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1244 THE IMPACT OF REPEAT BIOPSIES ON INFECTIOUS COMPLICATIONS IN MEN WITH PROSTATE CANCER ON ACTIVE SURVEILLANCE: A PROSPECTIVE STUDY
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
THE JOURNAL OF UROLOGY姞
CONCLUSIONS: Urologist ownership of a pathology facility with subsequent self-referral of prostate biopsy specimens did not result in a significant variation in rate of biopsy, rate of repeat biopsies, or indications for biopsy.
Era 6/10-2/12ⴱ
Patient Visits 3224
Repeat Biopsies (rate) ␣ 109 (8.0%)
Patients Biopsied (rate)  1260 (39.1%)
8/08-4/10†
3497
128 (9.6%)
1205 (34.5%)
11/06-8/08†
3368
87 (6%)
1350 (40.0%)
3051
75 (7%)
1057 (34.6%)
3/05-11/06†
7/03-3/05† 2695 82 (7%) 1080 (40.0%) ⴱ- physician owned. †-non-physician owned. ␣- % of all biopsies  - % of patient visits.
Source of Funding: None
1244 THE IMPACT OF REPEAT BIOPSIES ON INFECTIOUS COMPLICATIONS IN MEN WITH PROSTATE CANCER ON ACTIVE SURVEILLANCE: A PROSPECTIVE STUDY Behfar Ehdaie*, Massimiliano Spaliviero, Anna Giallo-Uvino, Marryellen O’Sullivan, Jennifer Livingston, James Eastham, Peter Scardino, Karim Touijer, New York, NY INTRODUCTION AND OBJECTIVES: Prostate biopsy related infectious complications are associated with significant morbidity. Fluoroquinolone (FQ) resistant and extended spectrum beta-lactam (ESBL)-producing Escherichia coli have been increasingly recovered and contribute to the rising incidence of sepsis after prostate biopsy. Meanwhile, active surveillance is being increasingly used as treatment for low-risk prostate cancer, requiring men to undergo serial transrectal ultrasound (TRUS)-guided prostate biopsies. The risk of infectious complications associated with active surveillance remains understudied. METHODS: 615 consecutive men who underwent TRUSguided prostate biopsy were enrolled prospectively between January 2011 and January 2012 at Memorial Sloan-Kettering Cancer Center. Of these men, 433 were previously diagnosed with prostate cancer and received a 14-core TRUS-guided prostate biopsy as part of an active surveillance regimen or for confirmatory purposes prior to enrollment into active surveillance. Following the biopsy procedure, all men received a phone call by a nurse within 7 days, and information was collected on potential complications, potential antibiotic received and urine culture results in patients with infectious complications. RESULTS: Twelve patients (2.8%) had infectious complications requiring hospitalization after TRUS-guided biopsy. Five patients (41.7%) had FQ-resistant isolates (most Escherichia coli), and 2 (16.7%) were ESBL-producing isolates. The mean age of men with previous diagnosis of prostate cancer was 63. A total of 268 patients (61.9%) were found to have prostate cancer on the current biopsy. The median number of previous prostate biopsies was 1 (range 1-12). We evaluated the impact of other risk factors including history of BPH, previous infectious complications, and antibiotic regimen; however only the number of previous prostate biopsies was significantly associated with an increased risk of infectious complications (p⫽0.036). For every previous biopsy, the odds of an infection increase 1.3 times (OR 1.34, 95% CI 1.02-1.76). CONCLUSIONS: In men with prostate cancer on active surveillance, the number of previous prostate biopsies is associated with significant risk of infectious complications and every previous biopsy increases the risk an infectious complication. FQ-resistant and ESBLproducing isolates represent the most commonly identified organisms in this population. Men treated with active surveillance should be aware of the risks associated with serial repeat prostate biopsies. Source of Funding: This study was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers. Supported in part by funds from David H. Koch through the Prostate Cancer Foundation
