Fifteen‐year analysis of prostate biopsies in Western Australia including recent impact of multiparametric magnetic resonance imaging

Abstract

Background The number of men undergoing prostate biopsy and subsequent cancer detection rates has changed significantly over the past 15 years. We aim to evaluate changes in the diagnostic pathway of prostate cancer between 2003 and 2018. Methods A total of 13 844 Western Australian biopsy‐naive men were assessed to determine trends in age, prostate‐specific antigen levels, number of core samples, positive cores and tumour grade (Gleason) between 2003 and 2018. Further, in 2018, the impact of pre‐biopsy multiparametric magnetic resonance imaging (mpMRI) was also assessed. Results Between 2003 and 2012, the number of men undergoing biopsy increased from 1445 to 3100. During this time, the prostate cancer detection rate (%) remained unchanged. However, in 2018, 2042 men underwent prostate biopsy (reduction of 34.1%) and the detection rate increased to 72.6%. The incidence of low‐grade cancer (Gleason score <7) increased from 28.1% in 2003 to 36.2% in 2012, but it decreased significantly to 15.1% by 2018. High‐grade cancer (Gleason score >7) declined from 21.3% in 2003 to 15.2% in 2012 but then increased to 35.7% in 2018. The use of mpMRI in 2018 improved the detection rate of high‐grade cancer. However, its specificity remains low (29.7%) and a considerable proportion of low Prostate Imaging Reporting and Data System score lesions was later diagnosed with cancer unsuitable for active surveillance. Conclusion In recent years, there has been a significant increase in the diagnosis high‐grade cancer and a reduction in cancer suitable for active surveillance. mpMRI identifies high‐grade tumours but is not a reliable alternative to prostate biopsy.

Prostate‐specific antigen testing testing in the modern era

“…The effect of this can be seen, with health systems reporting a decrease in the number of prostate biopsies and a reduction in the detection of clinically insignificant prostate cancer (Gleason 3 + 3/ ISUP 1). 22 Like mpMRI, active surveillance has progressed to become the standard of care approach for men diagnosed with low-risk prostate cancer to delay or even mitigate the need for radical treatment. Before active surveillance, most men diagnosed with prostate cancer were initiated on 'curative' treatment with inherent risks of postoperative morbidity.…”

“…In Australia, this culminated in a world‐first government‐funded mpMRI for men with suspected PCa. The effect of this can be seen, with health systems reporting a decrease in the number of prostate biopsies and a reduction in the detection of clinically insignificant prostate cancer (Gleason 3 + 3/ISUP 1) 22 …”