Active surveillance – the effect on erectile function

The authors aimed to determine whether taking repeated tissue samples during active surveillance can reduce erectile functioning in prostate cancer patients. 

Active surveillance is a form of prostate cancer management that involves actively monitoring tumor growth and development in a patient without administering treatment. Biopsies (tissue samples taken from the cancer site) are routinely taken to monitor tumor growth and cancer progression. 

The authors aimed to determine whether frequent biopsies can impact erectile function in prostate cancer patients.

342 patients were used in this study with an average follow-up time of 3.5 years.

Five years after beginning active surveillance, 70 patients went on to further treatment where 23% received prostate surgery (surgical removal of the prostate gland) and 10% received radiation therapy (involves directing a beam of radiation at the tumor site in order to kill cancer cells with minimal damage to healthy cells).

During the first year after beginning active surveillance, patients experienced a decrease in erectile functioning which continued to decrease per year of surveillance. Erectile dysfunction was increased in patients who had comorbidities or in patients who received frequent biopsies compared to patients with no comorbidities and who underwent fewer biopsies. The most common comorbidities (secondary diseases as well prostate cancer) were high blood pressure (41%) and high levels of fat in the blood (44%).

Phosphodiesterase type 5 inhibitor (PDE5 inhibitors – drugs used to treat erectile dysfunction that are taken prior to sexual activity, for example tadalafil (Adcirca, Cialis), sildenafil (Viagra) and lodenafil (Helleva)) use increased from 5% at the start of the study to 27% after 5 years of active surveillance.

The authors concluded that patients who underwent active surveillance experienced a small decrease in erectile function and an increase in PDE5 inhibitor use (drugs used to help with erectile dysfunction). 

Further studies are required to determine the effect of biopsy on erectile function in active surveillance.

If you are considering active surveillance as a prostate cancer management option, please consult your doctor for potential risks and benefits.