The impact of serial prostate biopsies on sexual function in men on active surveillance for prostate cancer.
ABSTRACT NCCN Guidelines® recommend annual prostate biopsies for men with low risk prostate cancer on active surveillance. We determined whether erectile function decreases with the number of biopsies experienced.
During a median 3.2-year followup after prostate cancer diagnosis in 2003 to 2010 at our institution 427 men on active surveillance underwent a total of 1,197 biopsies and provided 1,398 erectile function evaluations via the Sexual Health Inventory for Men questionnaire. For analysis we decomposed the 25-point questionnaire responses into a 5-point erectile function score and a 3-level sexual activity status. We used separate models adjusted for patient characteristics to determine whether either outcome varied with biopsy exposure.
At diagnosis the median age was 61 years and median prostate specific antigen was 5.3 ng/ml. Of the cases 70% were clinical stage cT1 and 93% were Gleason score less than 7. Of biopsies followed by evaluations 40% were the first undergone by the patient and 9% were the fifth to ninth. At the first erectile function evaluation 15% of men were inactive, 8% engage in stimulation and 77% engaged in intercourse. Sexual activity level changed in greater than 20% of respondents between evaluations. Adjusted erectile function scores were not associated with biopsy exposure cross-sectionally or longitudinally but they corresponded with the 50th, 63rd and 80th percentiles of erectile function by increasing sexual activity level. Similarly, sexual activity was not associated with biopsy exposure. Separated outcomes were more accurate and informative than Sexual Health Inventory for Men scores.
Our study had high power to detect erectile function-biopsy associations but it estimated that the effects were negligible. We recommend erectile function scores over Sexual Health Inventory for Men scores to avoid biased assessment of erectile function.
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ABSTRACT: PURPOSE: Diagnosis and precise risk stratification of prostate cancer (PC) is essential for individualized treatment decisions. MRI/TRUS fusion has shown encouraging results for detecting clinically significant prostate cancer. Here we critically evaluate MRI-targeted TRUS-guided transperineal fusion biopsy in routine clinical practice. MATERIALS AND METHODS: 347 consecutive patients with suspicion of PC were prospectively included. The median age of patients was 65 years (range 42-84). Mean PSA level was 9.85ng/ml (0.5-104). 49% of men had previous negative TRUS-guided biopsies, 51% underwent primary biopsy. All patients underwent multiparametric (mp)-MRI at 3T and received systematic stereotactic prostate biopsies plus MRI-targeted TRUS-guided biopsies in case of MRI abnormalities. Imaging data and biopsy results were analyzed and a self-designed questionnaire was sent to all men regarding further clinical history and adverse effects of the biopsy. RESULTS: 200 of 347 (58%) biopsy samples showed PC. 73.5% of biopsy proven PC was clinically relevant (NCCN criteria). On mp-MRI, 104 men were reported as highly suspicious for PC and, in these, the tumor detection rate was 82.6% (86/104) with 72% Gleason scores ≥7. Overall, targeted cores detected significantly more cancer than systematic biopsies (30% vs. 8.2%). In patients without cancer-suspicious MRI-lesions, 11.7% (11/94) were diagnosed with intermediate risk disease. Regarding adverse effects, 50.6% of patients (152/300) reported mild hematuria, 26% temporary erectile dysfunction and 2.6% needed short-term catheterization after biopsy. In three patients (1%) non-septic febrile urinary tract infection occurred. CONCLUSIONS: MRI-targeted TRUS-guided transperineal fusion biopsy provides high detection rates of clinically significant tumors. mp-MRI still has some limitations, and therefore systematic biopsies should currently not be omitted. The morbidity of the transperineal saturation approach is reasonable and mainly self-limiting.The Journal of urology 04/2013; 190(4). DOI:10.1016/j.juro.2013.04.043 · 3.75 Impact Factor
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ABSTRACT: Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer screening and treatment. To perform a systematic review of complications from prostate biopsy. A literature search was performed using PubMed and Embase, supplemented with additional references. Articles were reviewed for data on the following complications: hematuria, rectal bleeding, hematospermia, infection, pain, lower urinary tract symptoms (LUTS), urinary retention, erectile dysfunction, and mortality. After biopsy, hematuria and hematospermia are common but typically mild and self-limiting. Severe rectal bleeding is uncommon. Despite antimicrobial prophylaxis, infectious complications are increasing over time and are the most common reason for hospitalization after biopsy. Pain may occur at several stages of prostate biopsy and can be mitigated by anesthetic agents and anxiety-reduction techniques. Up to 25% of men have transient LUTS after biopsy, and <2% have frank urinary retention, with slightly higher rates reported after transperineal template biopsy. Biopsy-related mortality is rare. Preparation for biopsy should include antimicrobial prophylaxis and pain management. Prostate biopsy is frequently associated with minor bleeding and urinary symptoms that usually do not require intervention. Infectious complications can be serious, requiring prompt management and continued work into preventative strategies.European Urology 06/2013; 64(6). DOI:10.1016/j.eururo.2013.05.049 · 12.48 Impact Factor
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ABSTRACT: Active surveillance (AS) is becoming an increasingly common management strategy for low-grade prostate cancer and involves repeated prostate biopsies over time. It has been hypothesized that serial biopsies can lead to reduced erectile function (EF) in patients on AS. We explored this hypothesis in a longitudinally followed cohort. We identified 342 men on AS whose first biopsy occurred between 2000 and 2009. We investigated EF using patient-reported outcomes, namely the six erectile function questions from the International Index of Erectile Function (IIEF-6). We estimated the change in EF over time using locally-weighted scatterplot smoothing. The median age in this cohort was 64 (IQR 58-68) years. Median follow-up on AS was 3.5 years (IQR 2.3-5.0), and the median number of biopsies was 5 (IQR 3-6). Over the first 4 years on AS, EF declined 1.0 points/year (95% confidence interval [CI], 0.2, 1.7) on the IIEF-6 (scale 1-30). When stratified by comorbidities or number of biopsies, we see an almost identical drop in EF over time. The use of Phosphodiesterase-5 inhibitors increased from 5% to 27% from baseline to year 5 on AS. In this longitudinally followed active surveillance cohort we observed a small decline of erectile function and an increased use of Phosphodiesterase-5 inhibitors over time. While we cannot separate out the effect of multiple biopsies from that of the natural aging process on erectile function in this observational study, our data suggests AS-related biopsies do not have a large impact on erectile function.The Journal of urology 09/2013; 191(3). DOI:10.1016/j.juro.2013.08.054 · 3.75 Impact Factor