title: Prostate Needle Biopsy Outcomes in the Era of the U.S. Preventive Services Task Force Recommendation against Prostate Specific Antigen Based Screening.
abstract: OBJECTIVE
  We determined whether the characteristics of patients undergoing prostate needle biopsies and prostate needle biopsy results changed after the U.S. Preventive Services Task Force recommendation in 2012 against prostate specific antigen based screening for prostate cancer for men of any age.
  
  
  METHODS
  A prospective database of patients undergoing prostate needle biopsies at Virginia Mason from 2004 to 2014 was reviewed. Welch's t-test and chi-square tests were used to compare patients seen before to those seen after the USPSTF recommendation. Relative risks and corresponding confidence intervals were estimated by general linear regression.
  
  
  RESULTS
  Patients in the post-USPSTF group (310) had a higher prostate specific antigen (p <0.001), were more likely to be diagnosed with higher clinical stage (2b, p=0.003; 2c-3a, p=0.027) and D'Amico high risk prostate cancer (p=0.036), with an adjusted relative risk for high risk prostate cancer of 1.25 (95% CI 1.02-1.52) compared to those in the pre-USPSTF group (1,416). Limiting the pre-USPSTF group to the 30 months before the draft guidelines (448 patients) yielded similar results. The absolute number of biopsies performed decreased by 31%, with the majority of the decrease occurring in the detection of intermediate risk tumors.
  
  
  CONCLUSIONS
  In the 2 and a half years after the USPSTF recommendation against prostate specific antigen based screening, patients undergoing prostate needle biopsies were significantly more likely to be diagnosed with high risk disease. However, a reduction in the number of prostate needle biopsies performed occurred concomitantly with a decrease in the detection of intermediate risk, potentially curable prostate cancer. Future focus on informed application of screening techniques may prevent the reversal of decades of improvement in the prostate cancer mortality rate.
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington.
authors.forename: John S
authors.initials: JS
authors.lastname: Banerji
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington.
authors.forename: Erika M
authors.initials: EM
authors.lastname: Wolff
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington.
authors.forename: John D
authors.initials: JD
authors.lastname: Massman
authors.affiliation: Center for Biomedical Statistics, University of Washington, Seattle, Washington.
authors.forename: Katherine
authors.initials: K
authors.lastname: Odem-Davis
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Porter
authors.affiliation: Section of Urology and Renal Transplantation, Virginia Mason, Seattle, Washington. Electronic address: john.corman@virginiamason.org.
authors.forename: John M
authors.initials: JM
authors.lastname: Corman
mesh_terms: D026683:Advisory Committees; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D016896:Treatment Outcome; D014481:United States
chemical_list: D017430:Prostate-Specific Antigen
keywords: biopsy; early detection of cancer; government agencies; needle; prostate-specific antigen; prostatic neoplasms