The impact of multiple prostate biopsies on risk for major complications following radical prostatectomy: a population-based cohort study

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

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 one 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.

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