Introduction: The impact of transrectal ultrasound guided prostate needle biopsy on erectile dysfunction remains uncertain. We examined whether transrectal ultrasound guided prostate needle biopsy contributes to the development or worsening of erectile dysfunction as assessed by IIEF-5 scores in patients who underwent multiple prostate needle biopsies.
Methods: The study population consisted of 826 men who underwent transrectal ultrasound guided 10 to 12-core prostate needle biopsy for suspicion or surveillance of prostate cancer. Men were evaluated for erectile dysfunction using the IIEF-5 questionnaire. Erectile dysfunction was modeled as a categorical variable, defined as any (0 to 20), mild (16 to 20), mild to moderate (11 to 15), moderate (6 to 10) or severe (0 to 5). The impact of multiple prostate needle biopsies was also evaluated.
Results: Of 826 men who underwent prostate needle biopsy 240 (29%) had undergone 1 or more and 168 (20%) had undergone 2 or more biopsies. Mean patient age was 63 years and mean IIEF-5 score was 16. On univariate analysis age (OR 1.11, 95% CI 1.09-1.14, p <0.001), and 1 (OR 1.79, 95% CI 1.06-3.03, p=0.03) or 2 (OR 1.80, 95% CI 1.02-3.17, p=0.04) prior prostate needle biopsies were associated with erectile dysfunction. On multivariate analysis age alone was predictive of severe erectile dysfunction (OR 1.09, 95% CI 1.05-1.12, p=0.002). A repeat prostate needle biopsy within 12 months was associated with worse erectile dysfunction (OR 1.55, 95% CI 1.08-2.93, p=0.02). When long-term erectile function was evaluated, prostate needle biopsy was not significant after adjustment for covariates.
Conclusions: In the short term prostate needle biopsy may be important in predicting transient (less than 1 year) erectile dysfunction. However, in the long term prostate needle biopsy does not predict erectile dysfunction in aging men.
Keywords: biopsy; erectile dysfunction; needle; prostate.