Evaluating prostate biopsy practices across Indian institutions: A multi-center prospective observational study

Area of Science:

• Urology
• Oncology
• Diagnostic Imaging

Background:

• Prostate cancer is a leading global malignancy in men.
• Prostate-specific antigen (PSA) screening aids early detection, but prostate biopsy remains the gold standard for diagnosis.
• Significant variability exists in prostate biopsy practices across Indian healthcare institutions.

Purpose of the Study:

• To evaluate current prostate biopsy techniques, indications, and complications in India.
• To assess the diagnostic yield of prostate biopsies across multiple institutions.
• To identify areas for improvement in prostate biopsy procedures.

Main Methods:

• A prospective, multi-center observational study involving 2479 patients across 43 Indian institutions.
• Data collected on demographics, PSA levels, imaging, biopsy route/technique, antibiotic prophylaxis, pain, complications, and histopathology.
• Analysis of initial or repeat biopsies in men aged 40 years and above.

Main Results:

• Elevated PSA (>40 years) was the primary indication (95.2%). Transrectal biopsy was predominant (91.8%) over transperineal (6.4%).
• Multiparametric MRI (mpMRI) was used in 45% of cases; targeted cores in 15.6%. Cancer detection rate (CDR) varied by PIRADS score (81.4% for PIRADS 5).
• Adenocarcinoma diagnosed in 61%. Transrectal biopsies showed higher CDR (61.3% vs. 47.2%) but increased infection rates (3.3% vs. 0%). Overall complication rate was 11%.

Conclusions:

• Substantial variability in prostate biopsy practices necessitates standardized training in India.
• Standardization can enhance diagnostic accuracy and improve patient safety in prostate cancer diagnosis.
• Further research into optimal biopsy techniques and protocols is warranted.