Is erectile function affected by multiple biopsies?

This study investigated whether multiple biopsies can influence erectile function in low-risk prostate cancer patients.

Continuous monitoring of prostate cancer (active surveillance) is becoming an increasingly common management strategy for patients with low risk cancer. It involves regularly repeating prostate biopsies (tissue removed from a living body to discover the presence or extent of cancer) to see if the cancer has grown or changed. It has been suggested that repeated prostate biopsies can lead to erectile dysfunction (difficulty in achieving or maintaining an erection), however, this remains controversial.

This study included 342 low-risk prostate cancer patients who were being continuously monitored for an average of 3.5 years. During this time patients had an average of 5 prostate biopsies. Erectile function was evaluated using a questionnaire with 6 questions relating to sexual function. The highest possible score for the questionnaire is 30, with higher scores indicating better erectile function.

While on active surveillance for 4 years patient scores only dropped slightly: 1.0 to 1.5 points per year. The use of PDE-5 inhibitors, such as sildenafil (Viagra), to help erectile function increased from 5% at the beginning of the study to 27% after 5 years of being monitored.

The authors concluded that repeated biopsies for patients on active surveillance does not have a large impact on erectile function.

As this was an observational study the authors could not separate out the effect of repeated biopsies from that of the natural aging process on erectile function.