Prostate biopsy in Western Australia 1998–2004

Abstract

We reviewed the status of prostate cancer diagnosis in Western Australia (WA) with the aim of improving decision-making about PSA testing and prostate biopsy. Our patient cohort was 5145 men undergoing an initial biopsy for prostate cancer diagnosis in WA between 1998 and 2004. Transrectal ultrasound-guided biopsies were performed by one of 18 clinicians whereas all pathology was assessed by one urological pathologist. Cancer detection rates were 59% for initial biopsies and 32% for repeat biopsies. High-grade cancer (Gleason sum > or =7) accounted for 69 and 38% of tumours diagnosed on initial and repeat biopsy, respectively. The rates of cancer diagnosis and detection of high-grade tumours were both 1.6-fold higher in WA patients compared with those obtained at baseline screening of the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial of US men (P<0.001). These higher than expected rates of cancer detection and high histological grade indicate that urological practice in WA between 1998 and 2004 was significantly more conservative than US practice over this time period, probably leading to underdiagnosis of prostate cancer. Our findings may be relevant to other countries where urological practice differs from that in the United States.

Associations between Testosterone Levels and Incident Prostate, Lung, and Colorectal Cancer. A Population-Based Study

“…We were also unable to explore the effects of increased PSA testing, which may result in increased registration of low-grade cancers that would have otherwise gone undetected. PSA testing is subsidized by the Australian public health system and (49). Thus, the threshold for biopsy seems to be high, and the spectrum of disease in our sample may be shifted upward relative to studies from other regions with a high prevalence of PSA testing.…”

Algorithm for selecting men for pelvic lymph node dissection (PLND) during radical prostatectomy based on clinical risk factors in an Australian population

“…In fact, contemporary series from USA institutions show a risk of LN disease generally < 5% [ 6, 7,15 ] , although the rate appears to be higher in European centres 15 ] . This difference again confi rms that the spectrum of prostate cancer treated in the Australian practice environment differs somewhat from that seen in USA centres [ 16 ] .…”

“…The present data is obviously of greatest relevance to the Australian practice context, and it is important to consider the unique features in the Australian epidemiology of prostate cancer that have been demonstrated [ 16 ] . Nonetheless, we feel that the principles of patient selection for PLND that we have developed from the present study should have wide applicability, as suggested by similar recommendations from the EAU.…”