Diagnoses rendered on prostate needle biopsy in community hospitals

BACKGROUND. Reported incidences of various diagnoses made on needle biopsy of the prostate vary significantly in the literature, most of which has originated from large, academic medical centers. METHODS. We recorded all the prostate needle biopsy results from three community hospitals for 1990-1993 to determine the rates of, and trends in, various diagnoses in these practices. RESULTS. Hospital H1 (1,192 case) halved the rate of atypical, nondefinitive diagnoses from 11.8% in 1990 to 5.7% in 1993 (P < 0.001). The rate at H2 (2,792 cases) remained essentially unchanged at 5.95 ± 0.55%, and H3 (1,306 cases) went from 2.3% to 6.0% (0.1 < P < 0.2). In the setting of an atypical, nondefinitive diagnosis, H1 and H2 recommended repeat biopsy less than 7% of the time. H3 made this recommendation in an average of 22.1% of atypical cases. Annual rates of high-grade prostatic intraepithelial neoplasia (PIN) showed no trend over time, and averaged 2.0% (1.2-3.25%) at H1 and 1.2% (0.3-2.0%) at H2. The diagnosis was never made at H3. The fraction of cancers diagnosed as low- grade (Gleason sum <4) showed a statistically significant decreasing trend over time at all three hospitals (P < 0.05). These data are compared with those from the Johns Hopkins Hospital (JHH), a large academic center in geographic proximity to hospitals H1-H3. CONCLUSIONS. At these three community hospitals, we discerned (1) convergence to a rate of approximately 6.0% of atypical, nondefinitive diagnoses; and (2) a progressively more appropriate fraction of carcinomas diagnosed as low-grade on needle biopsy. The rates of diagnosis of high-grade PIN and recommendation of repeat biopsy varied. These rates of PIN, atypical, nondefinitive diagnoses, and low-grade cancer represent an assessment of diagnostic habits.