The bound of prostate biopsy and erectile fuction - Beyond the Abstract

Prostate Biopsy guided by ultrasound (TRUS biopsy) has become the gold standard in diagnosing carcinoma of the prostate since the method’s introduction in 1989 by Hodge et al. (1). Millions of men throughout the world undergo a TRPB, with nearly a million biopsy procedures being done yearly in the United States (2, 3).

Although ED was recognized as a complication of prostate biopsy as early as 2001, it has not been well-established by data, unlike potential adverse events such as hematuria, pain, voiding dysfunction, and infection.

In some prospective published studies most men who underwent a transrectal ultrasonography (TRUS)-guided prostate biopsy experienced a significant decrease in International Index of Erectile Function-5 (IIEF-5) score.

In the study Led by Linden and cols 93 was evaluated and prior biopsy the 100% of them had an IIEF-5 score >21 points. At the evaluation 4 weeks post-biopsy, 66.6% of the patients maintained a score above 22 points, indicating no ED, and the resting 33.3% presented certain degree of ED with 26.8% being classified as mild ED, 4.30% having mild-moderate ED, 2.15% with moderate ED, and none of the patients with severe ED. Nearly a third of the patients during this first evaluation presented certain degree of ED in comparison to the base evaluation (p=0.001)(4).

At the second evaluation post-biopsy done after 12 weeks, 9.1% of patients persisted with ED, from these 3.41% being mild cases and 5.68% being mild-moderate ones. During this second evaluation, just as in the first, no severe cases of ED were observed, representing a statistical difference (p=0.04).
On the third evaluation done 6 months post-biopsy, none of the patients were classified as mild-moderate, and just 7.52% of patients persisted as cases of mild ED, this time the statistical difference was not significant. During the 6 month period of evaluation, none of the patients suffered severe ED and the majority of patients that showed ED were classified as mild according to the IIEF-5(4).

Muray and colleagues, studied 220 men. At presentation, 38.6% reported no erectile dysfunction (ED), 22.3% mild ED, 15.5% mild-to-moderate ED, 10% moderate ED, and 13.6% severe ED. Patients were sent IIEF-5 follow-up questionnaires at 1, 4, and 12 weeks. in the study cohort, median IIEF-5 score was significantly lower 1 week after biopsy than at baseline (15.5 vs 18.2; P < .001). And the score remained significantly lower at 4 weeks (17.3 vs 18.4; P = .008) and 12 weeks (16.9 vs 18.4; P = .004)(5).

This studies suport that after a biopsy, the drop in IIEF-5 scores and the presence of erectile dysfunction are temporary and transient, with greater impairment during the first month following the procedure and improvement starting after the first month, with almost total recovery at 6 months. But Murray also found that patients who had a final prostate cancer diagnosis were more likely to have a decline in IIEF-5 after biopsy, we did not identify this relationship, because we not include these patients. For the patients who did not get a diagnosis of prostate cancer, median IIEF-5 score was lower only at the 1-week follow-up (P < .001). But for those with prostate cancer detected, the median score was lower at 1 week (P < .001) and at 12 weeks (P = .001) after biopsy. Age appears to play a role in men do in terms of their erections after undergoing prostate biopsy, the investigators report. For men younger than 60 years, median IIEF-5 score was lower only at the 1-week follow-up (P = .015). But for men 60 years and older, scores were lower at 1 week (P < .001), 4 weeks (P = .024), and 12 weeks (P = .005)(5).
The cause of erectile dysfunction following a transrectal prostate biopsy is unknown but it could be tied to certain factors such as the temporary inflammatory tissue process, inflammation or damage to the neurovascular plexus, the presence of hematomas or edema. Other causes could be attributed to the presence of pelvic pain, prostatitis or anxiety (6).

Written By:

Edgar Linden-Castro
Urology Departament, Centro Medico Puerta de Hierro, Guadalajara, Jalisco, Mexico.

Marcela Pelayo-Nieto
Urology Department, Centro Médico Nacional 20 de Noviembre, Mexico City, Mexico

REFERENCES

Grewal S, Vetter J, Brandes SB, et al. A population-based analysis of contemporary rates of reoperation for nile prosthesis procedures. Urology 2014; 84:112.
Carson CC, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of follow-up. J Urol 2011; 185:614.

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