The prostate is a tiny organ surrounded by critical vessels controlling sexual and urinary function. If radiation therapy delivers dose to any surrounding structures, erectile dysfunction and bladder and renal irritation can result. Vessel-sparing radiation and an improved understanding of the anatomy of the prostate can reduce sexual dysfunction.1
“We always have to keep cure as our first priority, but quality of life is a major secondary concern for men with prostate cancer,” said Patrick W. McLaughlin, MD, professor of radiation oncology at the University of Michigan Medical School, Ann Arbor, Michigan, and senior author.
“In the past cure came at a steep price in lost quality of life, but with modern refinements it is increasingly possible to meet the new standard of successful prostate cancer treatment: cure with quality of life.”
In a review in Lancet Oncology, the authors describe the importance of functional anatomy in determining plans of treatment with radiation oncologists that can spare critical urinary and sexual structures. Functional anatomy can vary from patient to patient.
MRIs can enable radiation oncologists to administer vessel-sparing radiation by showing the distinct functional anatomy of a patient. In addition, MRIs can inform the best treatment options. For example, if the tumor is outside the prostate gland, then radiation therapy should be administered after surgery.
Vessel-sparing radiation would require physicians to train in MRI anatomy so that they could properly identify key structures.
“The benefit of the functional anatomy approach goes well beyond improving sexual function. It has improved urinary and rectal function as well,” explained McLaughlin.
Vessel-sparing radiation can preserve sexual function in 90% of men at the 5-year follow-up while achieving excellent rates of successful treatment of aggressive disease.
MRIs can play an integral role in guiding not only vessel-sparing but also overall treatment approaches.
“For patients who appear to have slow-growing, non-aggressive cancers, MRI can confirm there is no aggressive cancer present. For such patients, surveillance is an excellent choice. By avoiding treatment altogether when appropriate, all the side effects and quality of life impact from treatment is avoided,” said McLaughlin.
“On the other end of the spectrum, MRI may actually reveal more serious cancers not sampled by the biopsy. This can shift treatment to a more aggressive approach necessary to cure such cancers.”
1. Lee JY, Spratt DE, Liss AL, McLaughlin PW. Vessel-sparing radiation and functional anatomy-based preservation for erectile function after prostate radiotherapy. Lancet Oncol. 2016;17(5):e198-e208. doi:10.1016/S1470-2045(16)00063-2.