Chiu Peter K, Alberts Arnout R, Venderbos Lionne D F, Bangma Chris H, Roobol Monique J
Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
BJU Int. 2017 Sep;120(3):394-400. doi: 10.1111/bju.13913. Epub 2017 Jun 5.
To investigate biopsy complications and hospital admissions that could be reduced by the use of European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators.
All biopsies performed in the Rotterdam section of the ERSPC between 1993 and 2015 were included. Biopsy complications and hospital admission data were prospectively recorded in questionnaires that were completed 2 weeks after biopsy. The ERSPC risk calculators 3 (RC3) and 4 (RC4) were applied to men attending the first and subsequent rounds of screening, respectively. Applying the predefined RC3/4 probability thresholds for prostate cancer (PCa) risk of ≥12.5% and high-grade PCa risk ≥3%, we assessed the number of complications, admissions and costs that could be reduced by avoiding biopsies in men below these thresholds.
A total of 10 747 biopsies with complete questionnaires were included. For these biopsies a complication rate of 67.9% (7294/10 747), a post-biopsy fever rate of 3.9% (424/10747) and a hospital admission rate of 0.9% (92/10747) were recorded. The fever rate was found to be static over the years, but the hospital admission rate tripled from 0.6% (1993-1996) to 2.1% (2009-2015). Among 7704 biopsies which fit the criteria for RC3 or RC4, 35.8% of biopsies (2757/7704), 37.4% of complications (1972/5268), 39.4% of fever events (128/325) and 42.3% of admissions (30/71) could have been avoided by using one of the risk calculators. More complications could have been avoided if RC4 had been used and for more recent biopsies (2009-2015). Our findings show that 35.9% of the total cost of biopsies and complication treatment could have been avoided.
A significant proportion of biopsy complications, hospital admissions and costs could be reduced if biopsy decisions were based on ERSPC risk calculators instead of PSA only. This effect was most prominent in more recent biopsies and in men with repeated biopsies or screening.
研究使用欧洲前列腺癌筛查随机研究（ERSPC）风险计算器可减少的活检并发症和住院情况。
纳入1993年至2015年在ERSPC鹿特丹分部进行的所有活检。活检并发症和住院数据前瞻性记录在活检后2周完成的问卷中。ERSPC风险计算器3（RC3）和4（RC4）分别应用于参加第一轮和后续轮次筛查的男性。应用前列腺癌（PCa）风险≥12.5%和高级别PCa风险≥3%的预定义RC3/4概率阈值，我们评估了通过避免对低于这些阈值的男性进行活检可减少的并发症、住院次数和费用。
共纳入10747例有完整问卷的活检。这些活检的并发症发生率为67.9%（7294/10747），活检后发热率为3.9%（424/10747），住院率为0.9%（92/10747）。发现发热率多年来保持稳定，但住院率从0.6%（1993 - 1996年）增至2.1%（2009 - 2015年），增加了两倍。在符合RC3或RC4标准的7704例活检中，使用其中一种风险计算器可避免35.8%的活检（2757/7704）、37.4%的并发症（1972/5268）、39.4%的发热事件（128/325）和42.3%的住院（30/71）。如果使用RC4且针对更近的活检（2009 - 2015年），可避免更多并发症。我们的研究结果表明，活检及并发症治疗总成本的35.9%本可避免。
如果活检决策基于ERSPC风险计算器而非仅基于前列腺特异性抗原（PSA），则可减少相当比例的活检并发症、住院次数和费用。这种效果在更近的活检以及接受重复活检或筛查的男性中最为显著。
Zotero 插件