title: Variation in prostate cancer detection rates in a statewide quality improvement collaborative.
abstract: OBJECTIVE
  There remains significant controversy surrounding the optimal criteria for recommending prostate biopsy. To examine this issue further urologists in MUSIC assessed statewide prostate biopsy practice patterns and variation in prostate cancer detection.
  
  
  METHODS
  MUSIC is a statewide, physician led collaborative designed to improve prostate cancer care. From March 2012 through June 2013 at 17 MUSIC practices standardized clinical and pathological data were collected on a total of 3,015 men undergoing first-time prostate biopsy. We examined pathological biopsy outcomes according to patient characteristics and across MUSIC practices.
  
  
  RESULTS
  The average cancer detection rate was 52% with significant variability across MUSIC practices (range 43% to 70%, p<0.0001). Of all patients biopsied 27% were older than 69 years, ranging from 19% to 36% at individual practices. Men with prostate specific antigen less than 4 ng/ml comprised an average of 26% of the study population (range 10% to 37%). The detection rate in patients older than 69 years ranged from 42% to 86% at individual practices (p=0.0008). In the 793 patients with prostate specific antigen less than 4 ng/ml the cancer detection rate ranged from 22% to 58% across individual practices (p=0.0065). The predicted probability of cancer detection varied significantly across MUSIC practices even after adjusting for patient age, prostate specific antigen, prostate size, family history and digital rectal examination findings (p<0.0001).
  
  
  CONCLUSIONS
  While overall detection rates are higher than previously reported, the cancer yield of prostate biopsy varies widely across urology practices in Michigan. These data serve as a foundation for our efforts to understand and improve patient selection for prostate biopsy.
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, Michigan.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Riedinger
authors.affiliation: Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Womble
authors.affiliation: Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Linsell
authors.affiliation: Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Zaojun
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.affiliation: Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Spectrum Health Hospital System, Grand Rapids, Michigan. Electronic address: brian.lane@spectrumhealth.org.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
mesh_terms: D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D058996:Quality Improvement; D014572:Urology
keywords: Michigan; biopsy; physician's practice patterns; prostate; prostatic neoplasms