Erectile Dysfunction and Prostate Biopsy

Prostate biopsy (also referred to as transrectal ultrasonography-guided prostate needle biopsy) is usually conducted in clinical practice to rule out the possibility of prostate malignancy. However, like all invasive diagnostic tests, prostate biopsy is also associated with a mild risk of adverse effects or complications. For example; according to a new study reported in the peer reviewed British Journal of Urology International (1) investigators suggested that prostate biopsy can cause moderate but transient erectile dysfunction in patients in addition to varying degrees of urinary complaints.

Study suggested that prior to prostate biopsy, approximately 82% male patients reported ED in a sample of 46 men; however, one month after the biopsy, more than 91% patients complained ED and other urinary symptoms.

What are some risk factors that may aggravate the chances of developing ED after Prostate Biopsy?

Investigators believe that the nature of biopsy can significantly influence the severity of complications. For example, three primary forms of prostate biopsy are:

• Standard Biopsy: In this biopsy, technician takes approximately 10 or less tissue samples.
• The Modified 10-sample Biopsy: In this biopsy, 10 tissue samples are taken after nerve block (periprostatic region) to lessen the procedure associated pain and discomfort.
• Saturation Biopsy: This is the most aggressive form of biopsy, in which investigators takes approximately 20 tissue samples.

Saturation biopsies are mostly associated with some degree of erectile dysfunction and are usually performed in high risk candidates; such as those with a higher likelihood of malignancy due to abnormal PSA levels or individual

s with previous non-conclusive biopsies.

Other common adverse effects of saturation prostate biopsies reported in such patients are:

• Inability to pass urine without straining
• Frequent urination
• Pain during micturition
• Infection
• Prolonged bleeding or onset of blood in the urine (haematuria) or semen (hematospermia)
• Sepsis

Such adverse effects are more common in individuals with pre-exiting symptomatic prostatic enlargement.

Pathophysiology of Erectile Dysfunction in the setting of Prostate Biopsy

It is believed that damage to the neurovascular bundle in the vicinity of prostate gland plays a vital role in causing erectile dysfunction. In addition, a number of investigators also claim that prostate malignancy itself causes ED in some patients, which only becomes more noticeable after the biopsies. Other common explanations are:

• The procedure related anxiety and depression affects the emotional and neuropsychological help that directly translates into decreased libido or/and erectile dysfunction. Study conducted by Fang and colleagues (3) also suggested that risk of suicide and/or cardiovascular risk also increases in patients who are diagnosed with prostate biopsy; which suggests that biopsy may not be the sole cause of ED.

Study reported in British Journal of Cancer (4) suggested that chances of developing erectile dysfunction is higher in males who opt for active surveillance (instead of surgical intervention) to address prostatic enlargement or early cancer. In other words, recurrent biopsies are strongly linked to erectile dysfunction. In most uncomplicated cases, erectile dysfunction resolves by 10-12 weeks after the biopsy (especially if ED is due to peri-prostatic nerve block).

It is highly recommended to speak to your healthcare professional regarding the procedure and likely risk of complications, prior to the biopsy. Although, biopsy is associated with moderate risk of side effects; it nevertheless aid in early diagnosis and prompt treatment. In a new study, investigators concluded that approximately 40% asymptomatic patients who underwent prostate biopsy for the evaluation of abnormal PSA levels were diagnosed with prostate malignancy.

References:

1. 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.

2. RABBANI, F., STAPLETON, A. M., KATTAN, M. W., WHEELER, T. M., & SCARDINO, P. T. (2000). Factors predicting recovery of erections after radical prostatectomy. The Journal of urology, 164(6), 1929-1934.

3. Fang, F., Keating, N. L., Mucci, L. A., Adami, H. O., Stampfer, M. J., Valdimarsdóttir, U., & Fall, K. (2010). Immediate risk of suicide and cardiovascular death after a prostate cancer diagnosis: cohort study in the United States. Journal of the National Cancer Institute, 102(5), 307-314.

4. Macefield, R. C., Metcalfe, C., Lane, J. A., Donovan, J. L., Avery, K. N. L., Blazeby, J. M., ... & Vedhara, K. (2010). Impact of prostate cancer testing: an evaluation of the emotional consequences of a negative biopsy result. British journal of cancer, 102(9), 1335-1340.