Can Prostate Biopsy Cause Erectile Dysfunction?

If are recommended by your doctor to undergo prostate biopsy procedure for the detection of cancer, you must have a lot of questions and reservations. One of the most common question that people usually have is, can prostate biopsy cause erectile dysfunction or alter the quality of sex life at all?

The answer is yes; erectile dysfunction may occur after prostate biopsy in some susceptible individuals; but it is usually transient and self-limiting.

Accorded to a study published in the Journal of Urology, men who undergo prostate biopsy are at risk of temporary erectile dysfunction due to anxiety or pain; however, in most men, symptoms improve within a couple of weeks.

Pathophysiology Of Erectile Dysfunction And Prostate Biopsy

The risk of developing temporary erectile dysfunction is largely dependent on the number and volume of tissue samples obtained during the procedure. Needless to say that the risk is greater if more biopsies are taken.

There are three primary types of prostate biopsies; a typical standard one utilizes only 1 needle to take no more than 10 samples. The risk of complications like erectile dysfunction is higher if more than 10 tissues samples are obtained or if any type of nerve block is used for pain reduction.

According to a new study, investigators evaluated the risk of erectile dysfunction in men who undergo prostate biopsy. 25% of men in the study sample who underwent standard saturation biopsy admitted that they had erectile dysfunction before the biopsy but the percentage went up to 50% just a week after the procedure. The group in which men had nerve block, erectile dysfunction rate raised to 39% from 11% after the biopsy. However, by12th week post-procedure, the transient erectile dysfunction resolved in the study sample; suggesting no nerve damage or dysfunction takes places during the procedure.

Can Regular Prostate Biopsy Cause Erectile Dysfunction?

If your doctor asks you to get multiple prostate biopsies in a defined time period, what will be the risk of developing temporary or permanent erectile dysfunction? A study published in the Journal of Urology, reported the findings in 231 males with prostate cancer and on active surveillance for more than 10 years. All of them had 10-12 core prostate biopsy at least once and were also advised for biopsy every year. Participants were asked to complete SHIM (Sexual health inventory for men) and I-PSS (International Prostate Symptom Score) questionnaires.

The results indicated that SHIM scores significantly declined over the years based on the number of biopsies done, for example the decline in the SHIM scores of men who had the biopsies thrice or more was much worse than those who had 2 or less biopsies. Men who never faced erectile dysfunction before the prostate biopsy had their SHIM scores much lower when they undergo 3 or more biopsies in comparison with those who faced erectile dysfunction before having the biopsy.

If you are one of those men who are advised to get prostate biopsy, or more than one biopsies over time then be prepared to face erectile dysfunction on temporary basis. Keep the word "temporary" in mind, as the risk of experiencing erectile dysfunction increases with the increase in the number of prostate biopsies you are going to have. However, researchers also argue that other factors may also contribute (besides prostate biopsy); for example:

• Since prostate enlargement and malignancy is generally reported in the elderly population; chances are higher than ED is due to physiological aging (and not due to biopsy).
• Any ongoing disease process or malignancy can affect the integrity and physiological functioning of the prostate gland; which may culminate in ED. Therefore, ED itself should not stop you from seeking active surveillance or periodic prostatic evaluation.
• According to another study reported in the Journal of Urology (2), investigators suggested that the diagnosis of prostate cancer (or suspicion of prostate malignancy) can adversely affect erectile function due to anxiety and depression.

References

1. Braun, K., Ahallal, Y., Sjoberg, D. D., Ghoneim, T., Esteban, M. D., Mulhall, J., ... & Touijer, K. A. (2014). Effect of repeated prostate biopsies on erectile function in men on active surveillance for prostate cancer. The Journal of urology, 191(3), 744-749.

2. Fujita, K., Landis, P., McNeil, B. K., & Pavlovich, C. P. (2009). Serial prostate biopsies are associated with an increased risk of erectile dysfunction in men with prostate cancer on active surveillance. The Journal of urology, 182(6), 2664-2669.

3. Helfand, B. T., Glaser, A. P., Rimar, K., Zargaroff, S., Hedges, J., McGuire, B. B., ... & McVary, K. T. (2013). Prostate cancer diagnosis is associated with an increased risk of erectile dysfunction after prostate biopsy. BJU international, 111(1), 38-43.