title: The Impact of Repeat Prostate Biopsies on Oncologic, Pathological and Perioperative Outcomes after Radical Prostatectomy.
abstract: The impact of repeat biopsy sessions on radical prostatectomy remains controversial regarding perioperative, pathological and oncologic outcome.
  
  
  
  We analyzed the records of 12,624 patients who underwent radical prostatectomy from 2007 to 2013. The association of the number of biopsy sessions (range 1 to 3 or more) with pathological outcomes and perioperative complications was analyzed using the Wilcoxon matched pair test. To test the association between biopsy sessions and biochemical recurrence-free survival we used Kaplan-Meier curves and multivariable Cox regression analysis.
  
  
  
  Of the patients 89.2% had 1 biopsy session, 7.4% had 2 sessions and 3.4% had 3 or more sessions. Median followup was 36.6 months. In patients with 1, 2 and 3 or more biopsy sessions prostate volume (38, 44 and 45 ml) and prostate specific antigen (6.7, 7.6 and 10.1 ng/ml, respectively) were greater (each p <0.001). The perioperative outcome was more favorable. Patients with 1, 2 and 3 or more biopsy sessions more often had organ confined tumors (67.6%, 72.1% and 72.9%, p = 0.003) and higher tumor volume (3.1, 3.0 and 3.6 ml, p <0.001) but a lower tumor percent (7.5%, 3.7% and 2.4%, respectively, p <0.001). More biopsy sessions were associated with fewer lymph node metastases (1, 2 and 3 sessions 0.23, 0.13 and 0.17, respectively, p <0.001). Gleason score and surgical margin status did not differ. The overall biochemical recurrence rate was 18.9% and it was comparable among the biopsy groups. No association was found between the number of biopsies and biochemical recurrence.
  
  
  
  Patients with multiple biopsy sessions experience a slightly more favorable pathological outcome without an impact on the oncologic outcome. The perioperative outcome was more favorable in patients with multiple biopsies.
authors: Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: rosenbaumclemens@gmail.com.
authors: Clemens M
authors: CM
authors: Rosenbaum
authors: Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Philipp
authors: P
authors: Mandel
authors: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Pierre
authors: P
authors: Tennstedt
authors: Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Katharina
authors: K
authors: Boehm
authors: Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Felix K-H
authors: FK
authors: Chun
authors: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Markus
authors: M
authors: Graefen
authors: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Hans
authors: H
authors: Heinzer
authors: Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Derya
authors: D
authors: Tilki
authors: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Georg
authors: G
authors: Salomon
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods / Q000706:statistics & numerical data*; D002170:Canada; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D060787:Neoplasm Grading; D019990:Perioperative Care / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D017430:Prostate-Specific Antigen
keywords: biopsy; outcome and process assessment (health care); prostate specific antigen; prostatectomy; prostatic neoplasms