The Effect of Prostate Biopsy on Erectile Functions

Abstract

Prostate cancer (PCa) is the most common malignancy among men in the United States of America (USA). Tissue samples should be taken from different parts of prostate by transrectal ultrasound guided prostate needle biopsy (TPND) and these samples should be examined histopathologically for the diagnosis of PCa. In recent years, the serum prostate specific antigen (PSA) measurement and number of prostate biopsies performed have become more frequent. Re-biopsy should be considered in the patients with persistent high serum prostate specific antigen level and/or abnormal digital rectal examination without malignancy in first biopsy, the patients with multiple high grade prostatic intraepithelial neoplasia (PIN) and/or atypical small acinar proliferation (ASAP) in first biopsy, the patients on active surveillance (AS). TNPB is not a fully innocent method. ED has been always neglected as a complication following TPNB. There is an increasing tendency towards relationship between ED after TPNB. The studies including relationship between ED after TNPD are evaluated in this review. The possible etiological factors of permanent erectile dysfunction (ED) after prostate needle biopsy are pyschological and organic factors. Temporary inflammatory and neurovascular damage are likely important, possibly combined with the impact of TPNB. Furthermore increased anxiety at the time of screening, biopsy, and immediately following biopsy. Also other possible etiological factors are number of needle cores, use of periprostatic nerve block, disease involving neurovascular bundles. In light of literature, there is a strong relationship between ED after TPNB but the exact etiology is stil conflicting.