<jats:sec><jats:title>What's known on the subject? and What does the study add?</jats:title><jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>There have been several studies that have suggested there may be a relationship between prostate biopsy and erectile function and <jats:styled-content style="fixed-case">LUTS</jats:styled-content>. Previous studies have suggested a specific association between the type of local anaesthesia administered and/or the number of biopsies performed. Other studies have suggested an exacerbation of <jats:styled-content style="fixed-case">LUTS</jats:styled-content> after prostate biopsy.</jats:p></jats:list-item> <jats:list-item><jats:p>The present study identifies a positive cancer diagnosis as a novel characteristic that may explain a relationship between biopsy and worsening erectile function.</jats:p></jats:list-item> </jats:list></jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>To evaluate prospectively the characteristics, erectile function and lower urinary tract symptoms (<jats:styled-content style="fixed-case">LUTS</jats:styled-content>) of men undergoing prostate needle biopsy (<jats:styled-content style="fixed-case">PNBx</jats:styled-content>).</jats:p></jats:list-item> </jats:list></jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>From 2008 to 2011, 134 men were prospectively administered the International Index of Erectile Function (<jats:styled-content style="fixed-case">IIEF</jats:styled-content>), American Urological Association Symptom Index (<jats:styled-content style="fixed-case">AUA‐SI</jats:styled-content>), and quality‐of‐life (<jats:styled-content style="fixed-case">QoL</jats:styled-content>) questionnaires before and after undergoing a single 12‐core <jats:styled-content style="fixed-case">PNBx</jats:styled-content>.</jats:p></jats:list-item> <jats:list-item><jats:p>Comparisons of <jats:styled-content style="fixed-case">IIEF</jats:styled-content> and <jats:styled-content style="fixed-case">AUA‐SI</jats:styled-content> scores before and after <jats:styled-content style="fixed-case">PNBx</jats:styled-content>, based upon baseline characteristics and prostate cancer (<jats:styled-content style="fixed-case">PCa</jats:styled-content>) diagnosis, were performed.</jats:p></jats:list-item> <jats:list-item><jats:p>Univariable and multivariable logistic regression models were used to characterize predictors of change in <jats:styled-content style="fixed-case">IIEF</jats:styled-content> scores.</jats:p></jats:list-item> </jats:list></jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>In the 85 men who fulfilled the inclusion criteria, there were no significant differences between the mean (<jats:sc>sd</jats:sc>) total pre‐biopsy and the mean (<jats:sc>sd</jats:sc>) post‐biopsy <jats:styled-content style="fixed-case">IIEF</jats:styled-content> scores: 57.8 (12.9) vs 54.3 (17.2).</jats:p></jats:list-item> <jats:list-item><jats:p>Subgroup analysis showed that men who had biopsy‐proven <jats:styled-content style="fixed-case">PCa</jats:styled-content> had significantly greater changes in their post‐biopsy <jats:styled-content style="fixed-case">IIEF</jats:styled-content> scores compared with men without (−10.1 vs. 1.0; <jats:italic>P</jats:italic> < 0.001).</jats:p></jats:list-item> <jats:list-item><jats:p>After specific analyses of the <jats:styled-content style="fixed-case">IIEF</jats:styled-content> domains in these groups we found significant decreases in every domain, including erectile function (<jats:italic>P</jats:italic> = 0.01). On multivariate analyses, only <jats:styled-content style="fixed-case">PCa</jats:styled-content> diagnosis was associated with a significant change in <jats:styled-content style="fixed-case">IIEF</jats:styled-content> (odds ratio 7.2; <jats:italic>P</jats:italic> = 0.003).</jats:p></jats:list-item> <jats:list-item><jats:p>There were no differences in <jats:styled-content style="fixed-case">AUA‐SI</jats:styled-content> or <jats:styled-content style="fixed-case">QoL</jats:styled-content> scores in the overall population or in subgroups.</jats:p></jats:list-item> </jats:list></jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p><jats:list list-type="bullet"> <jats:list-item><jats:p>Cancer diagnosis appears to have an adverse effect on the erectile function of men undergoing <jats:styled-content style="fixed-case">PNBx</jats:styled-content> but no effect on <jats:styled-content style="fixed-case">LUTS</jats:styled-content>. This study highlights a potential negative psychological confounder that may influence erectile function before the treatment of <jats:styled-content style="fixed-case">PCa</jats:styled-content>.</jats:p></jats:list-item> <jats:list-item><jats:p>Additional prospective trials evaluating these relationships are warranted.</jats:p></jats:list-item> </jats:list></jats:p></jats:sec>