Negative influence of changing biopsy practice patterns on the predictive value of prostate-specific antigen for cancer detection on prostate biopsy.
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.
Schwartz
Michael J
MJ
Department of Urology, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
Hwang
David H
DH
Hung
Andrew J
AJ
Han
Jullet
J
McClain
Justin W
JW
Shemtov
M Mendel
MM
Te
Alexis E
AE
Sosa
R Ernest
RE
Vaughan
E Darracott
ED
Scherr
Douglas S
DS
D001706:Biopsy / Q000379:methods / Q000706:statistics & numerical data*; D015331:Cohort Studies; D051517:Digital Rectal Examination / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
D017430:Prostate-Specific Antigen