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The Impact of Prostate Biopsy on Urinary Symptoms, Erectile Function, and Anxiety

  • Benign Prostatic Hyperplasia (K McVary, Section Editor)
  • Published:
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Abstract

Transrectal ultrasound-guided prostate needle biopsy (PB) is considered the gold standard for the diagnosis of prostate cancer. Recently, lower urinary tract symptoms and erectile dysfunction have been reported following PB. We reviewed the literature on PB and these symptoms and summarized known findings between these conditions and other variables, such as periprostatic nerve block, saturation biopsy, serial biopsies, and psychological factors associated with PB and cancer. A PubMed search was performed using keywords “prostate biopsy,” “complications,” “erectile dysfunction,” “lower urinary tract symptoms,” “anxiety,” and “quality of life.” Eleven key papers are discussed and personal experience is drawn upon. Based upon available evidence, PB appears to be associated with short-term exacerbation of urinary symptoms in some men, as well as associated with anxiety and temporary erectile dysfunction, without a distinct relationship to periprostatic nerve block or the number of cores biopsied. Additional studies are warranted to determine the definitive etiology of these symptoms and to determine if interventions could reduce patient morbidity. In the interim, patients should be educated and counseled about these risks before undergoing PB.

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Abbreviations

ED:

Erectile dysfunction

HRQOL:

Health-related quality of life

IIEF:

International Index of Erectile Function

IIEF-5:

A shortened, five-item version of the IIEF (also called the Sexual Health Inventory for Men)

IPSS:

International Prostate Symptom Score

LUTS:

Lower urinary tract symptoms

PB:

Prostate biopsy

PCa:

Prostate cancer

PPNB:

Periprostatic nerve block

PSA:

Prostate-specific antigen

QOL:

Quality of life

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Hodge KK, McNeal JE, Stamey TA. Ultrasound guided transrectal core biopsies of the palpably abnormal prostate. J Urol. 1989;142(1):66–70.

    PubMed  CAS  Google Scholar 

  2. Hodge KK, et al. Random systematic vs directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989;142(1):71–4.

    PubMed  CAS  Google Scholar 

  3. Bostwick DG, Meiers I. Prostate biopsy and optimization of cancer yield. Eur Urol. 2006;49(3):415–7.

    Article  PubMed  Google Scholar 

  4. Djavan B, et al. Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol. 2001;166:856–60.

    Article  PubMed  CAS  Google Scholar 

  5. Raaijmakers R, et al. Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program. Urology. 2002;60(5):826–30.

    Article  PubMed  Google Scholar 

  6. Berger AP, et al. Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores. J Urol. 2004;171(4):1478–81.

    Article  PubMed  Google Scholar 

  7. Yu JH, et al. Evaluation of the risk factors for complications after prostate needle biopsy. Eur Urol Suppl. 2010;9(2):84–5.

    Article  Google Scholar 

  8. Stewart CS, et al. Prostate cancer diagnosis using a saturation needle biopsy technique after previous negative sextant biopsies. J Urol. 2001;166(1):91–2.

    Article  Google Scholar 

  9. Fleshner N, Klotz L. Role of "saturation biopsy" in the detection of prostate cancer among difficult diagnostic cases. Urology. 2002;60:93–7.

    Article  PubMed  Google Scholar 

  10. Boccon-Gibod LM, et al. Prostate saturation biposy in the reevalation of microfocal prostate cancer. J Urol. 2006;176:961–3.

    Article  PubMed  CAS  Google Scholar 

  11. Ashley RA, et al. Reassessing the diagnostic yield of saturation biopsy of the prostate. Eur Urol. 2008;53(5):976–83.

    Article  PubMed  Google Scholar 

  12. Rosen RC, et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.

    Article  PubMed  CAS  Google Scholar 

  13. Cappelleri JC, et al. Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology. 1999;54:346–51.

    Article  PubMed  CAS  Google Scholar 

  14. Rosen RC, et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res.1999. 1999 (11).

  15. Barry MJ, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148(5):1549–57.

    PubMed  CAS  Google Scholar 

  16. Zisman A, et al. The impact of prostate biopsy on patient well-being: a prospective study of voiding impairment. J Urol. 2001;166:2242–6.

    Article  PubMed  CAS  Google Scholar 

  17. Zisman A, et al. The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J Urol. 2001;165(2):445–54.

    Article  PubMed  CAS  Google Scholar 

  18. Bozlu M, et al. Voiding impairment after prostate biopsy: does tamsulosin treatment before biopsy decrease this morbidity? Urology. 2003;62:1050–3.

    Article  PubMed  Google Scholar 

  19. Chrisofos M, et al. Can prostate biopsies affect erectile function? Andrologia. 2006;38(3):79–83.

    Article  PubMed  CAS  Google Scholar 

  20. Berger AP, et al. Periprostatic administration of local anesthesia during transrectal ultrasound-guided biopsy of the prostate: a randomized, double-blind, placebo-controlled study. Urology. 2003;61(3):585–8.

    Article  PubMed  Google Scholar 

  21. Öbek CAN, et al. Comparison of three different methods of anesthesia before transrectal prostate biopsy: a prospective randomized trial. J Urol. 2004;172(2):502–5.

    Article  PubMed  Google Scholar 

  22. Tuncel A, et al. The impact of transrectal prostate needle biopsy on sexuality in men and their female partners. Urology. 2008;71(6):1128–31.

    Article  PubMed  Google Scholar 

  23. Aktoz T, et al. Multimodal approach to management of prostate biopsy pain and effects on sexual function: efficacy of levobupivacaine adjuvant to diclofenac sodiujm—a prospective randomized trial. Andrologia. 2009;42:35–40.

