« Back

Serial prostate biopsies linked to increased risk of erectile dysfunction, study shows

Friday, January 08 2010 | Comments

---

What's This? In men with prostate cancer on active surveillance, serial prostate biopsies appear to have a negative effect on erectile function but do not have an effect on lower urinary tract symptoms (LUTS), according to study results.

The diagnostic procedure of choice for prostate cancer detection is needle biopsy of the prostate, the authors explained. They noted that prostate biopsy has been associated with erectile dysfunction (ED) and LUTS, although most studies appear to show that these post-biopsy side effects are temporary.

However, because prostate biopsy needles are increasingly laterally directed and the number of needles used per biopsy has increased, the researchers examined whether there is a longer-term effect on ED and LUTS among men undergoing multiple prostate biopsies.

To explore this issue, they administered the 5-item Sexual Health Inventory for Men (SHIM) and International Prostate Symptom Score (I-PSS) questionnaires to 333 men with prostate cancer undergoing active surveillance. The questionnaires were administered during the previous decade at the beginning of each patient's protocol entry, and then again in March 2008. At protocol entry, all of the men had at least one 10- to 12-core prostate biopsy, with yearly surveillance biopsies recommended thereafter.

The primary endpoints were changes from baseline in SHIM score and I-PSS.

The follow-up questionnaires were returned by 231 of the men. After the researchers applied exclusion criteria, 152 of the men were included in the SHIM analysis and 123 were included in the I-PSS analysis.

An increase in the number of biopsies was significantly associated with a decrease in SHIM score (P=.04). Additionally, a history of >=3 biopsies was associated with a significantly greater decrease in SHIM score as compared with a history of <=2 biopsies (P=.02).

Multivariate analysis revealed that biopsy number, but not age, prostate volume on transrectal ultrasound, or prostate-specific antigen, was significantly associated with decreasing SHIM score (P=.02).

In men who did not have baseline ED, there was a trend toward steeper decreases in SHIM score after >=3 biopsies than in men with mild to moderate baseline ED (P=.06).

Serial prostate biopsies did not affect LUTS, as there was no significant difference in mean I-PSS at baseline and follow-up (P=.183).

"Men with prostate cancer in an expectant management program who undergo an annual 10- to 12-core surveillance prostate biopsy are at risk for ED," the authors concluded. "This risk appears to increase with increasing biopsy number and is most dramatic after undergoing 3 or more surveillance biopsies."

They suggested that men undergoing this surveillance protocol should be warned of the possible adverse effect on erectile function. (Fujita K, et al. J Urol 2009;182:2664-2669.)

Print  |  E-mail