Multiple Biopsies and Radical Prostatectomy Outcomes
Multiple Biopsies and Radical Prostatectomy Outcomes
Active surveillance of prostate cancer patients involves subjecting them to multiple prostate biopsies, and we sought to investigate the effects of this on functional outcomes after robotic-assisted radical prostatectomy (RARP). Between May 2009 and December 2009, 367 patients who consecutively underwent RARP by a single surgeon were divided into two groups, one that had single prostate biopsy and another multiple biopsies before RARP. The groups were matched for significant clinicopathologic preoperative variables, and only premorbidly potent low-risk cases that underwent nerve sparing were included. This left 50 and 23 patients for analysis in the single and multiple biopsy groups, respectively. The primary endpoint was potency and continence at 3 and 6 months after surgery. We found continence rates of 84% (83%) and 94% (96%) for single (multiple) biopsy groups at 3 and 6 months, respectively (P=0.88, P=0.77). Multiple biopsy patients had worse postoperative erectile function at 6 months (57% versus 80%, P=0.03). Men subject to multiple preoperative biopsies are more likely to become impotent postoperatively than those who undergo surgery after a single biopsy. This should be borne in mind when counseling men regarding repeat biopsy as part of an active surveillance strategy.
There has been a stage during migration of prostate cancer in recent years, with more and more localized disease being diagnosed. With this, there has been a rise in the proportion of low grade, low stage, low-tumor volume (so-called 'low risk') prostate cancer presenting to urologists. The gold standard of radical prostatectomy may thus be an overtreatment for a number of these patients destined never to suffer as a result of their disease. The problem is that we do not know which 'low-risk' patients will progress and which will not. This dilemma has provided the rationale for active surveillance, a treatment strategy aimed at not causing harm by subjecting the patient to radical treatment, but rather regular monitoring of the patient's disease and intervening with radical therapy as necessary. However, most active surveillance protocols require a prostate biopsy at baseline and at regular intervals, and thus there are concerns of morbidity resulting from multiple biopsies. One of the less well-studied adverse effects of biopsy is its impact on erectile function. Some authors have suggested that multiple biopsies per se can cause nerve damage and subsequent ED. The other, even less investigated event, is the impact of multiple biopsies on the operative ability to perform nerve sparing if such patients end up having surgery in the future. To our knowledge, there have been no studies investigating these effects of multiple biopsies on patients undergoing robotic-assisted radical prostatectomy (RARP). To answer that question, we retrospectively evaluated our cohort of 367 patients who underwent RARP by a single surgeon at our institution over an eight-month period.
Abstract and Introduction
Abstract
Active surveillance of prostate cancer patients involves subjecting them to multiple prostate biopsies, and we sought to investigate the effects of this on functional outcomes after robotic-assisted radical prostatectomy (RARP). Between May 2009 and December 2009, 367 patients who consecutively underwent RARP by a single surgeon were divided into two groups, one that had single prostate biopsy and another multiple biopsies before RARP. The groups were matched for significant clinicopathologic preoperative variables, and only premorbidly potent low-risk cases that underwent nerve sparing were included. This left 50 and 23 patients for analysis in the single and multiple biopsy groups, respectively. The primary endpoint was potency and continence at 3 and 6 months after surgery. We found continence rates of 84% (83%) and 94% (96%) for single (multiple) biopsy groups at 3 and 6 months, respectively (P=0.88, P=0.77). Multiple biopsy patients had worse postoperative erectile function at 6 months (57% versus 80%, P=0.03). Men subject to multiple preoperative biopsies are more likely to become impotent postoperatively than those who undergo surgery after a single biopsy. This should be borne in mind when counseling men regarding repeat biopsy as part of an active surveillance strategy.
Introduction
There has been a stage during migration of prostate cancer in recent years, with more and more localized disease being diagnosed. With this, there has been a rise in the proportion of low grade, low stage, low-tumor volume (so-called 'low risk') prostate cancer presenting to urologists. The gold standard of radical prostatectomy may thus be an overtreatment for a number of these patients destined never to suffer as a result of their disease. The problem is that we do not know which 'low-risk' patients will progress and which will not. This dilemma has provided the rationale for active surveillance, a treatment strategy aimed at not causing harm by subjecting the patient to radical treatment, but rather regular monitoring of the patient's disease and intervening with radical therapy as necessary. However, most active surveillance protocols require a prostate biopsy at baseline and at regular intervals, and thus there are concerns of morbidity resulting from multiple biopsies. One of the less well-studied adverse effects of biopsy is its impact on erectile function. Some authors have suggested that multiple biopsies per se can cause nerve damage and subsequent ED. The other, even less investigated event, is the impact of multiple biopsies on the operative ability to perform nerve sparing if such patients end up having surgery in the future. To our knowledge, there have been no studies investigating these effects of multiple biopsies on patients undergoing robotic-assisted radical prostatectomy (RARP). To answer that question, we retrospectively evaluated our cohort of 367 patients who underwent RARP by a single surgeon at our institution over an eight-month period.
