Functional outcome and Quality of Life (QoL) in patients undergoing radical prostatectomy without prior prostate biopsy

Purpose To evaluate the impact of omitting preoperative biopsy on postoperative functional outcomes and health-related quality of life (HRQOL) in patients without prostate biopsy prior to radical prostatectomy (RP). Methods This retrospective cohort study used data from the prostatectomy database at LMU University Hospital. Patients were divided into a biopsy group (n = 8995) and a non-biopsy group (n = 68). Propensity score matching was performed to control for confounders, resulting in a matched cohort (biopsy group n = 186, non-biopsy group n = 68). Urinary continence (ICIQ-SF, pads/day), sexual function (IIEF-5), and HRQOL (EORTC QLQ-C30) were compared between the two groups at multiple time points (preoperatively and at 3–48 months postoperatively) in matched and unmatched cohorts, and also in pT2 subgroups. Results All patients in the non-biopsy group were pathologically confirmed to have prostate cancer. In the unmatched cohort, HRQOL was significantly better in the biopsy group at 3 months. In the matched cohort, the non-biopsy group showed no advantage regarding continence and sexual function, but higher symptom burden at several time points. Similar trends were observed in the pT2 subgroups. Conclusion For patients with highly suspected prostate cancer, RP without biopsy resulted in significant prostate cancer in all patients. This study, with a relatively short follow up and a limited number of patients, did not demonstrate any functional or HRQOL outcome advantage for the non-biopsy group.