Prostate cancer detection and complication rates with transrectal ultrasound-guided prostate biopsies among different operators

Objective: To evaluate interoperator differences in cancer detection and complication rates using transrectal ultrasound (TRUS)-guided prostate biopsies. We also analyzed whether there was a correlation between the experience of the operator and the cancer detection rate. Materials and methods: Medical records of 1879 patients who underwent a TRUS-guided prostate biopsy between 2005 and 2009 were retrospectively reviewed. Among them, 1496 patients who underwent a first biopsy without previous prostate surgery were selected for the analysis. Five urology residents performed 327, 351, 218, 332, and 268 biopsies, respectively. Cancer detection rates were analyzed by comparing the initial 20 and 100 patients with the final 20 and 100 patients. Patients were subdivided into two groups: prostate-specific antigen (PSA) of approximately 4-10 and >10 ng/mL. Prostate cancer (CaP) detection and complication rates were compared among operators. Results: Cancer was detected in 541 patients (36%). The operators performed a median of 403 (range: approximately 277-436) transrectal sono-guided prostate biopsies with CaP detection rates of approximately 33.9-42.2% (p = 0.243). Among different operators, we found no differences in cancer detection rates for the initial 100 or final 100 patients, even when separating patients into PSA >10 ng/mL and 4 < PSA < 10 ng/mL groups. But significant individual variations in CaP-positive rates (p = 0.046) were observed in the first 20 biopsies for patients with PSA >10 ng/mL receiving a TRUS biopsy; however, variable PSA levels in different groups of patients may have been responsible for this finding. There were no differences in complication rates among the different operators for the initial 20 and final 20 biopsies or for the initial 50 and final 50 biopsies. Conclusion: No clinically significant differences in CaP detection existed among operators performing TRUS-guided prostate biopsies. Complication rates did not differ among the operators. A TRUS-guided prostate biopsy is a rapidly learned technique and is a good diagnostic tool for CaP detection. Copyright (C) 2012, Taiwan Urological Association. Published by Elsevier Taiwan LLC. Open access under CC BY-NC-ND license.