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

Study Type - Prognosis (cohort) Level of Evidence 2b 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.

Written by:
Helfand BT, Glaser AP, Rimar K, Zargaroff S, Hedges J, McGuire BB, Catalona WJ, McVary KT   Are you the author?
Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

Reference: BJU Int. 2012 May 28
doi: 10.1111/j.1464-410X.2012.11268.x.

PubMed Abstract
PMID: 22639942