A new study from a German research group is likely to fuel concerns about some of the risks associated with prostate biopsy.
This newly published study by Klein et al. reports on the adverse effects associated with multiple core prostate biopsy, and most particularly the effects on voiding of urine and erectile function in the 3-month period immediately following biopsy. Additional commentary is also available in a Reuters Health report on the Yahoo News web site.
Klein et al. report on information gathered from a series of 198 men who received prostate biopsies with local (lidocaine) anesthesia between September 2008 and January 2009. The patients were categorized into one of three groups:
- Patients in Group 1 ( n = 71) all received a standard 10-core TRUS-guided biopsy.
- Patients in Group 2 (n = 74) all received a standard 10-core TRUS-guided biopsy but with a periprostatic nerve block (using prilocaine hydrochloride).
- Patients in Group 3 (n = 53) all had a history of prior negative biopsy and received a 20-core saturation biopsy with a periprostatic nerve block (again using prilocaine hydrochloride).
Eighty of the original 198 patients were diagnosed with prostate cancer based on their biopsy results and were therefore excluded from further analysis of the complications of biopsy since most went on to receive some form of therapy that is known to affect erectile and voiding function (even if only transiently).
The basic results of this study are therefore based on the 118 patients who had a negative biopsy, as follows:
- Compared to pre-biopsy levels, the median International Prostate Symptom Score (IPSS) was significantly increased in all patients at 1 week post-biopsy.
- This effect was still evident at 4 weeks and 12 weeks post-biopsy among the patients in Group 3 (the saturation biopsy patients).
- Compared to pre-biopsy levels, patients in Group 2 also had a higher median IPSS score at 4 and 12 weeks post-biopsy, but this effect was not statistically significant.
- Compared to pre-biopsy levels, the median International Index of Erectile Function (IIEF-5) score was significantly decreased in all patients at week 1 post-biopsy.
- This effect was still evident at 4 weeks post-biopsy in Groups 1 and 2 but (perhaps surprisingly) not in Group 3.
- Quality of life was significantly affected at all times after biopsy for patients in Group 3.
The authors conclude that prostate biopsy causes impaired voiding function in all patients, but particularly in those who receive a periprostatic nerve block and/or a saturation biopsy, where the effect appears to last for several weeks. In addition, prostate biopsy also affects erectile function, regardless of the use of periprostatic function or the number of biopsy cores.
This paper includes a significant amount of more detailed information. Like some other recent papers it appears to give us much greater insight into issues that have rarely been addressed before but which have significant potential to impact the appropriateness and the frequency of the use of prostate biopsy in individuals.
It has been well understood that prostate biopsy comes with a variety of risks, among them being risks for intraprostatic bleeding and hematuria, pain, and infection. The association of prostatic biopsy with voiding dysfunction has been studied in the past, but these have been very few data on the risk for erectile dysfunction.
This study would seem to suggest that voiding dysfunction and erectile dysfunction are generally temporary, short-term complications of a prostate biopsy. However, The “New” Prostate InfoLink would concur with the authors of this article that patients need to be made aware of the potential complications of prostate biopsy before agreeing to this procedure. Most importantly, patients undergoing saturation biopsy need to be fully informed about the risk for prolonged difficulty with voiding of urine. With these reservations, TRUS-guided biopsy remains a relatively well-tolerated procedure that is essential for the appropriate diagnosis of localized prostate cancer at the present time.