Effect of repeat prostate biopsies on functional outcomes after radical prostatectomy

PURPOSE: Growing acceptance of active surveillance (AS) results in a relevant number of patients who will undergo radical prostatectomy (RP) after multiple biopsy sessions (Bx) due to cancer progression. The effect of repeat Bx on functional outcomes after RP remains controversial.

METHODS: Overall, 11,140 patients who underwent RP from 2007 to 2015 were analyzed. Number of Bx sessions (1 vs. 2 vs. ≥3) before RP was examined. Association between number of Bx sessions and erectile dysfunction (ED) and urinary incontinence (UI) was assessed by univariable and multivariable logistic regressions.

RESULTS: A total of 9,797 (87.9%) had 1 Bx, 937 (8.4%) had 2 Bx, and 406 (3.6%) had 3 or more Bx. Median age was 65 years (IQR: 59-69). Increasing Bx sessions were associated with advanced age at surgery (1, 2, and ≥3 Bx: 65, 65, and 67 years, P<0.001); 982 (45.9%), 906 (57.9%), and 597 (60.9%) patients achieved potency at 1, 2, and 3 years after RP, respectively. On adjusted analysis repeat Bx compared to initial Bx had no influence on ED at 1, 2, and 3 years. At 1, 2, and 3 years after RP, 6,107 (87.9%), 4,825 (90.9%), and 3,696 (91.6%) patients achieved continence. Number of Bx session had no influence on UI at follow up.

CONCLUSION: Our findings demonstrate that ED and UI rates are comparable among patients undergoing RP after initial and repeat Bx sessions. This is of importance when counseling AS patients. No adverse functional outcomes are expected if AS has to be discontinued and RP as curative option is contemplated.