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*173. Comprehensive Examination of Serial Prostate Biopsy Studies and Proprietary Technical Advances 1994-1999

Eugene Allan Brewer MD, Urologist, VAMC Big Spring TX; Katie Lara RN, Head Nurse, VAMC Big Spring TX

Objectives: We review our experience using traditional and modified prostate biopsy techniques over the past five years and identify a number of clinical, laboratory, and technical factors that are responsible for a dramatic increase in the number of prostate malignancies diagnosed at our facility.

Methods: By using a combination of serial digital rectal examination and serum prostate specific antigen testing, we identify a cohort of patients whose prostate cancer may remain undiagnosed to progress to higher stages of disease. We compare our results of serial prostate needle biopsy using both traditional and modified techniques of prostate needle biopsy under ultrasound control to the nationally published rates of diagnostic yield for each of these procedures. We identify proprietary techniques developed in our facility to increase the productivity of prostate needle biopsy as a diagnostic modality and prostate cancer screening as a preventive measure.

Results: Over a five year period beginning in 1994, we have increased by over five hundred percent the number of T2 and T3 localized prostate cancers diagnosed at our facility; we have increased by five-fold the number of T1a PSA-only cancers diagnosed at our facility; and have reduced by half the percentage of advanced and incurable metastatic prostatic malignancies at the time of initial diagnosis reported at our facility.

Conclusions: We examine the changing face of prostate cancer with regard to earlier diagnosis and stage within the context of the serial biopsy studies we have conducted, with suggestions on how to further increase the diagnostic accuracy of PSA testing, clinical examination, and biopsy technique using emerging technology and biogenetic labeling.

Impact: Prostate cancer is the number one cancer in men in this country; nearly two hundred thousand men, and the women who care about them, will be impacted by this disease in this year 2000 and nearly fifty thousand men will die of a disease that when found early can be cured.

Prostate cancer is a high index disease among the veteran population; we will demonstrate by example how it can be successfully diagnosed earlier, and its severity lessened, in any VA hospital in America.