Originally published 8/12/2015
Since the original blog is six years old as of this writing, it’s time to revisit recent published literature on the topic of prostate biopsy and risk of post-biopsy erectile dysfunction (ED). Early in 2021, two separate literature reviews were conducted, and both had similar findings. The first included 7 full text articles from which data was assembled and analyzed. Based on standardized erectile function self-report questionnaires, the authors found that scores dropped an average of 4.61 points at 1-month post-biopsy; however, ED had resolved by 3- and 6-month post biopsy. The authors advise, “Patients should be counselled regarding the transient effect on erectile function post biopsy.”[i]
The second review included nine studies, all of which used the same standardized questionnaire as the above paper, but some reported on either transrectal or transperineal prostate biopsy. This review likewise found a drop in erectile function scores at 1-month post-biopsy, though not as marked at an average of 2.2 points. This paper, too, reported that at 3 and 6 months “there was no difference compared to baseline.”
Both papers point to the possibility that transient ED can occur following prostate biopsy, but the good news is that sexual function appears to return to normal within 6 months at the latest.
No one looks forward to a transrectal ultrasound-guided (TRUS) needle biopsy of the prostate. Probably the most dreaded part is the pain factor, which for decades went largely unacknowledged or understated by the physicians doing the procedure. Thank goodness today’s urologists can administer an injection called a periprostatic nerve block. Patients should ask their urologist in advance if he/she offers this. With pain out of the way, is there anything else to worry about?
Common risks include infection (which is why you start on antibiotics before a biopsy), blood in urine or semen, minor rectal bleeding, and difficulty urinating. However, there is another risk recently brought to light in “A Prospective Study of Erectile Function after Transrectal Ultrasonography-guided Prostate Biopsy,” published by the British Journal of Urology International.[ii] There were 220 patients in the study, and before TRUS biopsy their erectile function was evaluated by a questionnaire called the International Index of Erectile Function (IIEF), and again at 1, 4 and 12 weeks after biopsy. Before the procedure, 38.6% reported no ED, 22.3% mild ED, 15.5% mild-to-moderate ED, 10% moderate, and 13.6% severe. The authors found that on average, IIEF scores were significantly reduced (meaning higher incidence of self-reported ED) at 1 week after biopsy, which continued to be reduced at 4 and 12 weeks. The team concluded that “the effects of TRUS-guided prostate biopsy on erectile function have probably been underestimated…” The authors note that all men should be advised of this risk, and men over 60 especially need counsel as their sexual function already tends to diminish.
A news article on this study points out that other factors related to prostate biopsy could also have a negative impact on sexual function. These include, “Psychogenic causes, fear of results, anxiety related to biopsy, and even anatomical considerations such as nerve damage and hematoma…”[iii] Other researchers on the topic, such as Dr. Brian Helfand of the North Shore University Health System in Chicago and the University of Chicago, have reported similar findings.
At our Center, real-time MRI-guided biopsies helps avoid the risk of ED after biopsy. On the physical level, thanks to our high resolution multiparametric MRI, we can target biopsy needles directly into the core of a suspected tumor, and avoid hitting the urethra or neurovascular bundles. Also, we are able to reduce the number of needles used. Psychologically, because we are able to show the patient in advance what looks suspicious on MRI, and talk it through, there is less fear of the unknown. Finally, we know that no one likes surprises. When our biopsy results come back from the lab, we are confident that they are the most accurate they can be, thanks to taking samples from the area most likely to harbor aggressive disease. How many men over the decades got TRUS biopsy results that said one thing, only to find out after surgery that the Gleason grade was higher, or there were positive surgical margins?
We believe we are helping patients by providing in-bore prostate biopsy. Not can we prevent post-biopsy ED, but we offer an accurate, pain-free biopsy that gives the best treatment planning guidance.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Mehta A, Kim WC, Asward KG, Brunckhorst O et al. Erectile Function Post Prostate Biopsy: A Systematic Review and Meta-analysis. Urology. 2021 Jan 29;S0090-4295(21)00107-2.
[ii] Murray KS, Bailey J, Zuk K et al. A prospective study of erectile function after transrectal ultrasonography-guided prostate biopsy. BJU Int. 2015 Aug;116(2):190-5. doi: 10.1111/bju.13002. Epub 2015 Mar 23.
[iii] Jody A. Charnow, Ed. “Erectile Function Worsens in Most Men After Prostate Biopsy.” July 29, 2015. http://www.renalandurologynews.com/erectile-dysfunction-ed/erectile-function-worsens-in-most-men-after-prostate-biopsy/article/429030/
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
