Erectile Dysfunction is a Transient Complication of Prostate Biopsy: A Systematic Review and Meta-Analysis

Purpose: Because the association between erectile dysfunction and prostate biopsy is variable in the available literature, we sought to perform a systematic review and meta-analysis of sexual dysfunction in males within 6 months of prostate biopsy.

Materials and methods: We conducted a systematic literature search in 4 databases: MEDLINE® (via PubMed®), Embase® (via Ovid®), Web of Science™ and the Cochrane Library. We included studies focused on sexual dysfunction in men of all age groups undergoing transrectal or transperineal prostate biopsy for suspicion of prostate cancer. We included studies with International Index of Erectile Function 5 scores pre-biopsy and post-biopsy at 1, 3 or 6 months. We performed an effect size meta-analysis comparing patient baseline International Index of Erectile Function 5 (IIEF-5) scores with post-biopsy IIEF-5 scores.

Results: We identified 9 studies that met our inclusion criteria, of which 6 examined transrectal prostate biopsy, 2 examined transperineal prostate biopsy and 1 examined both. At 1 month after biopsy, the mean IIEF-5 score decreased by approximately 2.2 points as determined by the effect size (-0.43, p=0.002). However, at 3 and 6 months after biopsy, there was no difference compared to baseline (effect size=-0.08, p=0.52 and effect size=-0.11, p=0.18, respectively). An exploratory subgroup analysis examining transrectal prostate biopsy at 3 months showed a statistically significantly lower mean IIEF-5 score compared to baseline (p=0.047), corresponding to an approximately 1.25-point decrease in IIEF-5.

Conclusions: Prostate biopsy does cause a mild, transient decrease in average IIEF-5 scores at 1-month post-biopsy. However, this resolves at 3 months on average, and average IIEF-5 remains at baseline at 6 months post-biopsy.