BACKGROUND: A prostate-specific antigen (PSA) level above 4 ng/mL has historically been recognized as an appropriate threshold to recommend biopsy; however the risk of high-grade disease observed among men with lower PSA levels in the Prostate Cancer Prevention Trial has led to calls to change the criteria for biopsy referral. PURPOSE: To aid providers when discussing aggressiveness of biopsy by cataloging available community biopsy patterns and determine whether lower PSA thresholds are being used to recommend biopsy. METHODS: Laboratory and biopsy records were reviewed among 59,764 men in a large Washington State health plan between 1998 and 2007. Follow-up in the 12-month period after a test was categorized as biopsy, urology visit without biopsy, additional PSA testing with no urology visit, or no PSA-related follow-up. Data analysis occurred between 2010 and 2011. RESULTS: Twenty-eight percent of tests with PSA levels ≥4.0 ng/mL, 2.9% of tests with levels between 2.5 and 4.0 ng/mL, and 0.4% of tests with levels <2.5 ng/mL were followed with a biopsy within 12 months. More than 40% of elevated tests (≥4.0 ng/mL) were followed by a urologist visit without a biopsy, and more than 30% of tests ≥4.0 did not have any PSA-related follow-up within 12 months. PSA velocity, defined as annualized rate of change in PSA level, was strongly associated with biopsy, especially when absolute PSA was <4.0 ng/mL. There appear to be no discernable temporal trends in biopsy thresholds or practice patterns based on PSA lower levels or velocity. CONCLUSIONS: Despite recent calls to more aggressively recommend biopsy at lower PSA thresholds, the practice in this large health plan has remained consistent over time. Published by Elsevier Inc.
BACKGROUND: A prostate-specific antigen (PSA) level above 4 ng/mL has historically been recognized as an appropriate threshold to recommend biopsy; however the risk of high-grade disease observed among men with lower PSA levels in the Prostate Cancer Prevention Trial has led to calls to change the criteria for biopsy referral. PURPOSE: To aid providers when discussing aggressiveness of biopsy by cataloging available community biopsy patterns and determine whether lower PSA thresholds are being used to recommend biopsy. METHODS: Laboratory and biopsy records were reviewed among 59,764 men in a large Washington State health plan between 1998 and 2007. Follow-up in the 12-month period after a test was categorized as biopsy, urology visit without biopsy, additional PSA testing with no urology visit, or no PSA-related follow-up. Data analysis occurred between 2010 and 2011. RESULTS: Twenty-eight percent of tests with PSA levels ≥4.0 ng/mL, 2.9% of tests with levels between 2.5 and 4.0 ng/mL, and 0.4% of tests with levels <2.5 ng/mL were followed with a biopsy within 12 months. More than 40% of elevated tests (≥4.0 ng/mL) were followed by a urologist visit without a biopsy, and more than 30% of tests ≥4.0 did not have any PSA-related follow-up within 12 months. PSA velocity, defined as annualized rate of change in PSA level, was strongly associated with biopsy, especially when absolute PSA was <4.0 ng/mL. There appear to be no discernable temporal trends in biopsy thresholds or practice patterns based on PSA lower levels or velocity. CONCLUSIONS: Despite recent calls to more aggressively recommend biopsy at lower PSA thresholds, the practice in this large health plan has remained consistent over time. Published by Elsevier Inc.
Authors: H B Carter; C H Morrell; J D Pearson; L J Brant; C C Plato; E J Metter; D W Chan; J L Fozard; P C Walsh Journal: Cancer Res Date: 1992-06-15 Impact factor: 12.701
Authors: Paul A Fishman; Michael J Goodman; Mark C Hornbrook; Richard T Meenan; Donald J Bachman; Maureen C O'Keeffe Rosetti Journal: Med Care Date: 2003-01 Impact factor: 2.983
Authors: Andrew J Vickers; Tineke Wolters; Caroline J Savage; Angel M Cronin; M Frank O'Brien; Kim Pettersson; Monique J Roobol; Gunnar Aus; Peter T Scardino; Jonas Hugosson; Fritz H Schröder; Hans Lilja Journal: Eur Urol Date: 2009-08-07 Impact factor: 20.096
Authors: Louise C Walter; Kathy Z Fung; Katharine A Kirby; Ying Shi; Roxanne Espaldon; Sarah O'Brien; Stephen J Freedland; Adam A Powell; Richard M Hoffman Journal: JAMA Intern Med Date: 2013-05-27 Impact factor: 21.873