e509
1245 THE IMMEDIATE IMPACT OF US PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS ON PSA SCREENING BEHAVIORS OF PRIMARY CARE PHYSICIANS Joshua Cohn*, Chicago, IL; Justin Lakeman, Eric Brown, Jonathan Silverstein, Charles Brendler, Michael McGuire, Brian Helfand, Evanston, IL INTRODUCTION AND OBJECTIVES: In May 2012, the United States Preventive Services Task Force (USPSTF) released its final recommendation against prostate specific antigen (PSA) screening in all men. The immediate impact of this recommendation on PSA testing in a primary care setting is unknown. METHODS: NorthShore University HealthSystem Enterprise Data Warehouse was used to compare the frequency of PSA testing by primary care physicians. Eligibility criteria: men aged 40-79 years evaluated by Internal Medicine or Family Practice, no history of prostate cancer or urologic referral. Baseline characteristics including age, prior PSA, ethnicity, and insurance were documented. The proportion of men with at least one PSA test over a 5 month period was compared between two cohorts: pre-USPSTF recommendations (6/2011-10/ 2011) and post recommendations (6/2012-10/2012). Chi-squared analysis was used for comparison of proportions. Given the large study population, a more conservative Bayes Factor (ratio of likelihood of null hypothesis to likelihood of alternative) was calculated to assist interpretation of differences in screening between the two cohorts. RESULTS: The study population was comprised of 41,171 men: 18,399 in the pre-recommendation (2011) cohort and 22,772 in the post-recommendation (2012) cohort. The pre-USPSTF cohort was significantly younger (32.4 vs. 30.3% aged 40-49, p⬍0.001) and less likely to be insured by Blue Shield (35.5 vs. 37.4%, p⬍0.001) (Table 1, left side). Bayes Factor analysis substantially favored a decrease in overall screening (7.9 vs. 6.9%, p⬍0.001) and appeared to be most evident in men aged 70-79 (9.1 vs. 5.6%, p⬍0.001), Caucasians (9.2 vs. 7.7%, p⬍0.001), and those with prior highest PSA ⬍2.5 ng/dL (10.5 vs. 8.5%, p⬍0.001) (Table 1, right side). Of the 9,764 patients present in both cohorts, 844 (8.6%) underwent screening in the 2011 cohort vs. 759 (7.8%) in the 2012 cohort (p⫽0.03). CONCLUSIONS: In the short time interval since the USPSTF recommendations were finalized, there is already evidence of decreased PSA screening. The recommendations may be associated with more selective screening practices, as indicated by a significant decrease in screening frequency within the oldest patients and in those without a history of an elevated PSA.
Source of Funding: None
THE JOURNAL OF UROLOGY姞
CONCLUSIONS: Urologist ownership of a pathology facility with subsequent self-referral of prostate biopsy specimens did not result in a significant variation in rate of biopsy, rate of repeat biopsies, or indications for biopsy.
Era 6/10-2/12ⴱ
Patient Visits 3224
Repeat Biopsies (rate) ␣ 109 (8.0%)
Patients Biopsied (rate)  1260 (39.1%)
8/08-4/10†
3497
128 (9.6%)
1205 (34.5%)
11/06-8/08†
3368
87 (6%)
1350 (40.0%)
3051
75 (7%)
1057 (34.6%)
3/05-11/06†
7/03-3/05† 2695 82 (7%) 1080 (40.0%) ⴱ- physician owned. †-non-physician owned. ␣- % of all biopsies  - % of patient visits.
