The Impact of Prostate Biopsy on Urinary Symptoms, Erectile Function, and Anxiety

Abstract

Transrectal ultrasound-guided prostate needle biopsy (PB) is considered the gold standard for the diagnosis of prostate cancer. Recently, lower urinary tract symptoms and erectile dysfunction have been reported following PB. We reviewed the literature on PB and these symptoms and summarized known findings between these conditions and other variables, such as periprostatic nerve block, saturation biopsy, serial biopsies, and psychological factors associated with PB and cancer. A PubMed search was performed using keywords "prostate biopsy," "complications," "erectile dysfunction," "lower urinary tract symptoms," "anxiety," and "quality of life." Eleven key papers are discussed and personal experience is drawn upon. Based upon available evidence, PB appears to be associated with short-term exacerbation of urinary symptoms in some men, as well as associated with anxiety and temporary erectile dysfunction, without a distinct relationship to periprostatic nerve block or the number of cores biopsied. Additional studies are warranted to determine the definitive etiology of these symptoms and to determine if interventions could reduce patient morbidity. In the interim, patients should be educated and counseled about these risks before undergoing PB.

Complications After Systematic, Random, and Image-guided Prostate Biopsy

“…Significant anxiety regarding the possibility of cancer may also have an impact on erectile function. One study found a reduction in all IIEF domains only among men diagnosed with prostate cancer on biopsy, while no significant decrease was found in their counterparts with negative biopsy results 22 28 . Another prospective AS study of 342 patients undergoing TRUS-PB found that EF decreased by 1-point every year for the first 4 years 33 .…”

“…Prostate volume, in particular the transition zone volume, is a well-documented and significant factor associated with subjective voiding impairment and acute urinary retention in most studies 22 . For example, in 5802 men from the Rotterdam section of the ERSPC, prostate volume, transition zone volume/total prostate volume ratio, and a higher IPSS score were all predictors of urinary retention 11 .…”

“…Moreover, the peri-prostatic nerve blockade (PPNB) could affect EF, due to the direction of anesthetic into the neurovascular bundles; however, the changes in IIEF seem to be similar among the different analgesia techniques 22,23 . Significant anxiety regarding the possibility of cancer may also have an impact on erectile function.…”

Relationship between non-suspicious MRI and insignificant prostate cancer: results from a monocentric study

“…It is associated with short-term exacerbation of urinary symptoms and erectile dysfunction, as well as anxiety over the procedure [30].…”

New Onset of Erectile Dysfunction in a Cohort of Patients Enrolled in Active Surveillance for Low Risk Prostate Cancer: A Preliminary Study to Evaluate Incidence and Prognostic Factors

“…Few data with conflicting opinions [7][8][9] have been reported in literature about the prevalence of ED in men under AS and about its correlations with comorbidity; aim of our study is to evaluate this evenience in our experience and to determine the variables that promote the onset of ED.…”