Sampling, submission, and report format for multiple prostate biopsies: a 1999 survey

Much variation occurs in sampling, submission, and reporting of prostate biopsies. Current practice standards among physicians across the United States are uncertain.

We surveyed predominantly nonacademic urologists and pathologists. The response rate was 57 (21%) of 271 urologists and 47 (55%) of 85 pathologists.

Fifty-five percent of urologists performed six (or more) site-designated biopsies; 41% used unspecified bilateral biopsies. More than one half of urologists and pathologists reported submitting or receiving six or more separate, site-designated containers. The remainder of physicians (less than one half) reported the submission of all left needle cores in one container and all right cores in the other. Most pathologists (70%) stated that billing depended on the number of containers; 15% were unsure. One hundred percent of academic and 68% of nonacademic urologists deemed the report format therapeutically relevant (P <0.03), as did 57% of pathologists. Physicians submitting or receiving sextant needle biopsies in separate containers shared a 3:1 preference for issuance of a separate line diagnosis for each sextant site instead of condensing all diagnoses into one line with one Gleason score. Similarly, for each biopsy site, 61% of urologists wanted a separate Gleason score, and 68% wanted a separate designation for the percentage of tissue with tumor. Fifty-six percent and 64% of urologists and pathologists, respectively, deemed it relevant to specify the site(s) of high-grade prostatic intraepithelial neoplasia, even if cancer were present.

Much variation persists in prostate biopsy sampling and reporting, hindering communication among physicians from different institutions. However, similar percentages of urologists and pathologists reported separate versus combined site sampling and separate versus combined site report format preferences.