Australian ultrasound-guided biopsy trends: a 17-year analysis of national data

Prostate cancer diagnosis is primarily performed through ultrasound-guided biopsy. Australia has a Stage 4 aging population and as prostate cancer is a disease of middle aged to elderly patients, it would be expected that there would be an increase in the diagnosis of prostate cancer. However, several key events have occurred in the last 10 years including the introduction of multiparametric magnetic resonance imaging (mpMRI) of the prostate and publication of major prostate cancer screening trials and guidelines. We aimed to characterize the trends in prostate biopsy in Australia in the context of these changes.

Population and prostate biopsy data were obtained from the Australian Government Bureau of Statistics Census data and the Australian Department of Health Medicare Benefits Schedule between 2000 and 2017. A meta narrative review of publications, guidelines, and policy announcements regarding prostate cancer screening and diagnosis in Australia was performed. Prostate biopsy trends were analyzed from 2000 to 2017 by age-group and year.

The 2016 Census data showed the male population of Australia was 11,546,638. Between 2000 and 2017, a total of 373,158 ultrasound-guided biopsies were performed in Australia. A general decline in the total number of prostate biopsies performed was observed from 2009 onwards. There was a transition of the highest prostate biopsy age-group from 55-64 to 65-74 years with the transition occurring in 2012. Biopsy numbers in the age-group 75-84 years also slowly increased from 2000 to 2009 and declined for a short period of time till 2013 and is on the rise again.The decrease in 2010 coincides with the increased uptake of mpMRI in Australia as a new tool in the screening for prostate cancer. Furthermore, this decrease also coincides with the release of the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) prostate cancer screening trials in 2009 and the policy statements developed as a result of these by Royal Australian College of General Practitioners and Urological Society of Australia and New Zealand.

Interesting trends have been identified through this population study. With an aging population, it would be expected that the number of prostate biopsies would be increasing. It is likely that the introduction of mpMRI in Australia and the release of prostate cancer screening guidelines have decreased the number of patients being screened for prostate cancer. Furthermore, increasing use of active surveillance may be responsible for the increase in the prostate biopsies occurring in the older age-groups.