Impact of training level of urology residents on the detection of prostate cancer on TRUS biopsy

Abstract

The objective of this study is to evaluate the performance of urology residents at each training level in detecting prostate cancer with transrectal ultrasound-guided (TRUS) biopsy. The inclusion criteria were: (1) prostate-specific antigen (PSA) 4-10 ng/ml; and (2) 10-12 cores per biopsy session. Data from repeat biopsy sessions were excluded. Overall prostate cancer detection rate for 170 patients was 39.4%. PSA, digital rectal examination (DRE), and prostate volume were predictors of cancer detection. There were no significant differences in overall cancer detection rates, PSA, DRE, or prostate volume between resident levels. In conclusion, urology residents at all levels of training perform equally well at detecting cancer using TRUS prostate biopsy technology.

Operator is an Independent Predictor of Detecting Prostate Cancer at Transrectal Ultrasound Guided Prostate Biopsy

“…The overall cancer detection rate in this study was previously reported at almost 50%, 14,15 which is higher than in traditional series with a rate of 27% to 44% in similar cohorts. [22][23][24][25][26][27][28] This is similar to findings in studies of saturation techniques for initial biopsy with a 43% to 46% rate. 19,29 We believe that our high detection rate is explained by solid techniques, significant case load, excellent equipment, end firing probes and ultrasound to find hypoechoic lesions which, as we already reported, increases the yield.…”

“…22 However, emerging data suggest that equipment has a role, such that end fire probes have a higher cancer detection rate than side fire probes (45.8% vs 38.5%). 28 In our study cancer detection differences were likely based on technique rather than on patient or equipment factors.…”

“…The only study of the influence of operator on the cancer detection rate at TRUS-BX was done in 170 patients undergoing initial biopsy with PSA between 4 and 10 ng/ml. 22 This involved multiple operators in 4 cohorts (years 1 to 4 of resident training) and the object of the study was to identify different cancer detection rates based on training year. No significant differences were identified but the study was prone to type II error.…”

Impact of resident involvement in endoscopic bladder cancer surgery on pathological outcomes

“…These findings are consistent with two prior studies by Mariappan et al that described an association between surgeon experience and adequate muscle-containing bladder specimens [12,13]. Further, urological studies to date have demonstrated conflicting findings when assessing the impact of residents on surgical outcomes; however, when focusing on endoscopic studies, a disadvantageous influence appears to exist [3,4,[14][15][16][17][18]. A recent study of 8152 transurethral resection procedures showed that resident participation was associated with increased odds of prolonged operative time and 30 day hospital readmission rates [19].…”

A review of transrectal ultrasound guided prostate biopsies: Is there still a role for finger guided prostate biopsies?

“…Although urology trainees performed both FG and TRUS biopsies, with equal experience in both approaches, the learning curve associated with TRUS biopsy might impact the quality of the TRUS biopsies in our study. Investigators have, however, found no learning curve associated with the procedure in studies that assessed the cancer detection rate [21,22].…”