Number of pre-op prostate biopsies not linked to outcomes

Number of preoperative biopsies does not appear to have any clinically significant effect on self-reported urinary or erectile function outcomes at 1 year after radical prostatectomy, researchers say.

New York-Number of preoperative biopsies does not appear to have any clinically significant effect on self-reported urinary or erectile function outcomes at 1 year after radical prostatectomy (RP), researchers say.

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Their study, which was presented at the 2015 AUA annual meeting in New Orleans and published online in BJU International (June 26, 2015), included men who underwent open or minimally invasive RP for prostate cancer at Memorial Sloan Kettering Cancer Center, New York between 2008 and 2011 and who were potent and continent preoperatively. It identified 2,082 patients, of whom 1,668 (80%) had one biopsy prior to RP, 324 (16%) had two biopsies, and 90 (4%) had three or more biopsies.

As assessed by responses to a web-based survey, about one-third of 1,249 men with data on erectile function achieved satisfactory recovery at 12 months postoperatively, defined as an International Index of Erectile Function score ≥22. Among 1,813 men with data on urinary function, about two-thirds achieved satisfactory recovery at both 6 and 12 months, defined as a urinary domain score ≥17.

Dr. AndersonMultivariable logistic regression analyses found that when compared to men who had a single biopsy, men who had two biopsies or three or more biopsies were equally likely to have satisfactory erectile function at 12 months and satisfactory urinary function at both 6 and 12 months, reported first author Christopher B. Anderson, MD, who conducted the study as a urologic oncology fellow at Memorial Sloan Kettering.

“Men whose prostate cancer progresses while on active surveillance will have undergone multiple prostate biopsies prior to radical prostatectomy. The findings of our study, however, did not confirm our hypothesis that more preoperative biopsies would be associated with worse postoperative urinary and erectile function,” Dr. Anderson said.

“Currently, therefore, we can tell patients we don’t have a reason to be concerned that undergoing follow-up biopsies during active surveillance will affect their functional outcomes if they do require radical prostatectomy.”

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Most study patients not on surveillance

However, Dr. Anderson acknowledged the study has limitations.

“Most of the men in our study were not on active surveillance, and only a small number had three or more biopsies,” he said.

“More research is needed to determine if having three or more biopsies will impact functional outcomes, and we plan to look at this question again after we have collected more data.”

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Using the available data, a sensitivity analysis was also performed to determine whether the number of biopsies was associated with any change in erectile or urinary domain score when the scores were modeled as continuous variables. Its results showed that men who had two biopsies had significantly lower urinary function scores at 6 and 12 months compared with men who had only a single biopsy prior to RP.

“We suspect, however, that the differences in scores are unlikely to be clinically meaningful,” said Dr. Anderson, who is currently assistant professor of urology at Columbia University Medical Center, New York.

In addition, pre-specified subgroup analyses were performed that excluded high-risk patients (13% of the cohort) and biopsies performed more than 3 years before RP. The results of those analyses were similar to the findings of the primary analysis.

The hypothesis that more preoperative biopsies could have a negative effect on functional outcomes after RP was explored because of the anecdotal observation that surgery could be more difficult in men who had multiple biopsies.

“We postulated that trauma from biopsy could incite an inflammatory reaction and even infection. These events could lead to fibrosis and injury to the periprostatic vasculature and nerves that could make nerve-sparing more difficult,” Dr. Anderson told Urology Times.

The model covariates were age, smoking status, cardiovascular disease, preoperative PSA, clinical tumor stage, and biopsy Gleason sum.