Prostate Biopsy Practices in Ontario: Results of a Provincial Survey Assessing Self-reported Practices in Ontario
CUA Online Library. L. Chin J. 06/24/13; 31226; MP-01.07
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Abstract
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Introduction & Objective: Prostate biopsy (Bx) is one of the most commonly performed urologic diagnostic procedures, due in part to ubiquitous use of prostate specific Antigen (PSA) testing, and evolving practices such as active surveillance and focal therapy. Cancer Care Ontario (CCO) Surgical Oncology Program is a provincial (population 13.5M) initiative in improving quality of cancer surgical care via practice guideline development and community of practice engagement. With standardization and quality improvement as the objective, a population-based survey to assess current BX practices in Ontario was undertaken. One specific goal was identification of inappropriate or egregious practices, in view of Bx-related morbidities.
Methods: An 18-question survey was developed by a provincially appointed multidisciplinary working group of clinical leaders (2 urologists (URO), 2 pathologists (PATH), 1 radiologist (RAD)), covering the entire spectrum of Bx practice (referral patterns, Bx performance, specimen submission & processing, path. reporting). The survey was sent to Ontario UROs and RADs who perform Bx. from a provincial directory.
Results: General Practice : Response rate was 62%. 93% of prostate biopsies were ordered by urologists or radiation oncologists, 7% by primary care physicians. Among URO at academic centers, only 21% performed their own bx, while 62% of community URO did their own. More of those in practice >15 years perform their own Bx (58% vs 35%) compared to recent graduates. Bx training was through Residency, Mentorship, Fellowship and courses. Most frequently cited reasons for Bx included positive DRE, PSA qualifiers, family history (hx),suspicious ultrasound (TRUS), and Ca P risk tables.
Bx Techniques: 76% Bx were performed in a hospital radiology facility. URO on average performed more Bx per month than RAD (14 vs.8). 92% of URO used transrectal ultrasound (TRUS)guidance as the main technique. Direct digital guidance was used by 4 URO in >80% of their patients. All 4 have been in practice > 15 yrs. URO routinely take 12-core bx in 58% of cases while RAD only 26%.
Specimen Submission : 56% (URO + RAD) submitted individual tissue cores separately, 33% combined samples from each of the general sextant sites, 5% in right and left lobes and 10 URO (2%) routinely submitted all cores in a single container. Clinical information provided to PATH varied widely, including clinical hx, prior Bx results, and less commonly, surveillance protocol participation, family hx, and prior endocrine therapy.
Pathology Reporting: See Table 1 Some key relevant pathological features were not mentioned 100% of the time.
Conclusion:
Although most URO and RAD in the province conform to practice standards, some substandard practices were identified, possibly due to deficiency in training and/or access to resources, providing opportunities for remediation. The survey results are being used to develop a provincial prostate Bx Practice Guideline on parameters including bx indications, techniques, specimen submission, provision of relevant information to BX performers and to pathologists. This model of knowledge transfer via communities of practice engagement and practice guideline development should result in overall improvement of prostate cancer care in the province.
Methods: An 18-question survey was developed by a provincially appointed multidisciplinary working group of clinical leaders (2 urologists (URO), 2 pathologists (PATH), 1 radiologist (RAD)), covering the entire spectrum of Bx practice (referral patterns, Bx performance, specimen submission & processing, path. reporting). The survey was sent to Ontario UROs and RADs who perform Bx. from a provincial directory.
Results: General Practice : Response rate was 62%. 93% of prostate biopsies were ordered by urologists or radiation oncologists, 7% by primary care physicians. Among URO at academic centers, only 21% performed their own bx, while 62% of community URO did their own. More of those in practice >15 years perform their own Bx (58% vs 35%) compared to recent graduates. Bx training was through Residency, Mentorship, Fellowship and courses. Most frequently cited reasons for Bx included positive DRE, PSA qualifiers, family history (hx),suspicious ultrasound (TRUS), and Ca P risk tables.
Bx Techniques: 76% Bx were performed in a hospital radiology facility. URO on average performed more Bx per month than RAD (14 vs.8). 92% of URO used transrectal ultrasound (TRUS)guidance as the main technique. Direct digital guidance was used by 4 URO in >80% of their patients. All 4 have been in practice > 15 yrs. URO routinely take 12-core bx in 58% of cases while RAD only 26%.
Specimen Submission : 56% (URO + RAD) submitted individual tissue cores separately, 33% combined samples from each of the general sextant sites, 5% in right and left lobes and 10 URO (2%) routinely submitted all cores in a single container. Clinical information provided to PATH varied widely, including clinical hx, prior Bx results, and less commonly, surveillance protocol participation, family hx, and prior endocrine therapy.
Pathology Reporting: See Table 1 Some key relevant pathological features were not mentioned 100% of the time.
Conclusion:
Although most URO and RAD in the province conform to practice standards, some substandard practices were identified, possibly due to deficiency in training and/or access to resources, providing opportunities for remediation. The survey results are being used to develop a provincial prostate Bx Practice Guideline on parameters including bx indications, techniques, specimen submission, provision of relevant information to BX performers and to pathologists. This model of knowledge transfer via communities of practice engagement and practice guideline development should result in overall improvement of prostate cancer care in the province.
