(576) Harm Done? A Prospective Evaluation of Sexual Outcomes After Transperineal Prostate Biopsy

Introduction Prostate cancer (PCa) is the second most common malignancy among men worldwide. Transrectal (TR) prostate biopsy has long been the standard diagnostic method but is associated with infection, bleeding, and a false-negative rate of up to 49%. In contrast, transperineal (TP) biopsy offers a lower infection risk and higher accuracy in detecting clinically significant PCa, particularly in MRI-guided procedures. Despite these advantages, little is known about the potential short-term impact of TP biopsy on sexual function. Both erectile and ejaculatory dysfunctions (ED and EjD) have been reported after prostate biopsy, yet the evidence remains conflicting. This study aimed to prospectively assess erectile and ejaculatory function following TP prostate biopsy in sexually active men using validated questionnaires. Objective To evaluate the impact of transperineal prostate biopsies (TP-Bx) on erectile and ejaculatory function in sexually active men. Methods This prospective study included adult male patients who underwent TP prostate biopsy between April 2024 and May 2025. Indications included elevated PSA (>4 ng/mL), abnormal digital rectal examination, or suspicious MRI findings (PIRADS ≥3). Baseline data (age, BMI, Charlson Comorbidity Index, PSA, and biopsy cores) were collected. Sexual function was evaluated using the International Index of Erectile Function (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the short form of the Male Sexual Health Questionnaire–Ejaculatory Dysfunction (MSHQ-EjD-SF) before the biopsy, and at 1 and 3 months post-procedure. Results A total of 249 men were analyzed. The median age was 66.0 years (IQR 61.5–69.5), BMI 25.8 (23.9–27.3), PSA 8.3 ng/mL (5.6–12.2), and median biopsy core number was 12. Prostate cancer was diagnosed in 132 patients (53%). Across the entire cohort, there were no significant changes in erectile or ejaculatory function scores at 1 and 3 months compared to baseline. Median IIEF-5 scores remained stable at 11.0 (IQR 8.0–13.0) at all time points (T1 vs. T2, p=0.266; T1 vs. T3, p=0.322). PEDT and MSHQ-EjD-SF scores also showed no significant differences over time (p>0.05 for all). In contrast, in the subgroup of 132 patients diagnosed with prostate cancer, significant deterioration was observed. Median IIEF-5 scores decreased from 11.0 (IQR 8.0–13.0) at baseline to 10.0 (IQR 7.0–12.0) at both 1 and 3 months (p<0.001). PEDT scores increased from 10.0 (IQR 8.0–13.0) to 12.0 (IQR 9.0–14.0) (p<0.001), while MSHQ-EjD-SF scores declined from 13.0 (IQR 11.0–14.0) to 12.0 (IQR 10.0–13.0) (p<0.001). Conclusions Transperineal prostate biopsy appears to have minimal overall impact on erectile and ejaculatory function. However, patients diagnosed with prostate cancer exhibited significant short- and mid-term declines in sexual function, suggesting that psychological stress associated with cancer diagnosis, along with possible neurovascular irritation, contributes to these changes. Structured follow-up and psychosocial counseling should be considered in this subgroup to mitigate post-biopsy sexual dysfunction. Disclosure No