Prostate Biopsies and Erectile Dysfunction: What Men Need to Know
"Navigating the impact of serial transperineal sector prostate biopsies on long-term sexual health"
Active surveillance (AS) has become an increasingly common approach for managing low-risk prostate cancer. This strategy allows men to delay or avoid radical treatments like surgery or radiation, which can have significant side effects, including erectile dysfunction (ED). However, AS isn't without its own set of considerations. Regular prostate biopsies are a crucial part of monitoring the disease, but emerging research suggests these procedures might also impact sexual health.
A key method for monitoring prostate cancer during AS is the transperineal sector prostate biopsy (TPSBx). This procedure helps doctors assess the cancer's characteristics and detect any signs of progression. While TPSBx is generally considered safe, with short-term complications like hematuria (blood in urine) and urinary retention being relatively well-documented, the long-term effects on erectile function have been less clear. Given that men on AS often undergo multiple biopsies over several years, understanding this potential impact is essential.
A recent study published in ecancer medicalscience sheds light on the relationship between serial TPSBx and erectile dysfunction. Researchers investigated whether repeated biopsies have a lasting negative effect on men's sexual function. By following a group of men undergoing AS, they uncovered important insights that can help patients and healthcare providers make informed decisions about prostate cancer management.
What Current Evidence Shows
Research on erectile function after prostate biopsy remains active, with prospective evidence for transperineal biopsy described as limited. A 2025 comparative meta-analysis identified 22 studies reporting International Index of Erectile Function outcomes at baseline and 1, 3, and 6 months, with 12 studies included after eligibility screening. Earlier systematic reviews and meta-analyses likewise examined whether prostate biopsy affects erectile function and whether biopsy-related factors predict post-procedure erectile dysfunction. These reviews reflect variable findings in the available literature rather than a single settled estimate.
Approaches and Uncertainty
Prostate biopsy methods are used to obtain tissue for evaluation, but the available evidence does not establish that every man experiences the same sexual effects afterward. Erectile function can be influenced by the procedure itself as well as by individual health and baseline sexual function, making short-term changes difficult to interpret uniformly. Patients should therefore discuss expected recovery, potential complications, and their own risk factors with the treating clinician.
How the Evidence Developed
Concern about erectile dysfunction after prostate biopsy led researchers to conduct systematic reviews and meta-analyses because earlier reports were inconsistent. A 2020 review specifically examined sexual dysfunction within 3 months of biopsy, while another systematic review described the association between biopsy and erectile dysfunction as variable. More recent work has also examined transperineal biopsy, including a 2024 report that assessed sexually active men at 1 and 6 months and described transient erectile dysfunction in fewer than 5% of men.
Do Prostate Biopsies Really Affect Erectile Function?
The study, led by James JY Chong and colleagues, aimed to determine the long-term impact of serial TPSBx on erectile function. The research involved 64 men with prostate cancer who were enrolled in an AS program. These men had undergone an initial transrectal prostate biopsy (TRBx) and a confirmatory initial TPSBx. As part of the AS protocol, they received a repeat TPSBx 24 months later.
- Baseline: Before each TPSBx
- Short-Term: One, three, and six months after the first TPSBx
- Long-Term: One, three, and six months after the second TPSBx
Recent Comparative Research
A 2025 meta-analysis was designed to compare erectile dysfunction after transrectal and transperineal prostate biopsy at 1, 3, and 6 months. Its stated purpose was to support evidence-based counseling and shared decision-making. Separately, research on transrectal prostate needle biopsy evaluated erectile function and used power Doppler ultrasonography to examine the prostate and both neurovascular bundles. Together, these studies show that current research is assessing both patient-reported sexual outcomes and possible tissue-level effects.
Why Results Can Differ
Evidence about erectile dysfunction after prostate biopsy is not completely consistent. Differences in study design, biopsy approach, follow-up timing, baseline erectile function, and the way outcomes are measured may contribute to differing results. For that reason, a reported change after biopsy should not automatically be interpreted as proof that the biopsy alone caused persistent erectile dysfunction.
Transrectal and Transperineal Approaches
A comparative analysis by Ermis O., Sonmez G., Tozsin A., Sonmez G., Cakir O. O., Aydin A., and colleagues examines erectile dysfunction following transrectal versus transperineal prostate biopsy. The study's focus is the comparison of sexual outcomes between these two biopsy approaches. The available source information identifies the comparison but does not provide numerical results, so no specific difference between the methods can be concluded from this material alone.
What Does This Mean for Men on Active Surveillance?
The study's findings suggest that serial TPSBx may have an adverse impact on erectile function in men undergoing active surveillance for prostate cancer, potentially increasing the risk of long-term ED. While the initial TPSBx caused short-term ED that resolved within six months, repeated biopsies seemed to have a more sustained negative effect. This information is crucial for both patients and physicians when considering the benefits and risks of active surveillance.
Putting the Evidence Together
A systematic review and meta-analysis was undertaken to assess the effect of prostate biopsy on erectile function and identify biopsy-related predictors of post-procedure erectile dysfunction. Its purpose reflects the need to interpret individual studies within a broader evidence base rather than relying on one report. The most appropriate counseling therefore acknowledges that sexual effects are possible but that their frequency, duration, and predictors require careful interpretation across studies.
What Research Still Needs to Clarify
Future studies may help clarify how biopsy technique, baseline erectile function, and follow-up timing relate to sexual recovery. More consistent outcome definitions and prospective follow-up could make results easier to compare across studies. Until that evidence develops, clinicians and patients should treat estimates of post-biopsy erectile dysfunction as dependent on the population and methods studied.
Measuring Sexual Outcomes
A systematic review and meta-analysis through August 2020 pooled changes in the International Index of Erectile Function-5 compared with baseline at 1, 3, and 6 months. The researchers used a random-effects model to combine these time-specific results. This approach highlights a broader challenge: sexual effects may change over time, so both measurement choice and follow-up interval can influence the apparent impact of biopsy.
Patients' Sexual Function Matters
A prospective study evaluated erectile and ejaculatory function after transrectal ultrasound-guided prostate biopsies in sexually active men. By focusing on both erectile and ejaculatory outcomes, the study recognizes that biopsy-related sexual concerns extend beyond erections alone. Prospective assessment in sexually active participants can help describe how the procedure affects functions that matter directly to patients.