Because the association between erectile dysfunction (ED) 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 six months of prostate biopsy.
We conducted a systematic literature search in four databases [MEDLINE (via PubMed), Embase (via Ovid), Web of Science, and The Cochrane Library] and included studies focused on sexual dysfunction in men of all age groups undergoing transrectal (TRUS) or transperineal (TPBx) prostate biopsy for suspicion of prostate cancer. We included studies with the International Index of Erectile Function 5 (IIEF-5) scores pre-biopsy and post-biopsy at 1, 3, or 6 months. We performed an effect size meta-analysis comparing patients' baseline IIEF-5 with post-biopsy IIEF-5.
We identified nine studies that met our inclusion criteria, of which 6 examined TRUS, 2 examined TPBx, and 1 examined both. At 1-month after biopsy, the mean IIEF-5 decreased by approximately 2.2 points as determined by the effect size (-0.43, p=0.002). However, at 3 and 6-months post-biopsy, there was no difference compared to baseline (effect size=-0.08 with p=0.52 and effect size=-0.11 with p=0.18, respectively). An exploratory subgroup analysis examining TRUS 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.
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.
The Journal of urology. 2020 Oct 07 [Epub ahead of print]
J Fainberg, C D Gaffney, H Pierce, A Aboukhshaba, Bilal Chughtai, P Christos, J A Kashanian
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York., Department of Health Policy and Research, Weill Cornell Medical College, New York, New York.