Abstract: PD43-09
Sources of Funding: None

Introduction

The cornerstone of prostate cancer diagnosis remains the transrectal ultrasound guided biopsy (TRUS), which most frequently occurs in the office setting under local anesthesia. However there are now at least 4 other techniques of prostate biopsy aimed at improving outcomes such as patient comfort, significant cancer detection, and infectious complications: TRUS under IV sedation, TRUS with MRI/fusion, transperineal template (TP), and in-bore MRI. In this study, we explored the cost implications of these modalities with TRUS as the standard. The long-term purpose is to determine how to maximize results and cost-savings.

Methods

Basic costs of 4 prostate biopsy modalities such as standard biopsy under local anesthesia, standard biopsy under sedation anesthesia, transperineal and MRI-fusion biopsies performed at MD Anderson Cancer Center were investigated. From September 2010 to December 2015, data of 25-30 patients for each group were analyzed retrospectively. Costs were categorized as pre-procedure, anesthesia pharmacy and recovery, urology and pathology including both technical and professional costs. MR and complication costs were not included in the analysis.

Results

Compared to standard prostate biopsy performed under local anesthesia, the cost of standard biopsy under sedation, transperineal and MRI-fusion biopsy increased significantly x1.8 (78%), x2.7 (173%) and x2.6 (159%) times, respectively (p < 0.001). Cost analysis results and details are shown in table 1. Although transperineal and MRI-fusion biopsy total charge seem close to each other transperineal cost is significantly higher than MRI-fusion biopsy (p= 0.004).

Conclusions

Compared to the TRUS standard, the addition of imaging, anesthesia, TP increase costs significantly, but have known benefits in sensitivity and reduced sepsis. Therefore, future techniques should aim to combined these methods into a platform feasible for outpatient/local anesthesia.

Funding

None