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Additional benefit of using a risk‐based selection for prostate biopsy: an analysis of biopsy complications in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer
Author(s) -
Chiu Peter K.,
Alberts Arnout R.,
Venderbos Lionne D. F.,
Bangma Chris H.,
Roobol Monique J.
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13913
Subject(s) - medicine , prostate cancer , biopsy , prostate biopsy , prostate , relative risk , gynecology , surgery , cancer , urology , confidence interval
Objective To investigate biopsy complications and hospital admissions that could be reduced by the use of European Randomized Study of Screening for Prostate Cancer ( ERSPC ) risk calculators. Materials and Methods All biopsies performed in the Rotterdam section of the ERSPC between 1993 and 2015 were included. Biopsy complications and hospital admission data were prospectively recorded in questionnaires that were completed 2 weeks after biopsy. The ERSPC risk calculators 3 ( RC 3) and 4 ( RC 4) were applied to men attending the first and subsequent rounds of screening, respectively. Applying the predefined RC 3/4 probability thresholds for prostate cancer ( PC a) risk of ≥12.5% and high‐grade PC a risk ≥3%, we assessed the number of complications, admissions and costs that could be reduced by avoiding biopsies in men below these thresholds. Results A total of 10 747 biopsies with complete questionnaires were included. For these biopsies a complication rate of 67.9% (7294/10 747), a post‐biopsy fever rate of 3.9% (424/10747) and a hospital admission rate of 0.9% (92/10747) were recorded. The fever rate was found to be static over the years, but the hospital admission rate tripled from 0.6% (1993–1996) to 2.1% (2009–2015). Among 7704 biopsies which fit the criteria for RC 3 or RC 4, 35.8% of biopsies (2757/7704), 37.4% of complications (1972/5268), 39.4% of fever events (128/325) and 42.3% of admissions (30/71) could have been avoided by using one of the risk calculators. More complications could have been avoided if RC 4 had been used and for more recent biopsies (2009–2015). Our findings show that 35.9% of the total cost of biopsies and complication treatment could have been avoided. Conclusion A significant proportion of biopsy complications, hospital admissions and costs could be reduced if biopsy decisions were based on ERSPC risk calculators instead of PSA only. This effect was most prominent in more recent biopsies and in men with repeated biopsies or screening.