Introduction & Objective: Prostate biopsy (Bx) is one of the most commonly performed urologic diagnostic procedures, due in part to ubiquitous use of prostate specific Antigen (PSA) testing, and evolving practices such as active surveillance and focal therapy. Cancer Care Ontario (CCO) Surgical Oncology Program is a provincial (population 13.5M) initiative in improving quality of cancer surgical care via practice guideline development and community of practice engagement. With standardization and quality improvement as the objective, a population-based survey to assess current BX practices in Ontario was undertaken. One specific goal was identification of inappropriate or egregious practices, in view of Bx-related morbidities.
Methods: An 18-question survey was developed by a provincially appointed multidisciplinary working group of clinical leaders (2 urologists (URO), 2 pathologists (PATH), 1 radiologist (RAD)), covering the entire spectrum of Bx practice (referral patterns, Bx performance, specimen submission & processing, path. reporting). The survey was sent to Ontario UROs and RADs who perform Bx. from a provincial directory.
Results: General Practice : Response rate was 62%. 93% of prostate biopsies were ordered by urologists or radiation oncologists, 7% by primary care physicians. Among URO at academic centers, only 21% performed their own bx, while 62% of community URO did their own. More of those in practice >15 years perform their own Bx (58% vs 35%) compared to recent graduates. Bx training was through Residency, Mentorship, Fellowship and courses. Most frequently cited reasons for Bx included positive DRE, PSA qualifiers, family history (hx),suspicious ultrasound (TRUS), and Ca P risk tables.
Bx Techniques: 76% Bx were performed in a hospital radiology facility. URO on average performed more Bx per month than RAD (14 vs.8). 92% of URO used transrectal ultrasound (TRUS)guidance as the main technique. Direct digital guidance was used by 4 URO in >80% of their patients. All 4 have been in practice > 15 yrs. URO routinely take 12-core bx in 58% of cases while RAD only 26%.
Specimen Submission : 56% (URO + RAD) submitted individual tissue cores separately, 33% combined samples from each of the general sextant sites, 5% in right and left lobes and 10 URO (2%) routinely submitted all cores in a single container. Clinical information provided to PATH varied widely, including clinical hx, prior Bx results, and less commonly, surveillance protocol participation, family hx, and prior endocrine therapy.
Pathology Reporting: See Table 1 Some key relevant pathological features were not mentioned 100% of the time.
Conclusion:
Although most URO and RAD in the province conform to practice standards, some substandard practices were identified, possibly due to deficiency in training and/or access to resources, providing opportunities for remediation. The survey results are being used to develop a provincial prostate Bx Practice Guideline on parameters including bx indications, techniques, specimen submission, provision of relevant information to BX performers and to pathologists. This model of knowledge transfer via communities of practice engagement and practice guideline development should result in overall improvement of prostate cancer care in the province.
Methods: An 18-question survey was developed by a provincially appointed multidisciplinary working group of clinical leaders (2 urologists (URO), 2 pathologists (PATH), 1 radiologist (RAD)), covering the entire spectrum of Bx practice (referral patterns, Bx performance, specimen submission & processing, path. reporting). The survey was sent to Ontario UROs and RADs who perform Bx. from a provincial directory.
Results: General Practice : Response rate was 62%. 93% of prostate biopsies were ordered by urologists or radiation oncologists, 7% by primary care physicians. Among URO at academic centers, only 21% performed their own bx, while 62% of community URO did their own. More of those in practice >15 years perform their own Bx (58% vs 35%) compared to recent graduates. Bx training was through Residency, Mentorship, Fellowship and courses. Most frequently cited reasons for Bx included positive DRE, PSA qualifiers, family history (hx),suspicious ultrasound (TRUS), and Ca P risk tables.
Bx Techniques: 76% Bx were performed in a hospital radiology facility. URO on average performed more Bx per month than RAD (14 vs.8). 92% of URO used transrectal ultrasound (TRUS)guidance as the main technique. Direct digital guidance was used by 4 URO in >80% of their patients. All 4 have been in practice > 15 yrs. URO routinely take 12-core bx in 58% of cases while RAD only 26%.
Specimen Submission : 56% (URO + RAD) submitted individual tissue cores separately, 33% combined samples from each of the general sextant sites, 5% in right and left lobes and 10 URO (2%) routinely submitted all cores in a single container. Clinical information provided to PATH varied widely, including clinical hx, prior Bx results, and less commonly, surveillance protocol participation, family hx, and prior endocrine therapy.
Pathology Reporting: See Table 1 Some key relevant pathological features were not mentioned 100% of the time.
Conclusion:
Although most URO and RAD in the province conform to practice standards, some substandard practices were identified, possibly due to deficiency in training and/or access to resources, providing opportunities for remediation. The survey results are being used to develop a provincial prostate Bx Practice Guideline on parameters including bx indications, techniques, specimen submission, provision of relevant information to BX performers and to pathologists. This model of knowledge transfer via communities of practice engagement and practice guideline development should result in overall improvement of prostate cancer care in the province.
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