SAN DIEGO, CA USA (UroToday.com) -
Do multiple prostate biopsies affect post-operative urinary and sexual function in patients undergoing prostatectomy?
Men on active surveillance for prostate cancer (AS) often undergo multiple prostate needle biopsies (PNBx) and some will progress to active treatment upon evidence of disease progression. The authors of this study hypothesized that as the number of PNBx prior to radical prostatectomy (RP) rises, the risks of post-operative erectile dysfunction (ED) and urinary incontinence (UI) increase.
Using U.S. Surveillance, Epidemiology, and End Results (SEER) Medicare-linked data, the authors examined data from 10 743 men without a baseline diagnosis of ED or incontinence who underwent RP for non-metastatic clinical localized low grade prostate cancer between 1995 and 2005. The number of PNBx were categorized as less than or greater than 2. Receipt of ≥ 2 PNBx was associated with 20% higher rates of an ED diagnosis and 10% higher rates of ED-related procedures. Diagnosis of urinary incontinence (18% higher) and incontinence-related procedures (23% higher) were also more likely in patients who underwent ≥ 2 biopsies.
The authors suggest clinicians preoperatively inform patients who receive multiple PNBx for clinically localized prostate cancer, as they may be at risk of higher rates of ED and urinary incontinence following RP. A question was posed as to whether the effects increase with each additional biopsy. The authors noted that it was a “dose dependent” effect.
Clearly, these data must be interpreted with caution given the many challenges that exist in extracting clinically meaningful results from administrative datasets. For instance, a recent study from University of California San Francisco failed to show an associated risk of ED and long-term lower urinary tract dysfunction following prostate biopsies. As such, these data must be first validated before they deter clinicians from offering patients AS, requiring rebiopsy for low risk prostate cancer.
Presented by Florian Roghmann, Vincent QH Trinh, Hugo Lavigueur-Blouin, Andreas Becker, Malek Meskawi, Al'a Abdo, Joachim Noldus, Pierre I Karakiewicz, Quoc-Dien Trinh, and Maxine Sun at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Anthony T. Corcoran, MD
