Impact of Subsequent Biopsies on Comprehensive Health Related Quality of Life in Patients with and without Prostate Cancer - Beyond the Abstract

Active surveillance (AS) is the preferred management strategy for NCCN-defined low-risk prostate cancer.  AS protocols have been around for many years, in an attempt to preserve patient health-related quality of life by delaying invasive treatment. 

With the availability of multiple diagnostic modalities for detection and follow-up of prostate cancer, more and more patients are having successive prostate biopsies while they are either under suspicion for prostate cancer or being followed, after a prostate cancer diagnosis, to monitor potential grade progression.  This means that many men will be subject to repetitive biopsies that can pose a risk of infection and other serious complications.  In this study, we sought to explore whether men undergoing more than one successive biopsy experience reductions in health-related quality of life, compared to men who undergo only the diagnostic biopsy. 

To address this research question, we conducted a prospective cohort study examining men who provided informed consent to enroll in the Center for Prostate Disease Research Multicenter National Database between 2007 and 2015.  Health-related quality of life was captured using two validated, patient reported outcomes instruments: (1) the Expanded Prostate Cancer Index Composite (EPIC) and (2) the RAND 36-Item Short Form Health Survey (SF-36).  Each instrument was administered at “baseline” (pre-treatment) and then collected every 3 months in the first year and annually, thereafter. 

Among the 637 eligible patients, 20% were confirmed with prostate cancer and managed on AS, while 80% remained under suspicion for prostate cancer; mean follow up times were 34.7 and 31.6 months, respectively, in these groups. Subsequent prostate needle biopsies were performed on 60% of prostate cancer patients compared to 27% of patients without cancer. No significant impact on health-related quality of life was observed for those undergoing subsequent prostate needle biopsies over the five year study period. 

Our ability to risk stratify patients continues to become more sophisticated, pathologic tissue assessment remains the gold standard for the identification of prostate cancer. While the proportion of men being managed on AS is on the rise, a concomitant increase in serial prostate needle biopsies is expected to take place. Therefore, this study lends timely support to the preservation of health-related quality of life for patients enduring repeat biopsy procedures.

Written by: Jennifer Cullen, PhD, MPH Acting Co-Director & Director, Epidemiologic Research Program In support of the Center for Prostate Disease Research (CPDR), Bethesda, Maryland

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