Erectile function following transperineal prostate biopsy: a prospective longitudinal study of 170 patients.

Abstract

INTRODUCTION & OBJECTIVES: Data on erectile dysfunction (ED) associated with prostate biopsy is limited and heterogeneous. Transperineal prostate biopsy (TPB) has increasingly been utilized by Urologists due to negligible rates of sepsis combined with better sampling of the prostate. This study aims to evaluate the impact of TPB on erectile function. METHOD: All patients undergoing TPB at a private group practice of seven Urologists were enrolled in this ethics approved study. Patients were provided the validated Sexual Health Inventory for Men (SHIM) questionnaire (aka IIEF-5) at pre-biopsy and at 1, 3, and 12 months follow-up. Patients who had undergone subsequent treatment including prostatectomy, radiation, or androgen deprivation therapy, were excluded from analysis. RESULTS: Between October 2013 and May 2015, 170 patients had completed a baseline SHIM questionnaire and at least one other follow-up SHIM questionnaire. The mean age was 63.3 years (SD 7.2), mean pre-biopsy PSA was 7.8 ng/mL (SD 0.8) and median number of biopsy cores taken was 24 (IQR 22–24). Within this cohort, 60% (102/170) had initial biopsies, 11.1% (19/170) had previous negative TRUS biopsies and 28.9% (49/1770) had their biopsy as part of active surveillance. A total of 156 (91.8%), 30 (17.6%), and 38 (22.4%) patients had recorded baseline and follow-up SHIM questionnaires at 1, 3 and 12 months, respectively. The mean change in SHIM scores between baseline and follow-up was −2.18 (P < 0.001), −2.77 (P = 0.0154), and −1.29 (P = 0.0061) after 1, 3, and 12 months, respectively. There was no statistically significant difference between patients diagnosed with cancer and those without cancer diagnosis at any stage of follow-up. CONCLUSIONS: There appears to be a mild reduction in erectile function after TPB. Although this effect is mild and improves over time, patients should be counselled regarding this possible outcome prior to biopsy.