    Article  Google Scholar 

  24. • Klein T, et al. The impact of prostate biopsy and periprostatic nerve block on erectile and voiding function: a prospective study. J Urol. 2010;184(4):1447–52. This randomized trial found that prostate biopsy may cause urinary symptoms and erectile dysfunction, regardless of anesthesia or number of cores sampled.

    Article  PubMed  Google Scholar 

  25. Akyol I, Adayener C. Transient impotence after transrectal ultrasound-guided prostate biopsy. J Clin Ultrasound. 2008;36(1):33–4.

    Article  PubMed  Google Scholar 

  26. Akbal C, et al. Erectile function in prostate cancer–free patients who underwent prostate saturation biopsy. Eur Urol. 2008;53(3):540–6.

    Article  PubMed  Google Scholar 

  27. Cooperberg MR, Carroll PR, Klotz L. Active surveillance for prostate cancer: progress and promise. J Clin Oncol. 2011;29(27):3669–76.

    Article  PubMed  Google Scholar 

  28. Klotz L. Active surveillance for favorable-risk prostate cancer: background, patient selection, triggers for intervention, and outcomes. Curr Urol Rep. 2012;13(2):153–9.

    Article  PubMed  Google Scholar 

  29. • Fujita K, et al. Serial prostate biopsies are associated with an increased risk of erectile dysfunction in men with prostate cancer on active surveillance. J Urol. 2009;182(6):2664–9. This study demonstrated that men who undergo serial biopsies are at a higher risk for erectile dysfunction.

    Article  PubMed  Google Scholar 

  30. Dale W, et al. The role of anxiety in prostate carcinoma. Cancer. 2005;104(3):467–78.

    Article  PubMed  Google Scholar 

  31. Macefield RC, et al. Impact of prostate cancer testing: an evaluation of the emotional consequences of a negative biopsy result. Br J Canc. 2010;102(9):1335–40.

    Article  CAS  Google Scholar 

  32. Mehnert A, et al. Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients. Eur J Canc Care. 2010;19(6):736–45.

    Article  CAS  Google Scholar 

  33. Sharpley CF, Christie DRH, Bitsika V. Variability in anxiety and depression over time following diagnosis in patients with prostate cancer. J Psychosoc Oncol. 2010;28(6):644–65.

    Article  PubMed  Google Scholar 

  34. Franco EL, et al. Immediate risk for cardiovascular events and suicide following a prostate cancer diagnosis: prospective cohort study. PLoS Medicine. 2009;6(12):e1000197.

    Article  Google Scholar 

  35. Bill-Axelson A, et al. Suicide risk in men with prostate-specific antigen–detected early prostate cancer: a nationwide population-based cohort study from pcbase sweden. Eur Urol. 2010;57(3):390–5.

    Article  PubMed  Google Scholar 

  36. Fang F, et al. Immediate risk of suicide and cardiovascular death after a prostate cancer diagnosis: cohort study in the united states. J Natl Canc Inst. 2010;102(5):307–14.

    Article  Google Scholar 

  37. Brindle LA, et al. Measuring the psychosocial impact of population-based prostate-specific antigen testing for prostate cancer in the UK. BJU Int. 2006;98(4):777–82.

    Article  PubMed  Google Scholar 

  38. • Helfand BT, et al. Prostate cancer diagnosis is associated with an increased risk of erectile dysfunction after prostate biopsy. BJU Int. 2012. May 28. doi: 10.1111/j.1464–410X.2012.11268.x. [Epub ahead of print] This study found that men diagnosed with cancer had erectile dysfunction, while men with benign disease did not.

  39. Hayes JH, et al. Active surveillance compared with initial treatment for men with low-risk prostate cancer: a decision analysis. JAMA. 2010;304(21):2373–80.

    Article  PubMed  CAS  Google Scholar 

  40. Burnet KL, et al. Does active surveillance for men with localized prostate cancer carry psychological morbidity? BJU Int. 2007;100(3):540–3.

    Article  PubMed  Google Scholar 

  41. van den Bergh RCN, et al. Do anxiety and distress increase during active surveillance for low risk prostate cancer? J Urol. 2010;183(5):1786–91.

    Article  PubMed  Google Scholar 

  42. van den Bergh RCN, et al. Anxiety and distress during active surveillance for early prostate cancer. Cancer. 2009;115(17):3868–78.

    Article  PubMed  Google Scholar 

  43. Arredondo SA, et al. Watchful waiting and health related quality of life for patients with localized prostate cancer: data from CaPSURE. J Urol. 2004;172(5):1830–4.

    Article  PubMed  Google Scholar 

  44. Vasarainen H, et al. Prostate cancer active surveillance and health-related quality of life: results of the Finnish arm of the prospective trial. BJU Int. 2012;109(11):1614–9.

    Article  PubMed  Google Scholar 

  45. Goh AC, et al. Perception of cancer and inconsistency in medical information are associated with decisional conflict: a pilot stufy of men with prostate cancer who undergo active surveillance. BJU Int. 2011. Dec 7. doi: 10.1111/j.1464–410X.2011.10791.x. [Epub ahead of print].

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The authors report no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Alexander P. Glaser

  2. Division of Urology, John and Carol Walter Center for Urological Health, NorthShore University HealthSystem, Glenview, IL, USA

    Kristian Novakovic & Brian T. Helfand

Authors
  1. Alexander P. Glaser
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  2. Kristian Novakovic
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  3. Brian T. Helfand
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Correspondence to Brian T. Helfand.

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Glaser, A.P., Novakovic, K. & Helfand, B.T. The Impact of Prostate Biopsy on Urinary Symptoms, Erectile Function, and Anxiety. Curr Urol Rep 13, 447–454 (2012). https://doi.org/10.1007/s11934-012-0277-6

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  • DOI: https://doi.org/10.1007/s11934-012-0277-6

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