Are Repeat Prostate Biopsies Safe? A Cohort Analysis From the SEARCH Database

The Journal of Urology, 05/11/2012

Multiple biopsy sessions are not associated with an increased risk of biochemical recurrence in men undergoing radical prostatectomy. Multiple biopsy sessions appear to select for a low risk cohort.

Methods

  • Men in the SEARCH (Shared Equal Access Regional Cancer Hospital) database who underwent radical prostatectomy between 1988 and 2010 after a known number of prior biopsies were included in the analysis.
  • Number of biopsy sessions (range 1 to 8) was examined as a continuous and categorical (1, 2 and 3 to 8) variable.
  • Biochemical recurrence was defined as a prostate specific antigen greater than 0.2 ng/ml, 2 values at 0.2 ng/ml or secondary treatment for an increased prostate specific antigen.
  • The association between number of prior biopsy sessions and biochemical recurrence was analyzed using the Cox proportional hazards model.
  • Kaplan-Meier estimates of freedom from biochemical recurrence were compared among the groups.

Results

  • Of the 2,739 men in the SEARCH database who met the inclusion criteria 2,251 (82%) had only 1 biopsy, 365(13%) had 2 biopsies and 123 (5%) had 3 or more biopsies.
  • More biopsy sessions were associated with higher prostate specific antigen (p <0.001), greater prostate weight (p <0.001), lower biopsy Gleason sum (p = 0.01) and more organ confined (pT2) disease (p = 0.017).
  • The Cox proportional hazards model demonstrated no association between number of biopsy sessions as a continuous or categorical variable and biochemical recurrence.
  • Kaplan-Meier estimates of freedom from biochemical recurrence were similar across biopsy groups (log rank p = 0.211).

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