title: Trends in prostate biopsy in Ontario, 1992-2014: a cohort study.
abstract: BACKGROUND
  Prostate cancer is a substantial public health concern; however, in recent years, national guidelines have recommended against prostate cancer screening. We sought to determine if prostate biopsy incidence has changed over time in Ontario. We hypothesized that there has been a decrease in the incidence of prostate biopsy in recent years.
  
  
  METHODS
  This cohort study used population-based administrative databases from Ontario, Canada. We used a diagnostic code to identify if a patient received his first prostate biopsy between 1992 and 2012 (the last year for which records in the Ontario Cancer Registry were complete). Age-stratified and overall age-standardized incidences of prostate biopsy were determined. Changes over time in prostate biopsy incidence and the proportion of prostate biopsies that showed malignant disease were examined using negative binomial regression adjusting for patient age.
  
  
  RESULTS
  We identified 231 266 Ontario men aged 40 years and older who received their first prostate biopsy between 1992 and 2014. Up to 2007, biopsy incidence increased in younger men, but decreased in older men. After 2007, biopsy incidence decreased in all age groups, with the age-standardized overall biopsy incidence dropping from 480 per 100 000 in 2007 to 250 per 100 000 in 2014. A total of 84 149 (39%) incident biopsies showed malignant disease. The proportion of biopsies classified as showing malignant disease increased during the study period, from 25.6% in 1992 to 49.2% in 2010, and then decreased in all age groups.
  
  
  CONCLUSIONS
  Previously increasing biopsy rates decreased significantly in recent years, suggesting that prostate cancer screening in Ontario may be changing.
authors.affiliation: Division of Urology (Lavallee), Department of Surgery, Ottawa Hospital Research Institute and Institute of Clinical Evaluative Sciences; Division of Urology (Breau), Department of Surgery, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute (Fergusson); and Department of Medicine (van Walraven), Ottawa Hospital Research Institute, Ottawa, Ont.
authors.forename: Luke T
authors.initials: LT
authors.lastname: Lavallée
authors.affiliation: Division of Urology (Lavallee), Department of Surgery, Ottawa Hospital Research Institute and Institute of Clinical Evaluative Sciences; Division of Urology (Breau), Department of Surgery, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute (Fergusson); and Department of Medicine (van Walraven), Ottawa Hospital Research Institute, Ottawa, Ont.
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Breau
authors.affiliation: Division of Urology (Lavallee), Department of Surgery, Ottawa Hospital Research Institute and Institute of Clinical Evaluative Sciences; Division of Urology (Breau), Department of Surgery, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute (Fergusson); and Department of Medicine (van Walraven), Ottawa Hospital Research Institute, Ottawa, Ont.
authors.forename: Dean
authors.initials: D
authors.lastname: Fergusson
authors.affiliation: Division of Urology (Lavallee), Department of Surgery, Ottawa Hospital Research Institute and Institute of Clinical Evaluative Sciences; Division of Urology (Breau), Department of Surgery, Ottawa Hospital Research Institute; Ottawa Hospital Research Institute (Fergusson); and Department of Medicine (van Walraven), Ottawa Hospital Research Institute, Ottawa, Ont.
authors.forename: Carl
authors.initials: C
authors.lastname: van Walraven