The Impact of Multiple Prostate Biopsies on Risk for Major Complications Following Radical Prostatectomy: A Population-based Cohort Study - 26/07/17

Doi : 10.1016/j.urology.2017.03.048

Daniel Olvera-Posada ^a,^b, Blayne Welk ^a,^c,^d, J. Andrew McClure ^c, Jennifer Winick-Ng ^c, Jonathan I. Izawa ^a,^e, Stephen E. Pautler ^a,^e,^*
^a Division of Urology, Department of Surgery, Western University, London, ON, Canada
^b Instituto de Cirugía, TEC Salud, Monterrey, Mexico
^c Institute for Clinical Evaluative Sciences, London, ON, Canada
^d Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
^e Division of Surgical Oncology, Department of Oncology, Western University, London, ON, Canada

^*Address correspondence to: Stephen E. Pautler, M.D., F.R.C.S.C., Division of Urology, Department of Surgery, St. Joseph's Hospital, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada.Division of UrologyDepartment of SurgerySt. Joseph's Hospital268 Grosvenor StreetLondonOntarioN6A 4V2Canada

Abstract

Objective

To evaluate the impact of multiple transrectal ultrasound-guided prostate biopsies (TRUS-Bx) before radical prostatectomy (RP) on surgical outcomes.

Materials and Methods

Administrative databases were used to identify all patients who had a RP performed in the province of Ontario from April 1, 2002, to March 31, 2013. TRUS-Bx prior to RP were identified and patients were categorized as having one or more than one prior TRUS-Bx. The primary end point was a composite index of serious surgical complications. Secondary outcomes included oncological interventions, functional-related events, and general health service-related outcomes.

Results

Among 27,637 patients, 4780 (17.3%) had ≥2 biopsies performed before RP. The proportion of patients who experienced the composite end point was similar between those with one TRUS-Bx compared to those with ≥2 TRUS-Bx (1.05% vs 1.19%, OR 1.14, 95% CI 0.85-1.52). Patients with ≥2 biopsies were more likely to have a perioperative blood transfusion compared to patients with only 1 biopsy (15.5% vs 12.8%, OR 1.25, 95% CI 1.15-1.37), while readmission rate and 30-day mortality were similar. The need for radiotherapy and androgen deprivation therapy within the first year after RP was higher in patients with a single biopsy. Patients with multiple TRUS-Bx were more likely to require post-RP urodynamic evaluation and bladder neck contracture-related interventions but were not at increased odds of surgery for incontinence or erectile dysfunction.

Conclusion

Perioperative outcomes after RP are similar between men with single or multiple TRUS-Bx, although multiple TRUS-Bx were associated with an increased odds of perioperative blood transfusion.

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Plan

Materials and Methods

Study Design and Data Sources

Exposure and Baseline Variables

Outcomes

Statistical Analysis

Results

Primary and Secondary Outcomes

Sensitivity Analysis and Post Hoc Analyses

Discussion

Conclusion

Financial Disclosure: The authors declare that they have no relevant financial interests.

Funding Support: This study was supported by the ICES Western site. ICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Core funding for ICES Western is provided by the Academic Medical Organization of Southwestern Ontario (AMOSO), the Schulich School of Medicine and Dentistry (SSMD), Western University, and the Lawson Health Research Institute (LHRI). The opinions, results, and conclusions reported in this paper are those of the authors and are independent of the funding sources. No endorsement by ICES, AMOSO, SSMD, LHRI, or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred.