Prostate biopsy is the gold standard procedure used to diagnose prostate cancer, the most common non-dermatologic malignancy in men. Common adverse events following this procedure are well known and include hematospermia, hematuria, urinary tract infection, rectal bleeding, and rectal discomfort. More serious complications, such as serious infections and sepsis, are less common.
Penile erection is a complex process that occurs through a cascade of vascular, neurological and psychological events. Therefore, any damage or alteration of the normal physiological sequences in these processes, such as aging, side effects of medications, comorbid diseases or psychological stress, can affect the quality of a patient’s erections.
Erectile dysfunction has been reported after prostate biopsy. However, there has been significant controversy over whether prostate biopsies predispose patients to erectile dysfunction. Some well-studied factors that may influence erectile dysfunction after prostate biopsy include the age of the patient, damage to the neurovascular bundle during injection of local anesthesia, compression of the neurovascular bundle by hematoma or edema formation, the number of biopsies taken. , anxiety related to the biopsy, the type of biopsy (either transperineal or transrectal), and the time interval after the procedure.
The diagnosis of prostate cancer itself is associated with psychological stress, anxiety and depression, which in turn can cause erectile dysfunction. International Index of Erectile Function scores after prostate biopsy may take longer to return to baseline values in men diagnosed with cancer than in those with benign pathology8.
The literature on erectile dysfunction after prostate biopsy is heterogeneous and full of conflicting results. Therefore, for patient counseling and management, it is necessary to better understand the association between PB and ED. We hypothesize that prostate biopsy is associated with erectile dysfunction, but that this effect is likely transient. To provide clear evidence on the duration and extent of ED after biopsy, we conducted a systematic review and meta-analysis of validated measures of sexual function 1, 3, and 6 months after prostate biopsy.
Aim:
Because the association between erectile dysfunction and prostate biopsy is variable in the available literature, we sought to conduct a systematic review and meta-analysis of sexual dysfunction in men within 6 months after prostate biopsy.
Materials and methods:
We conducted a systematic literature search in 4 databases: MEDLINE® (via PubMed®), Embase® (via Ovid®), Web of Science™, and Cochrane Library. We included studies focusing on sexual dysfunction in men of all age groups undergoing transrectal or transperineal prostate biopsy for suspected prostate cancer.
Studies with International Index of Erectile Function 5 scores before and after biopsy at 1, 3, or 6 months were included. We performed an effect size meta-analysis comparing patient’s baseline International Index of Erectile Function 5 (IIEF-5) scores to post-biopsy IIEF-5 scores.
Results:
We identified 9 studies that met our inclusion criteria, of which 6 examined transrectal prostate biopsy, 2 examined transperineal prostate biopsy, and 1 examined both.
One month after biopsy, the mean IIEF-5 score decreased by approximately 2.2 points as determined by effect size (−0.43, p = 0.002).
However, at 3 and 6 months after biopsy, there were no differences compared to baseline (effect size = -0.08, p = 0.52 and effect size = -0.11, p = 0.18, respectively).
An exploratory subgroup analysis examining transrectal prostate biopsy at 3 months showed a statistically significantly lower mean IIEF-5 score compared to baseline (p = 0.047), corresponding to a decrease of approximately 1. 25 points in the IIEF-5.
Discussion
We conducted a systematic review and meta-analysis examining erectile dysfunction after prostate biopsy. Our results suggest that prostate biopsy is associated with a slight decrease in IIEF-5 scores, but that the effect is time-dependent.
We found that 1 month after biopsy there was a statistically significant decrease in the mean IIEF-5 score, which appeared to resolve by 3 months. The net decrease in IIEF-5 score at 1 month from the combined analysis of the TRUS-Bx and TPBx studies was 2.2 points (95% CI = −3.5 points, −0.8 points).
In particular, the minimally clinically important difference for the IIEF is 4 points overall, but varies from 2 to 7 points depending on the severity of the patient’s existing ED. This suggests that a change of 2 points on average could result in significant clinical discomfort for the patient. patients, especially those with mild symptoms to begin with.
At 3 months, the mean change in IIEF-5 score was no longer statistically significant. This effect persisted 6 months after the biopsy. For men who had TRUS-Bx, IIEF-5 scores remained slightly decreased at 3 months, suggesting that some men continue to have decreased IIEF-5 scores at 3 months, which they did not have before biopsy.
The etiology of erectile dysfunction after prostate biopsy is likely multifactorial. Klein et al investigated whether periprostatic nerve block could lead to postbiopsy in the ED by randomizing patients to receive traditional periprostatic nerve block versus lidocaine gel as the primary analgesic for prostate biopsy.
Mechanistically, they were concerned that the injection process could potentially damage the skin. nerves responsible for erection. They found that IIEF-5 scores decreased at one month in patients undergoing 10-core biopsy with and without periprostatic nerve block.
Both groups saw resolution of erectile dysfunction at 3 months. They found no correlation between the number of nuclei and postbiopsy SD. The authors concluded that erectile dysfunction could be associated with prostate biopsy regardless of periprostatic nerve block or number of nuclei, but that the deterioration is reversible within 3 months.
To our knowledge, this is the first systematic review and meta-analysis that evaluates the impact of prostate biopsies on erectile function as a comprehensive analysis and as a single adverse effect of this procedure. Erectile dysfunction is a major concern for the quality of life of men.
It is essential to understand the effect and outcome of prostate biopsy in this population to be transparent in terms of counseling, consent, and follow-up plan. As urologists monitor more men with active surveillance , we may begin to see more patients undergoing multiple biopsies over many years. The effects of repeat biopsy on erectile function remain unclear.
Conclusions: Prostate biopsy causes a mild and transient decrease in average IIEF-5 scores one month after the biopsy. However, this resolves by 3 months on average, and the average IIEF-5 remains at baseline at 6 months after biopsy. |
