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Journal of the National Cancer Institute Advance Access published online on September 11, 2007
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djm119
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Published by Oxford University Press 2007.

ARTICLES

Detection of Prostate Cancer via Biopsy in the Medicare–SEER Population During the PSA Era

H. Gilbert Welch, Elliott S. Fisher, Daniel J. Gottlieb, Michael J. Barry

Affiliations of authors: Department of Veterans Affairs Medical Center, White River Junction, VT (HGW, ESF); Institute for Health Policy and Clinical Practice at Dartmouth, Hanover, NH (HGW, ESF, DJG); Massachusetts General Hospital, Harvard Medical School, Boston, MA (MJB)

Correspondence to: H. Gilbert Welch, MD, MPH, VA Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009 (e-mail: h.gilbert.welch{at}dartmouth.edu).

Background: Despite the considerable attention given to the prostate-specific antigen (PSA) as a screening test for prostate cancer, it is needle biopsy—and not the PSA test result—that actually establishes the diagnosis of prostate cancer. We sought national estimates on the proportion of men found to have prostate cancer after a needle biopsy of the prostate and the risk of subsequent biopsies among those not found to have prostate cancer.

Methods: We linked Medicare claims data to Surveillance, Epidemiology, and End Results (SEER) data to analyze outcomes after 10429 needle biopsies performed in 1993 through 2001 in 8273 men aged 65 years and older enrolled in Medicare Part B who resided in a SEER area. We determined the proportion of needle biopsies that were followed by a diagnosis of prostate cancer, the cumulative risk of prostate cancer following multiple biopsies, and the risk of subsequent biopsy among men not found to have prostate cancer in the previous biopsy. All statistical tests were two-sided.

Results: The overall proportion of needle biopsies found to contain prostate cancer was 32% (95% confidence interval [CI] = 31% to 33%). The yield increased with age (26% for men aged 65–69 years, 31% for men aged 70–74 years, 35% for men aged 75–79 years, and 41% for men aged 80 years and older; Ptrend<.001). The cumulative risk of prostate cancer diagnosis increased with repeated biopsy, with 50% of men receiving a prostate cancer diagnosis after two biopsies, 62% after three biopsies, and 68% after four biopsies. Among men whose first recorded biopsy did not detect prostate cancer, the risk of having a subsequent biopsy was 11.6% (95% CI = 11% to 12%) at 1 year and 38% (95% CI = 36% to 40%) at 5 years.

Conclusions: About one-third of prostate biopsies identified prostate cancer in this population. Men not found to have prostate cancer on a first biopsy frequently undergo repeat biopsies, which raise the cumulative risk of prostate cancer diagnosis.


CONTEXT AND CAVEATS

Prior knowledge

To fully characterize the effects of prostate-specific antigen screening for prostate cancer, it is important to develop estimates of biopsy yield—i.e., the proportion of men whose prostate biopsies are found to contain prostate cancer.

Study design

Medicare claims data were linked to the National Cancer Institute's Surveillance, Epidemiology, and End Results to analyze outcomes after needle biopsies of the prostate in men aged 65 years and older.

Contribution

One-third of needle biopsies overall were found to contain prostate cancer, and the yield increased with age. The yield of second and subsequent biopsies was less than that of the first recorded biopsy, but the cumulative risk of prostate cancer increased with repeat biopsies. More than one-third of men whose first recorded biopsy did not detect prostate cancer had a subsequent biopsy within 5 years.

Implications

Multiple biopsies increase the likelihood that a man will be diagnosed with prostate cancer.

Limitations

The study was restricted to men aged 65 years and older, and its relevance to younger men is not known. Information on why biopsies were performed was not available. The number of biopsy cores sampled was not known.

 
Manuscript received June 7, 2006; revised June 28, 2007; accepted July 20, 2007.


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J Natl Cancer Inst 2007 99: 1353. [Extract] [Full Text] [PDF]





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