Prostate Biopsies More Accurate At Teaching Hospitals: Study

Men who get a prostate biopsy at a community hospital may be more likely later be re-diagnosed with a higher risk of prostate cancer than if they were biopsied at a teaching hospital, according to the findings of new research that suggests teaching hospital biopsies may be more accurate. 

In a study published in the medical journal Prostate Cancer and Prostatic Diseases, researchers at Princess Margaret Medical Center in Canada examined data on nearly 400 men who received initial biopsies at either a community hospital or academic hospital, and were placed on active surveillance; a “wait and watch” approach to cancer.

Nearly 27% of men who receive their initial diagnosis from a community hospital were reclassified with high-risk cancer diagnoses later, compared to only 14% who received the initial biopsy from an academic medical facility.

Patients placed on active surveillance are typically monitored by doctors, but are not treated right away, because the tumors are small and slow growing. The men were diagnosed with low-risk prostate cancer. Each then received another biopsy from the academic research hospital, Princess Margaret.

Academic medical centers are hospitals affiliated with a medical school, where medical students receive their practical training.

Often, certain procedures not routinely done in other hospitals will be conducted more frequently at a teaching hospital, potentially offering a higher level of care. However, some studies have suggested that teaching hospital patients have higher rates of infection and face a higher risk of a medical mistake that causes harm.

Nearly 20% of men biopsied at a community hospital were given a cancer misdiagnosis and had to later be upgraded from low-risk to aggressive tumor growth on the second biopsy, meaning at least half of the tissue sampled was malignant. This is compared to seven percent of men who received their first biopsy at a medical research center.

Study authors say tumors biopsied at a non-academic facility are three to four times more likely to be upgraded in grade or volume. The grade of a cancer tumor indicates how quickly it is growing and the volume is the percentage of the prostate taken by the tumor.

When reclassified men typically need to treat the cancer, as opposed to active surveillance.

Some men first treated at a community hospital often wait six months or longer to receive a second follow-up biopsy when placed under active surveillance, potentially leading to a high-risk reclassification because of the delay.

A rectal ultrasound was used to determine if the tissues to be removed were abnormal. Critics say the use of ultrasound guided biopsy is a flaw of the study, since it is much less accurate than targeted biopsies guided by MRI images, which is typically used at academic medical centers.

More than 200,000 men are diagnosed with prostate cancer every year. More than 30,000 of those men will die because of that diagnosis. While prostate cancer is highly treatable, a misdiagnosis or ignoring a potentially high-risk diagnosis can be fatal.

Overall, researchers say the results of the study are very accurate and point to the importance of getting a specialist at a medical research hospital to do the first biopsy, or immediately seeking their opinion if receiving an abnormal test from a community hospital, instead of opting for active surveillance.