Effects of prostate biopsy on voiding and erectile function


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.

7 Responses

  1. Great!

    The ““New” Prostate InfoLink” found a new reason to oppose biopsies. Is the opinion of the “New” Prostate InfoLink” that several weeks of erectile dysfunction warrant incurring the risk of NOT detecting prostate cancer?

    The study makes no mention of the “variety of risks, among them being risks for intraprostatic bleeding and hematuria, pain, and infection” that’s The “New Prostate InfoLink” mentions.

    A large number of posts seem to be intended to discourage men from taking action to diagnose prostate cancer early by taking PSA tests and, if necessary biopsies.

    I am at loss to understand why a site dedicated to fighting prostate cancer will take such a tack.

    Perhaps Sitemaster would kindly explain his position.

  2. Dear Reuven:

    You are putting words in our mouth that we have never expressed and you are making assumptions that are not based on fact.

    First, the comment about “variety of risks, among them being risks for intraprostatic bleeding and hematuria, pain, and infection” comes from the full article in the Journal of Urology — which we have access to but which is not available unless you have a subscription to the journal. We would point out that these are well known and common complications of prostate biopsy. We are sorry if you were not aware of this.

    Second, we absolutely don’t state that men shouldn’t have biopsies. We state the results of a study carried out by a German research team that apparently specializes in the management of prostate cancer and bring the results of this study to the attention of the reader.

    Our opinions are restricted to two statements. The first is at the beginning, where we state that the data from this study “is likely to fuel concerns about some of the risks associated with prostate biopsy.” Don’t you think people like Dr. Brawley will use this study to express their opinion that prostate cancer is “over-diagnosed?” The second is at the end, where we express the opinion that patients should be aware of the risks associated with biopsies before they have them. Don’t you think patients should be well informed?

    We have absolutely no desire to “oppose biopsies.” The last sentence of the commentary above clearly states that “TRUS-guided biopsy remains a relatively well-tolerated procedure that is essential for the appropriate diagnosis of localized prostate cancer at the present time.” We do, however, wish to ensure that any patient considering any form of procedure does so with all relevant information he or she cares to seek. And we have long been warning patients of the risks associated with saturation biopsies and overly frequent multiple biopsies.

    Being an advocate for the appropriate and sound diagnosis and management of prostate cancer does not necessarily equate to the belief that every man over 30 with a PSA of 2.5 ng/ml should get a biopsy tomorrow, let alone multiple repeat biopsies if the first one happens to be negative.

  3. My husband had a biopsy for an elevated PSA 6 years ago. Thankfully it was negative. However, he has not been able to urinate since.

    After many emergency room trips he has learned to catheterize himself. Neither his urologist, surgeon, or specialist has found the problem. He catheterizes himself 6-8 times a day. Our insurance company (Humana) has refused to pay for his catheters due to no clear diagnosis.

    His PSA is once again elevated. His urologist is suggesting another biopsy. I prefer he have the EPCA-2 blood test.

  4. I would suggest you ask for (a) a free PSA test and (b) a PCA3 test before doing anything else. These should be covered by insurance. The EPCA-2 test is not (as far as I am aware) commercially available, and there are questions about its value.

    You also ought to be able to get your insurance company to pay for the catheters. Try contacting the office of your state commissioner for health insurance. The fact that there is no diagnosis of the problem doesn’t mean that there isn’t a clinical need. The problem is simple: inability to normally express urine. Tell your primary care physician that you need help appealing this decision.

  5. Regardless, this is a valuable post for men just having a biopsy….

    Three weeks ago I had a 12-core biopsy that unfortunately (fortunately?) was 5-core-positive for prostate cancer (Gleason 6). Last week I developed urination frequency problems following the biopsy and I am hopeful that this is a transient matter as a result of the biopsy. This article seems to point in that direction and, for that, this article is very useful to men. Though my urologist explained the possible complications of bleeding, I don’t remember him telling me about frequency issues with urination. This article helps in that regard and hopefully men having this procedure will be informed of this. Thanks for posting this … and I would have the biopsy again or, otherwise, how would I know and seek further treatment. This article does not dissuade me one bit from that.

  6. I had a 10-core prostate biopsy with spinal pain medicine 1.5 years ago which was negative, and I continue to experience complete erectile dysfunction. I am only 58 years old and used to love sex with my wife, but the ED has caused us to have intimacy issues, and we may separate. Now I wish I had just died from prostate cancer.

    The uologist who performed the biopsy reminded me that I read and signed the release that had side effects listed, but he does not see any possible treatment to repair the damage done to my nerves during the procedure.

  7. Dear John:

    I think you need to go see a urologist who specializes in sexual function issues. While you may not be able to recover the ability to have spontaneous erections, there are almost certainly things that could be done to allow you to recover sexual functionality.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 1,153 other followers