Undergoing repeat biopsies during active surveillance (AS) for prostate cancer does not result in higher rates of erectile dysfunction (ED) or urinary incontinence within 1, 2, and 3 years after radical prostatectomy, a new study found.
Biopsies can cause local inflammation, prostatitis, edema, and hematoma that, in theory, might worsen functionality after radical prostatectomy (RP). Clemens M. Rosenbaum, MD, and colleagues from University Hospital Hamburg-Appendorf in Germany, studied ED and urinary incontinence (UI) rates for a cohort of 11,140 AS patients from their institution who had 1 or more biopsies prior to surgery. Previous studies have examined functional outcomes within just 1 year of RP, so the team expanded the timeframe to within 3 years. During AS, the vast majority (87.9%) had 1 biopsy, 8.4% had 2, and 3.6% had 3 or more. Most patients (81.8%) had open retropubic RP and 18.2% had robotic-assisted laparoscopic RP (RALP) during 2007 to 2015. Men with 3 or more biopsies tended to be older (age 67 vs 65 years), undergo RALP, and have bilateral nerve sparing.
Results published in Urologic Oncology showed that 45.9%, 57.9%, and 60.9% of patients achieved potency at 1, 2, and 3 years after RP, respectively. Adjusted univariate and multivariate logistic regression analyses found no greater influence of repeat biopsy on ED rates at 1, 2, and 3 years compared with a single biopsy. UI rates followed the same trend: By 1, 2, and 3 years after RP, 87.9%, 90.9%, and 91.6% of all patients, respectively, had achieved continence, regardless of their number of biopsies.
“The growing acceptance of AS has led to a relevant number of patients who will require RP after multiple [biopsy]. Those patients can be counseled that repeat [biopsies] do not seem to result in worse functional outcomes,” Dr Rosenbaum and colleagues stated. “Our data support the use of repeat [biopsy] in follow-up protocols in AS patients.”
Previous studies had yielded inconsistent results on the number of biopsies and ED risk, so the current study offers some assurance. The findings also confirm previous research showing no effect of repeat biopsies on UI rates.
Rosenbaum CM, Mandel P, Tennstedt P, et al. Effect of repeat prostate biopsies on functional outcomes after radical prostatectomy. Urol Oncol. doi: 10.1016/j.urolonc.2017.11.016