Prostate biopsy may affect semen parameters

New Orleans-Transrectal ultrasound-guided biopsy of the prostate appears to have an immediate impact on the semen parameters of reproductive-age men, according to findings from a small study from Beth Israel Medical Center, New York. However, these effects were transient in all but one patient.

First author Andrew D. Smith, MD, working with Harris M. Nagler, MD, said while most men will suffer no harm, the fact that one of nine patients experienced persistent changes beyond 4 months should raise concerns.

"Although changes in semen parameters were observed in only one patient, this may represent significant risk for a younger patient undergoing transrectal ultrasound-guided prostate biopsy," Dr. Smith, senior urology resident at Beth Israel Medical Center, said at the American Society for Reproductive Medicine annual meeting here. "These effects should be considered when recommending biopsy."

"We hypothesized that the trauma caused by biopsy can either directly injure the ejaculatory duct or cause damage around the duct, causing scarring and inflammation and thus impairing semen parameters," he said. "We are not saying all patients will have this result. But there are patients who may be adversely affected. We found one patient with a significant drop in semen parameters that could affect fertility."

The prospective study involved nine men (mean age, 58 years) who submitted semen for analysis 1 week before (first specimen) and 1 week after (second specimen) undergoing transrectal ultrasound-guided prostate biopsy. An additional specimen was collected 2 to 4 months following the biopsy (third specimen) to assess long-term changes in semen parameters. Periods of ejaculatory continence were controlled. Semen was assessed for semen volume, sperm concentration, total counts, and total motile sperm counts.

From the first to second specimen (1 week), at least three of four semen parameters were reduced in five of the patients and were increased in three of the patients. In one patient, two semen parameters declined and two increased. Five patients submitted samples 2 to 4 months after biopsy. In these patients, one had three of four parameters decreased and four experienced an increase in at least three of four parameters.

For patients who experienced decreases in semen parameters, the following mean reductions were observed, per group: 37% reduction in semen volume, 35% reduction in sperm concentration, 20% reduction in sperm count, and 32% reduction in sperm motility.

Of the five who submitted a third sample, four had semen parameters return to baseline, but one had persistent reductions.

"We believe this may indicate direct trauma or peri-ejaculatory duct fibrosis," Dr. Smith suggested.

"Because of the age-adjusted threshold for PSAs, we are tending to biopsy younger men who are more likely to be interested in fertility," added Dr. Nagler, professor of urology at Albert Einstein College of Medicine and chairman of the department of urology at Beth Israel. "Our data suggest there will be the occasional patient who might be harmed by this biopsy. The potential effect of prostate biopsy should be discussed with men who are undergoing biopsy and may be interested in future fertility."