullet, McClain, Justin W., Shemtov, M. Mendel, Te, Alexis E., Sosa, R. Ernest, Vaughan, E. Darracott, Scherr, Douglas S.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biopsy - methods; Biopsy - statistics & numerical data; biopsy practice patterns; Cohort Studies; detection; digital rectal examination; Digital Rectal Examination - statistics & numerical data; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Organ Size; Practice Patterns, Physicians' - statistics & numerical data; Predictive Value of Tests; Prostate - diagnostic imaging; Prostate - pathology; prostate cancer; Prostate-Specific Antigen - analysis; prostate‐specific antigen; Prostatic Neoplasms - pathology; Retrospective Studies; transrectal ultrasound; Tumors; Tumors of the urinary system; Ultrasonography, Interventional; Urinary tract. Prostate gland
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.23353

BACKGROUND. A correlation between prostate specific antigen (PSA) level and positive prostate biopsy rate was established in an era when biopsy practice patterns were different from what they are today. We evaluated if changes in biopsy practice patterns have affected the ability of PSA to predict cancer detection on prostate biopsy in the current era. METHODS. Of 3634 prostate biopsies performed from 1993–2005, 1607 met criteria for analysis. Biopsy data were divided into 3 time‐cohorts (1993–1997, 1998–2001, and 2002–2005) to assess for practice patterns shifts and correlation between PSA and biopsy results. RESULTS. Significant changes in biopsy practice patterns included an increase in biopsy cores and more frequent use of PSA 2.5–3.99 ng/mL as a biopsy indication. In men with normal DRE, a moderate correlation between PSA and positive biopsy rate did exist from 1993–1997, but was subsequently lost. On multivariate analysis, PSA was not a significant predictor of biopsy result in men with normal DRE. CONCLUSIONS. Early in the PSA era, the predictive power of PSA depended on multiple factors: high prevalence of disease, higher prevalence of high‐grade disease, and low likelihood of prostate cancer diagnosis in men with low PSA. Now, beyond the culling effect of increased biopsy incidence and with shifted biopsy practice patterns, the correlation between PSA and biopsy result is lost in men with normal DRE. Diagnosing a higher proportion of tumors in men with a PSA between 2.0–4.0 ng/mL has negatively influenced the predictive value of PSA for cancer detection. Cancer 2008. © 2008 American Cancer Society. A correlation between prostate‐specific antigen (PSA) level and positive prostate biopsy rate was established in an era when biopsy practice patterns were much different from what they are today. Increasing the number of biopsy cores and the proportion of tumors diagnosed in men with a PSA between 2.0 ng/mL and 4.0 ng/mL has negatively influenced the predictive value of PSA for cancer detection.