title: Repeat Prostate Biopsy Practice Patterns in a Statewide Quality Improvement Collaborative.
abstract: We examined rebiopsies in MUSIC (Michigan Urological Surgery Improvement Collaborative) to understand adherence to guidelines recommending repeat prostate biopsy in patients with multifocal high grade prostatic intraepithelial neoplasia or atypical small acinar proliferation.
  
  
  
  We analyzed data on men undergoing repeat biopsy, practice patterns and cancer detection rates. Multivariate regression modeling was used to calculate the proportion of patients undergoing rebiopsy. We used claims data to validate the treatment classification in MUSIC. To understand reasons for not performing rebiopsy we reviewed records of a sample of patients with atypical small acinar proliferation.
  
  
  
  We identified 5,375 men with a negative biopsy, of whom 411 (7.6%) underwent repeat biopsy. In 718 men with high grade prostatic intraepithelial neoplasia, 350 with atypical small acinar proliferation and 587 with high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation or atypical small acinar proliferation alone at initial biopsy the rebiopsy rate was 20.7%, 42.5% and 55.6%, respectively. The adjusted proportion of patients with rebiopsy in each practice ranged from 0% to 17.2% (p <0.001). The overall cancer detection rate at rebiopsy was 39.3%. It was highest after atypical small acinar proliferation (adjusted probability 0.39, 95% CI 0.30-0.48), and after high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation (adjusted probability 0.50, 95% CI 0.35-0.65). The greatest Gleason 7 or greatest detection rate of 41.1% was found in patients with high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation. Chart review revealed that 45.5% of patients with atypical small acinar proliferation underwent prostate specific antigen testing instead of rebiopsy while 36% failed to undergo rebiopsy despite a recommendation.
  
  
  
  Rebiopsy rates vary in Michigan practices with relatively low use in men with high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation or atypical small acinar proliferation alone. Quality improvement strategies should target patients with atypical small acinar proliferation and high grade prostatic intraepithelial neoplasia as they have the highest likelihood of cancer detection.
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan. Electronic address: fburks@urologist.org.
authors.forename: Frank N
authors.initials: FN
authors.lastname: Burks
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Telang
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan.
authors.forename: Alice
authors.initials: A
authors.lastname: Liu
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan.
authors.forename: Scott
authors.initials: S
authors.lastname: Hawken
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan.
authors.forename: Zack
authors.initials: Z
authors.lastname: Montgomery
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan.
authors.forename: Susan
authors.initials: S
authors.lastname: Linsell
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan.
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan.
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.affiliation: Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Department of Urology, University of Michigan (AL, SH, ZM, SL, JEM, DCM, KRG), Ann Arbor, Michigan.
mesh_terms: D061354:Acinar Cells / Q000473:pathology*; D000368:Aged; D001706:Biopsy; D049109:Cell Proliferation; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D060787:Neoplasm Grading; D010818:Practice Patterns, Physicians'; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D058996:Quality Improvement; D012086:Reoperation; D012189:Retrospective Studies
keywords: biopsy; diagnosis; prostatic intraepithelial neoplasia; prostatic neoplasms; quality improvement