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**5** 

Tine Hajdinjak *Center UROL Maribor* 

*Slovenia* 

**Future of Prostate Biopsy:** 

**Who Will Get It and How?** 

*Medical Faculty, University of Maribor* 

*Department of Surgery, General Hospital Murska Sobota* 

Prostate biopsy is a motor, driving force and entrance ticket for dealing with parade discipline in urology of recent years – prostate cancer. Therefore it receives a lot of attention and standard techniques are constantly challenged by new developments. Enormous amount of literature seem to have addressed all possible aspects regarding prostate biopsy. This chapter focuses less on historical overview but mainly on recent developments,

Prostate cancer has already become leading cancer among males in developed world (Jemal et al., 2011), second reason for death due to cancer among men in US (Jemal et al., 2010) and third in Europe (Malvezzi et al., 2011). Future is looking even more serious – numbers are expected to rise much further, as recently predicted in Canadian forecast analysis (Quon et al, 2011). The authors claim expected estimates of increase in prostate cancer cases should not be limited only to aging of population, which is huge itself and is expected to cause 39% increase in prostate cancer cases. At least three further factors should be taken into account. First and most important is lowering of PSA threshold for biopsy. It seems the move of decreasing PSA cutoff from 4 to 2.5 is getting from university centers to every urologist's and generalist's office (this is especially important as they are the ones who pick and refer patients to urologists for biopsy). Increase in number of people, referred to biopsy for this reason is estimated to be much greater compared to aging of population and may increase prostate cancer incidence by 200%. If it will increase prostate cancer incidence by 200%, increase in number of biopsies should be disproportionally higher, as biopsies have lower yield for this new target population with PSA values between 2.5 and 4. PSA screening is creating at present a lot of debate, it is a very hot topic and there are very strong opponents and supporters. Introduction of formal screening would of course increase burden of cancer and burden of biopsy. It is at present unlikely to happen, probably because people who decide on health policies and their advisers do not meet, treat and care for people with advanced prostate cancer. But, call it case finding or however one prefers, a "non-formal" screening programs are actually already available in many health systems, not only in selected first adopters, like Tyrol in Austria (Oberaigner et al., 2006), but also for example in Slovenia, where every general practitioner has available extra funds for PSA measurement on all of his male patients, every two years. Extent of "nonformal" screening programs can be seen from well-known PLCO trial, where control,

**1. Introduction** 

controversies and questions.

