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Sources of Funding: Emory Urology Research Scholars Grant; Winship Cancer Institute Prostate Cancer Pilot Grant

Introduction

Since the United States Preventative Services Task Force (USPSTF) recommendations against routine prostatic specific antigen (PSA) screening in 2012, PSA testing has declined significantly. We hypothesized that prostate biopsy incidence would mimic this pattern. We characterized trends from 2012-2014, and described factors associated with geographic variation in biopsy use.

Methods

Using Medicare Provider Utilization and Payment data (2012-2014), we captured reimbursements for prostate biopsies (i.e., CPT 55700) performed by physicians performing ≥10 annual biopsies. We calculated annual incidence (i.e., number of biopsies per 1,000 eligible men) across 306 hospital referral regions (HRR). HRR-level factors of interest included % men ≥75 years of age with PSA screening in 2012, % African-Americans, provider density, average hierarchical condition category (HCC) index (for Medicare risk adjustment), and number of male beneficiaries. Multivariable regression adjusted for factors associated with annual incidence of prostate biopsy, and predicted prostate biopsy incidence ratios were generated across all HRRs.

Results

Overall, we identified 359,698 biopsies performed by physicians, and the annual incidence ratio decreased from 10.95 biopsies/1,000 men in 2012 to 8.74 biopsies/1,000 men in 2014 (p<0.001). In 2014, the strongest associations with incidence of prostate biopsy were seen with % PSA screening (β=+2.25 per 10% screened, p<0.001) and biopsy provider density (β=+2.00 per provider per 1,000 men, p<0.001). There was also a significant associations seen with % African-American population (β=+0.47 per 10% increase, p=0.017) and inverse association with average HCC score (β=-0.07 per 0.01 increase, p=0.006). At the HRR-level in 2014, we noted nearly 40-fold variation across 306 HRRs, from predicted 0.75 to 19.51 biopsies per 1,000 eligible men (Figure, p<0.001)_x000D_

Conclusions

The incidence of prostate biopsies has decreased in parallel to drops in PSA screening and prostate cancer incidence after 2012. PSA screening and provider density were strongly associated with prostate biopsy incidence, and unmeasured patient and provider-level factors are likely driving considerable geographic variation in the use of prostate biopsy.

Funding

Emory Urology Research Scholars Grant; Winship Cancer Institute Prostate Cancer Pilot Grant