Serial transperineal sector prostate biopsies: impact on long-term erectile dysfunction

Area of Science:

• Urology
• Oncology
• Sexual Medicine

Background:

• Active surveillance (AS) for prostate cancer involves monitoring patients without immediate treatment.
• Transperineal sector prostate biopsies (TPSBx) are used for diagnosis and monitoring in AS protocols.
• The potential long-term impact of repeated biopsies on erectile function (ED) requires investigation.

Purpose of the Study:

• To evaluate the long-term effects of serial transperineal sector prostate biopsies (TPSBx) on erectile function (ED).
• To assess the impact of repeated TPSBx within an active surveillance (AS) program on sexual health outcomes.

Main Methods:

• Sixty-four men with prostate cancer in an AS program underwent initial and repeat TPSBx (24 months apart).
• The International Index of Erectile Function-5 (IIEF-5) questionnaire assessed ED at baseline and at 1, 3, and 6 months post-biopsy.
• Statistical analysis compared IIEF-5 scores before and after each biopsy procedure.

Main Results:

• The first TPSBx led to significant short-term ED, with IIEF-5 scores improving by six months.
• A second TPSBx resulted in a sustained deterioration of erectile function at one, three, and six months post-procedure.
• Serial TPSBx demonstrated an adverse impact on erectile function, suggesting an increased risk of long-term ED.

Conclusions:

• Initial transperineal sector prostate biopsies cause temporary erectile dysfunction.
• Serial TPSBx in men undergoing active surveillance for prostate cancer may lead to persistent erectile dysfunction.
• The risk of long-term ED associated with serial TPSBx should be thoroughly discussed during patient consent.