Findings from an international survey of urology trainee experience with prostate biopsy

Abstract

Objective: To assess urology trainees' exposure to transperineal prostate biopsy (TP-Bx) and intent to use TP-Bx in practice.

Subjects and methods: A 34-question survey about prostate biopsy was distributed to urology trainees in the United States and Europe. Primary outcomes were exposure to TP-Bx in training and intent to use TP-Bx post training. Exposure to transrectal prostate biopsy (TR-Bx) and magnetic resonance imaging-targeted biopsy (MRI-Bx) was also assessed. Survey answers were compared between groups as categorical variables using Fisher's exact test. Multivariable logistic regression was used to identify factors associated with intent of performing TP-Bx post training.

Results: A total of 658 trainees from 19 countries completed the survey. Of these, 313 trainees (48%) reported exposure to TP-Bx, 370 (56%) reported exposure to MRI-Bx, and 572 (87%) reported exposure to TR-Bx. There was significant heterogeneity in TP-Bx exposure among countries (P < 0.001), with the highest prevalence in Italy (72%) and the lowest prevalence in Greece (4%). Intent to perform TP-Bx post training was higher in those exposed to TP-Bx during training (89% vs 58%; P < 0.001) and did not differ between trainees in postgraduate year (PGY) 1-3 vs those in PGY ≥4 (73% vs 72%; P = 0.7). On multivariable regression, exposure to TP-Bx in training was independently associated with increased intent to perform TP-Bx post training (odds ratio 5.09, 95% confidence interval 3.29-8.03; P < 0.001).

Conclusions: Fewer than half of 658 surveyed urology trainees reported exposure to TP-Bx, with significant heterogeneity among countries. Greater experience with TP-Bx in training was associated with greater intent to perform TP-Bx post training. A minimum requirement of TP-Bx cases during urological training may increase resident familiarity and adoption of this guideline-endorsed prostate biopsy approach.

Keywords: biopsy; education; prostatic neoplasms; residency; surveys and questionnaires.

Figure 1. Survey results by year of training and country of training

Results of 658 surveyed urology trainees in Europe and the United States regarding biopsy availability at training program (panels A – C), exposure to biopsy in training (panels D – F), comfort using biopsy modality independently (panels G – I), and intent to use modality after training (panels J – L). Respondents were compared by post-graduate year (PGY) and country of training using Fisher’s exact test, with an asterisk indicating p-value <0.05. Only countries with a response rate ≥10% (n = 579) were included in comparisons by country

Figure 2. Independence with Biopsy and Post-Training Goals Stratified by Number of Biopsies Performed.

Results of surveyed urology trainees in Europe and the United States regarding comfort performing transrectal transperineal biopsy independently (panel A) and intent to perform transrectal, MRI-targeted, and transperineal prostate biopsy after training (panel B) stratified by the number of biopsies performed. Fisher’s exact test was used to compare respondents by the number of biopsies performed (in panel B both excluding and including respondents with zero biopsies) with an asterisk indicating p-value <0.05.