Serial Prostate Biopsy and Risk of Lower Urinary Tract Symptoms: Results From a Large, Single-institution Active Surveillance Cohort

Abstract

To describe the effect of serial prostate biopsy on lower urinary tract symptoms (LUTS) in men who undergo active surveillance (AS) at a large academic institution. This is a retrospective study of men enrolled in AS for≥6 months who underwent≥1 biopsy and completed≥1 International Prostate Symptom Score (IPSS) questionnaire. In additional to total IPSS, we report the mean difference between the first and last questionnaires for patients who completed≥2 questionnaires. Multivariate models, adjusting for disease features, age, race, prostate volume and baseline, or incident benign prostatic hypertrophy (BPH), were used to assess relationships between IPSS and total biopsy exposure. Four hundred eighty-two men were eligible, and 291 completed≥2 IPSS questionnaires. Overall, mean (standard deviation) age was 61.7 (7.8) years, and median prostate volume (interquartile range) was 42 (34-61) mL. At baseline, 11% provided history of BPH. Among men who completed multiple questionnaires, 25% experienced clinically significant worsening (IPSS increase≥4 points). In regression model, total IPSS was not significantly associated with greater biopsy exposure (P= .25). IPSS change from initial and the latest questionnaire was not significantly associated with initial or interval biopsy exposure in an adjusted longitudinal model (P= .64 and .50, respectively), but a trend was observed with greater age decade (+4.07 points, 95% CI-0.30 to 8.4; P= .07). Repeated prostate biopsy does not appear to independently pose additional risk of LUTS in an AS population. In unadjusted analyses, greater biopsy exposure is a surrogate for increasing follow-up time, age, and BPH risk, and thus, risk of LUTS onset and progression.