Prostate cancer diagnosis is associated with an increased risk of erectile dysfunction after prostate biopsy

Abstract

What's known on the subject? and What does the study add? There have been several studies that have suggested there may be a relationship between prostate biopsy and erectile function and LUTS. Previous studies have suggested a specific association between the type of local anaesthesia administered and/or the number of biopsies performed. Other studies have suggested an exacerbation of LUTS after prostate biopsy. The present study identifies a positive cancer diagnosis as a novel characteristic that may explain a relationship between biopsy and worsening erectile function. Objective To evaluate prospectively the characteristics, erectile function and lower urinary tract symptoms (LUTS) of men undergoing prostate needle biopsy (PNBx). Patients and Methods From 2008 to 2011, 134 men were prospectively administered the International Index of Erectile Function (IIEF), American Urological Association Symptom Index (AUA‐SI), and quality‐of‐life (QoL) questionnaires before and after undergoing a single 12‐core PNBx. Comparisons of IIEF and AUA‐SI scores before and after PNBx, based upon baseline characteristics and prostate cancer (PCa) diagnosis, were performed. Univariable and multivariable logistic regression models were used to characterize predictors of change in IIEF scores. Results In the 85 men who fulfilled the inclusion criteria, there were no significant differences between the mean (sd) total pre‐biopsy and the mean (sd) post‐biopsy IIEF scores: 57.8 (12.9) vs 54.3 (17.2). Subgroup analysis showed that men who had biopsy‐proven PCa had significantly greater changes in their post‐biopsy IIEF scores compared with men without (−10.1 vs. 1.0; P < 0.001). After specific analyses of the IIEF domains in these groups we found significant decreases in every domain, including erectile function (P = 0.01). On multivariate analyses, only PCa diagnosis was associated with a significant change in IIEF (odds ratio 7.2; P = 0.003). There were no differences in AUA‐SI or QoL scores in the overall population or in subgroups. Conclusions Cancer diagnosis appears to have an adverse effect on the erectile function of men undergoing PNBx but no effect on LUTS. This study highlights a potential negative psychological confounder that may influence erectile function before the treatment of PCa. Additional prospective trials evaluating these relationships are warranted.

A prospective study of erectile function after transrectal ultrasonography‐guided prostate biopsy

“…These data also suggests that older men (≥60 years) are predisposed to a worse erectile outcome after biopsy, therefore in this population, prostate biopsy should be used even more cautiously and physician-to-patient counselling should include this potential outcome in more detail. Similar to a study in March 2012, we found that those who had a final prostate cancer diagnosis were more likely to have a decline in IIEF-5 score after biopsy [16]. The exact mechanism of this decline in IIEF-5 score for these patients is most likely multifactorial in nature and many factors including psychogenic causes, fear of results, anxiety related to biopsy and even anatomical considerations including nerve damage and haematoma have potential in being related.…”

“…When evaluating LUTS with the IPSS (mild, total score 0-7; moderate, [8][9][10][11][12][13][14][15][16][17][18][19]; and severe, 20-35) at baseline compared with the other time-points, similar results were found. The mean IPSS at baseline was 10.2.…”

“…The IPSS classified LUTS into three categories: mild, total score 0-7; moderate, [8][9][10][11][12][13][14][15][16][17][18][19]; and severe, 20-35. Based on the IIEF-5, ED was classified into five categories: severe, total score 5-7; moderate, 8-11; mild-to-moderate, 12-16; mild, 17-21; and no ED or normal erectile function, 22-25.…”

The pre-treatment prevalence and types of sexual dysfunction among patients diagnosed with prostate cancer

“…Ageing is commonly associated with the development of prostate cancer and progressive erectile dysfunction (ED). Patients with prostate cancer commonly experience an increased rate of ED at baseline (Feldman et al, 1994;Hoffman, 2011;Johansson et al, 2011;Helfand et al, 2012). Similarly, sexual dysfunction (SD) is prevalent among ageing males and is associated with reduced quality of life and sense of well-being (Laumann et al, 1999;Kushiro et al, 2005).…”

Evaluation of Erectile Dysfunction and Risk Factors After Prostate Biopsy

“…Daha önceki çalışmalarda >60 yaş , daha önce biopsi öyküsü, prostat kanseri teşhisi olması, aktif izlemde olmasıvve biopside alınan kor sayısı ED riskini artıran durumlar olarak ortaya koyulmuştur (8,11,12,13). Bizim sonuçlarımızda <60 ve >60 yaş olanlarda ED riski bakımından anlamlı farklılık saptanmamıştır.…”