Serial Prostate Biopsies are Associated With an Increased Risk of Erectile Dysfunction in Men With Prostate Cancer on Active Surveillance

Fujita, Kazutoshi; Landis, Patricia; McNeil, Brian K.; Pavlovich, Christian P.

doi:10.1016/j.juro.2009.08.044

Cited by 143 publications

(112 citation statements)

References 22 publications

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“…4 Recently, there have been studies investigating urinary and erectile function after prostate biopsy. 2,3,5 There are few publications on preoperative and postoperative impact of serial prostate biopsies on active surveillance patients who ultimately undergo RARP. 5 This is especially relevant as one-third of men enrolled in AS may eventually require definitive surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Fujita et al 2 retrospectively analyzed 231 active surveillance patients to compare whether there was a correlation between increased number of biopsies and ED. Increased biopsy number was associated with a decrease in Sexual Health Inventory for Men score (P ¼ 0.04) and a history of three or more biopsies was associated with a greater decrease in sexual health inventory for men than after two or fewer biopsies (P ¼ 0.02).…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have suggested that multiple biopsies per se can cause nerve damage and subsequent ED. 2,3 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).…”

Section: Introductionmentioning

confidence: 99%

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The impact of multiple biopsies on outcomes of nerve-sparing robotic-assisted radical prostatectomy

et al. 2012

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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 ¼ 0.88, P ¼ 0.77). Multiple biopsy patients had worse postoperative erectile function at 6 months (57% versus 80%, P ¼ 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of multiple biopsies on outcomes of nerve-sparing robotic-assisted radical prostatectomy

et al. 2012

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“…While a significant number of patients may be found to have prostate cancer on repeat biopsy, 1,2 the potential morbidity of prostate biopsy must be considered. 3 A recent population-based study of Canadian men reported a 30-day hospital admission rate of 4.1% and a mortality rate of 0.9% due to biopsy-related complications. 4 We present an evaluation of PCA3 as a univariable predictor of prostate cancer on repeat biopsy and as a component of a multivariable nomogram.…”

Section: Discussionmentioning

confidence: 99%

“…In all, 10-39% of such patients may ultimately be found to have prostate cancer on repeat biopsy. 1,2 However, prostate biopsy is uncomfortable and can carry significant morbidity, 3,4 and most men who undergo repeat biopsy are ultimately found to be free of prostate cancer. Additionally, the probability of having a positive biopsy decreases with each subsequent biopsy.…”

Section: Introductionmentioning

confidence: 99%

Utility of PCA3 in patients undergoing repeat biopsy for prostate cancer

Reese

Cooperberg

et al. 2011

Prostate Cancer Prostatic Dis

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BACKGROUND: Men with persistently elevated and/or rising PSA levels after negative prostate biopsy often undergo multiple repeat biopsies. Prostate cancer antigen 3 (PCA3) has emerged as a predictor of prostate cancer. METHODS:We sought to define the utility of PCA3 in combination with other clinical data in predicting the risk of prostate cancer on repeat biopsy. We retrospectively obtained PCA3, PSA, PSA density (PSAD), digital rectal examination (DRE) and transrectal ultrasound (TRUS) findings from 103 patients at a single institution who had at least one prior negative prostate biopsy. The sensitivity and specificity of PCA3 in detecting prostate cancer was determined. Receiver operating characteristics curves were produced for each variable individually and in multivariable analysis, controlling for PCA3, PSAD, TRUS, PSA and DRE. A nomogram was created, internally validated and compared to another recently published nomogram. RESULTS:Of the 103 patients, 37 (31%) had prostate cancer on repeat biopsy. The sensitivity and specificity of PCA3 (using a cut point of 25) was 0.67 and 0.64, respectively. In multivariable analyses, PCA3 was independently associated with prostate cancer (odds ratio: 1.02, 95% confidence interval: 1.01-1.04), with area under the curve (AUC) of 0.64. A multivariable model containing PCA3, PSAD, PSA, DRE and TRUS findings showed the most diagnostic accuracy (AUC: 0.82). CONCLUSIONS:In the setting of prior negative biopsies, PCA3 was independently associated with prostate cancer in a multivariable model. In combination with other clinical data, PCA3 is a valuable tool in assessing the risk of prostate cancer on repeat biopsy.

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Sexual dysfunction and prostate cancer therapy

Ridout¹,

Emberton²,

Moore³

2016

Male Sexual Dysfunction

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Serial Prostate Biopsies are Associated With an Increased Risk of Erectile Dysfunction in Men With Prostate Cancer on Active Surveillance

Abstract: Serial prostate biopsies appear to have an adverse effect on erectile function in men with prostate cancer on active surveillance but do not affect lower urinary tract symptoms.

Cited by 143 publications

References 22 publications

The impact of multiple biopsies on outcomes of nerve-sparing robotic-assisted radical prostatectomy

The impact of multiple biopsies on outcomes of nerve-sparing robotic-assisted radical prostatectomy

Utility of PCA3 in patients undergoing repeat biopsy for prostate cancer

Sexual dysfunction and prostate cancer therapy

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