Can a trained non‐physician provider perform transrectal ultrasound‐guided prostatic biopsies as effectively as an experienced urologist?. (21st June 2012)

• Record Type: Journal Article
• Authors: Hori, Satoshi; Fuge, Oliver; Trabucchi, Kay; Donaldson, Peter; McLoughlin, John
• Is Part Of: BJU international. Volume 111:Number 5(2013:Mar.)
• Page Start: 739
• Page End: 744
• Publication Date: 2012-06-21
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2012.11294.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11294-sec-0001" sec-type="section"> <title>What's known on the subject? and What does the study add?</title> <p> <list id="bju11294-list-0005" list-type="bullet"> <list-item> <p>PSA testing has resulted in a large number of patients being referred to urologists for investigation of potential prostate cancer. Despite limited evidence, non‐physician providers now perform a number of routine urological procedures such as transrectal ultrasound‐guided prostatic biopsies (TRUSP) in a bid to help relieve this increasing workload.</p> </list-item> <list-item> <p>In the largest series to date, we provide evidence that an adequately trained non‐physician provider is able to perform TRUSP as effectively as an experienced urologist after an initial learning curve.</p> </list-item> </list> </p> </sec> <sec id="bju11294-sec-1001" sec-type="section"> <title>Objective</title> <p> <list id="bju11294-list-0001" list-type="bullet"> <list-item> <p>To evaluate differences in cancer detection rates between a trained non‐physician provider (NPP) and an experienced urologist performing transrectal ultrasound‐guided prostatic biopsies (TRUSP) at a single UK institution.</p> </list-item> </list> </p> </sec> <sec id="bju11294-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju11294-list-0002" list-type="bullet"> <list-item> <p>We retrospectively analysed a prospectively accrued database of patients (<italic>n</italic> = 440) referred for investigation of an abnormal digital rectal examination and/or a raised age‐specific prostate‐specific antigen (PSA) value undergoing first‐time outpatient prostatic biopsies who were sequentially allocated to either an NPP or a physician‐led TRUSP clinic.</p> </list-item> <list-item> <p>Differences in overall and risk‐stratified prostate cancer detection rates were evaluated according to TRUSP operator.</p> </list-item> <list-item> <p>Continuous variables were analysed using Mann–Whitney <italic>U</italic> test whereas categorical variables were analysed using Pearson's chi‐squared test. A multivariate binary logistic regression model was fitted for predictors of a positive biopsy.</p> </list-item> </list> </p> </sec> <sec id="bju11294-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju11294-list-0003" list-type="bullet"> <list-item> <p>In all, 57.3% (126/220) of patients who underwent physician‐led TRUSP were diagnosed with prostate cancer compared with 52.7% (116/220) in the NPP‐led clinic (<italic>P</italic> = 0.338).</p> </list-item> <list-item> <p>Sub‐group analysis revealed a lower cancer detection rate in men presenting with a low PSA level (<9.9 ng/mL) during the first 50 independent TRUSP procedures performed by the NPP (<italic>P</italic> = 0.014). This initial difference was lost with increasing case volume, suggesting the presence of a learning curve.</p> </list-item> <list-item> <p>Multivariate logistic regression analysis revealed age (odds ratio (OR) 1.054, 95% confidence interval (95% CI) 1.025–1.084, <italic>P</italic> ≤ 0.001), presenting PSA level (OR 1.05, 95% CI 1.02–1.081, <italic>P</italic> = 0.001), prostatic volume (OR 0.969, 95% CI 0.958–0.981, <italic>P</italic> ≤ 0.001) and clinical stage (OR 1.538, 95% CI 1.046–2.261, <italic>P</italic> = 0.029) to be predictors of a positive prostatic biopsy outcome.</p> </list-item> <list-item> <p>The choice of TRUSP operator was not predictive of a positive prostatic biopsy (OR 0.729, 95% CI 0.464–1.146, <italic>P</italic> = 0.171).</p> </list-item> </list> </p> </sec> <sec id="bju11294-sec-0004" sec-type="section"> <title>Conclusion</title> <p> <list id="bju11294-list-0004" list-type="bullet"> <list-item> <p>An adequately trained NPP is able to perform TRUSP as effectively as an experienced urologist after an initial learning curve of 50 cases.</p> </list-item> </list> </p> </sec> </abstract>