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Variations in prostate biopsy practice: A quantitative questionnaire-based study.

Matthew O Lipinski1, D Robert Siemens, Patti A Groome

  • 1Division of Cancer Care and Epidemiology, Cancer Research Institute; and the Department of Community Health and Epidemiology, Queen's University, Kingston, ON;

Canadian Urological Association Journal = Journal De L'Association Des Urologues Du Canada
|November 28, 2013
PubMed
Summary
This summary is machine-generated.

Urologist recommendations for prostate biopsies vary significantly in Ontario due to uncertain study results. Practice patterns depend on factors like patient age and examination findings, not just PSA levels.

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Area of Science:

  • Urology
  • Oncology
  • Medical Practice Variation

Background:

  • Ambiguous results from large prostate cancer studies create clinical uncertainty.
  • Lack of clear guidelines leads to practice variations in prostate biopsy recommendations.
  • Significant differences in urologist practices observed in North America.

Purpose of the Study:

  • To quantify the variation in prostate biopsy recommendations among urologists.
  • To identify factors influencing urologists' biopsy decisions.
  • To address practice variability in early prostate cancer investigation.

Main Methods:

  • Anonymous, cross-sectional survey distributed to Canadian Urological Association members in Ontario.
  • Questionnaire included demographic data and 10 closed-ended questions on biopsy preferences.
  • Respondent preferences compared against a guideline-informed standard using descriptive and correlative statistics.

Main Results:

  • Survey achieved a 74% response rate, revealing considerable variability in biopsy recommendations.
  • High concurrence (>80%) with study standards occurred in only 4 scenarios.
  • Low concurrence (42%) observed for scenarios involving free PSA; only annual biopsy volume predicted recommendations.

Conclusions:

  • Significant variation exists in prostate biopsy thresholds among practicing urologists in Ontario.
  • Age, suspicious rectal examinations, and total PSA levels are key drivers for biopsy recommendations in ambiguous cases.
  • Understanding these drivers is crucial for standardizing prostate cancer diagnostic practices.