Ro. Roberts et al., Positive and negative biopsies in the pre-prostate specific antigen and prostate specific antigen eras, 1980 to 1997, J UROL, 163(5), 2000, pp. 1471-1475
Purpose: We assess temporal trends in prostate biopsy incidence, utilizatio
n and cancer yield in the community before and after the introduction of se
rum prostate specific antigen (PSA) to the community medical practice
Materials and Methods: Study subjects comprised all Olmsted County men with
a first prostate biopsy performed between January 1, 1980 and December 31,
1997. Medical records of all study subjects (1,729) were reviewed for clin
ical information from the first and all subsequent biopsies.
Results: Annual age adjusted prostate biopsy incidence increased from 113/1
00,000 (95% confidence interval 76, 150) in 1980 tal 487/100,000 (421, 554)
in 1992 and decreased to 264/ 100,000 (219, 309) in 1997. For men 50 to 59
years old biopsy incidence increased 400% from 137/100,000 in 1980 to 1986
to 686/100,000 in 1993 to 1997. Overall, there were 93/100,000 more negati
ve biopsies and 49/100,000 more positive biopsies in 1993 to 1997 than in 1
980 to 1986. The,overall cancer yield of 36% was essentially unchanged acro
ss periods (p = 0.6). However, by age cancer yield decreased from 29% to 21
% (1980 to 1986 versus 1993 to 1997) for men 50 to 59 years old but increas
ed from 38% to 45% for those 70 to 79 years old.
Conclusions: Overall cancer yield from prostate biopsies has changed little
during the last 15 years. Increased cancer yield for men 70 years old or e
lder has been offset by the decreased yield in younger men. Attention must
now be given to diagnostic techniques which might reduce the incidence of n
egative biopsies and improve cancer yield in younger men.