Reply from Authors re: Alexandre R. Zlotta, Robert K. Nam. to biopsy or not to biopsy - Thou shall think twice. Eur Urol 2012;61:1115-7: Considerations for prostate biopsy decisions

Our group recently reported an increasing frequency of hospitalizations after prostate biopsy consistent with numerous international studies. This subject has important public health implications because prostate biopsies continue to be performed commonly. In 2008, approximately 370 733 new prostate cancer (PCa) cases were diagnosed in Europe. Estimating a PCa detection rate of approximately 30% on biopsy, this would suggest that >1 million prostate biopsies were performed in Europe that year. Among US Surveillance Epidemiology and End Results–Medicare participants from 1993 to 2001, Welch and colleagues showed that 10%, 14%, and 18% of men undergoing first, second, and third biopsy, respectively, had a repeat biopsy within 1 yr.
Because prostate biopsy is necessary as part of the diagnostic workup for abnormal screening tests, the frequency of unnecessary biopsies and complications from biopsy are germane to the screening debate. As discussed by Zlotta and Nam, PCa overdiagnosis is also a potential downstream consequence of PCa screening. However, [...]