Current practices of prostate biopsy in Australia and New Zealand – The survey

IntroductionThe information obtained from a prostate biopsy is arguably the most important for clinical decision-making in prostate cancer.

The field of prostate biopsy is rapidly changing and given questions remain on the optimal method of prostate biopsy, a wide variation in practice is thought to exist.

Conclusions A significant limitation of the study is the poor response rate,

rendering the study inadequate to formulate generalisations

There were however some clear trends in the practice of prostate biopsy in our region, but also marked variation.

There was significant use of MRI, especially by urologists performing TPT biopsy.

Frequent prophylactic use of carbapenems highlights the concern about sepsis with quinolone-resistant bacteria.

Despite LA infiltration being acknowledged in the literature as the current gold standard of analgesia for TRUS biopsy [1], the majority of biopsies were performed under IV sedation or GA. This raises questions as to why a minority use LA infiltration.

The more recent approach of transperineal template biopsy was used commonly, with nearly a quarter of respondents choosing this approach if they were to undergo a biopsy themselves.

ResultsOf the 644 USANZ members that the survey was distributed to,150 completed surveys were received (23.3% response rate).

General demographics were:

84.5% consultants

70.9% age <50yo

85.1% male

68% working in metropolitan settings

92.5% of responders were performing TRUS biopsy themselves (85.7% up to 20 TRUS biopsy/month)

Key findings:

19.6% have ordered MRI of prostate prior to an initial biopsy and 10.2% routinely used MRI pre repeat biopsy

98.6% use prophylactic antibiotics (ciprofloxacin 41.7% and norfloxacin 39.9% most commonly)

30.6% have used IV carbapenems and 27.7% routinely use them if the patient has travelled to Asia or used quinolones within 6 months of biopsy date

55.4% use IV sedation/GA for analgesia

38.4% perform transperineal template (TPT) biopsy

Comparative findings:

Carbapenem use is more common in metropolitan areas vs. regional areas (40.2% vs. 8.7%; P<0.001)

More IV sedation/GA usage in metropolitan areas vs. regional areas (79% vs. 59.6%; P=0.01)

Similar use of IV sedation/GA amongst consultants and trainees, but trainees use less peri-prostatic LA infiltration (35.2% vs. 63.6%; P=0.01)

General pathologists used more commonly in regional areas (38.3% vs. 21.2%; P=0.03)

Consultants use specialist uro-pathologists more commonly than trainees (77.3% vs. 17.7%; P<0.001)

Trainees trending towards preferring TPT biopsy if personally needed a biopsy, 36.4% would prefer TPT vs. 18.4% of consultants, while fewer would want TRUS 63.6% vs. 81.6% of consultants

MethodsA 31-question multiple-choice survey was constructed using a web-based provider, freeonlinesurveys.com.

Permission was obtained by USANZ to insert a link to the online survey on the weekly USANZ e-newsletter. The survey link was also advertised in posts on the USANZ e-forum, Netwit.

Overall results were collated automatically by the survey website’s software.

Data for various parameters was then gathered and compared using Chi-Square Test for equal proportions or Fisher's exact test where the numbers were small.

A two-sided p value less than 0.05 was considered statistically significant.

AimThis study aims to provide a snapshot of current practices regarding prostate biopsy in our region.

References1. Autorino R, De Sio M, Di Lorenzo G, et al. How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature. J Urol 174: 2091-7, 2005.

Paul Davis¹, Eldho Paul², Jeremy Grummet¹1. Department of Urology, The Alfred Hospital, Melbourne, Australia2. Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia

No. 167

Posters Proudly Supported by:

TRUS biopsy

TPT biopsy

Figure 1 – Biopsy Technique that Urologists would choose if personally

needed Prostate Biopsy

Periprostatic LA infiltration

IV Sedation

Intrarectal LA gel

Regional Nerve Block

Oral Analgesia

0 10 20 30 40 50 60 70 80

Figure 2 – Type of Analgesia that Urologists

would choose if personally needed Prostate Biopsy –

percentage measurement