Source of Funding: None
1244 THE IMPACT OF REPEAT BIOPSIES ON INFECTIOUS COMPLICATIONS IN MEN WITH PROSTATE CANCER ON ACTIVE SURVEILLANCE: A PROSPECTIVE STUDY Behfar Ehdaie*, Massimiliano Spaliviero, Anna Giallo-Uvino, Marryellen O’Sullivan, Jennifer Livingston, James Eastham, Peter Scardino, Karim Touijer, New York, NY INTRODUCTION AND OBJECTIVES: Prostate biopsy related infectious complications are associated with significant morbidity. Fluoroquinolone (FQ) resistant and extended spectrum beta-lactam (ESBL)-producing Escherichia coli have been increasingly recovered and contribute to the rising incidence of sepsis after prostate biopsy. Meanwhile, active surveillance is being increasingly used as treatment for low-risk prostate cancer, requiring men to undergo serial transrectal ultrasound (TRUS)-guided prostate biopsies. The risk of infectious complications associated with active surveillance remains understudied. METHODS: 615 consecutive men who underwent TRUSguided prostate biopsy were enrolled prospectively between January 2011 and January 2012 at Memorial Sloan-Kettering Cancer Center. Of these men, 433 were previously diagnosed with prostate cancer and received a 14-core TRUS-guided prostate biopsy as part of an active surveillance regimen or for confirmatory purposes prior to enrollment into active surveillance. Following the biopsy procedure, all men received a phone call by a nurse within 7 days, and information was collected on potential complications, potential antibiotic received and urine culture results in patients with infectious complications. RESULTS: Twelve patients (2.8%) had infectious complications requiring hospitalization after TRUS-guided biopsy. Five patients (41.7%) had FQ-resistant isolates (most Escherichia coli), and 2 (16.7%) were ESBL-producing isolates. The mean age of men with previous diagnosis of prostate cancer was 63. A total of 268 patients (61.9%) were found to have prostate cancer on the current biopsy. The median number of previous prostate biopsies was 1 (range 1-12). We evaluated the impact of other risk factors including history of BPH, previous infectious complications, and antibiotic regimen; however only the number of previous prostate biopsies was significantly associated with an increased risk of infectious complications (p⫽0.036). For every previous biopsy, the odds of an infection increase 1.3 times (OR 1.34, 95% CI 1.02-1.76). CONCLUSIONS: In men with prostate cancer on active surveillance, the number of previous prostate biopsies is associated with significant risk of infectious complications and every previous biopsy increases the risk an infectious complication. FQ-resistant and ESBLproducing isolates represent the most commonly identified organisms in this population. Men treated with active surveillance should be aware of the risks associated with serial repeat prostate biopsies. Source of Funding: This study was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers. Supported in part by funds from David H. Koch through the Prostate Cancer Foundation
e509
1245 THE IMMEDIATE IMPACT OF US PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS ON PSA SCREENING BEHAVIORS OF PRIMARY CARE PHYSICIANS Joshua Cohn*, Chicago, IL; Justin Lakeman, Eric Brown, Jonathan Silverstein, Charles Brendler, Michael McGuire, Brian Helfand, Evanston, IL INTRODUCTION AND OBJECTIVES: In May 2012, the United States Preventive Services Task Force (USPSTF) released its final recommendation against prostate specific antigen (PSA) screening in all men. The immediate impact of this recommendation on PSA testing in a primary care setting is unknown. METHODS: NorthShore University HealthSystem Enterprise Data Warehouse was used to compare the frequency of PSA testing by primary care physicians. Eligibility criteria: men aged 40-79 years evaluated by Internal Medicine or Family Practice, no history of prostate cancer or urologic referral. Baseline characteristics including age, prior PSA, ethnicity, and insurance were documented. The proportion of men with at least one PSA test over a 5 month period was compared between two cohorts: pre-USPSTF recommendations (6/2011-10/ 2011) and post recommendations (6/2012-10/2012). Chi-squared analysis was used for comparison of proportions. Given the large study population, a more conservative Bayes Factor (ratio of likelihood of null hypothesis to likelihood of alternative) was calculated to assist interpretation of differences in screening between the two cohorts. RESULTS: The study population was comprised of 41,171 men: 18,399 in the pre-recommendation (2011) cohort and 22,772 in the post-recommendation (2012) cohort. The pre-USPSTF cohort was significantly younger (32.4 vs. 30.3% aged 40-49, p⬍0.001) and less likely to be insured by Blue Shield (35.5 vs. 37.4%, p⬍0.001) (Table 1, left side). Bayes Factor analysis substantially favored a decrease in overall screening (7.9 vs. 6.9%, p⬍0.001) and appeared to be most evident in men aged 70-79 (9.1 vs. 5.6%, p⬍0.001), Caucasians (9.2 vs. 7.7%, p⬍0.001), and those with prior highest PSA ⬍2.5 ng/dL (10.5 vs. 8.5%, p⬍0.001) (Table 1, right side). Of the 9,764 patients present in both cohorts, 844 (8.6%) underwent screening in the 2011 cohort vs. 759 (7.8%) in the 2012 cohort (p⫽0.03). CONCLUSIONS: In the short time interval since the USPSTF recommendations were finalized, there is already evidence of decreased PSA screening. The recommendations may be associated with more selective screening practices, as indicated by a significant decrease in screening frequency within the oldest patients and in those without a history of an elevated PSA.
Source of Funding: None