With MRI-guided stereotactic body radiation planning, radiation oncologists could help minimize radiation to pivotal structures involved in erectile function, new data suggest.
Among patients with prostate cancer who received MRI-guided stereotactic body radiation therapy , more than 80% demonstrated “classic” neurovascular bundle patterns and over 96% showed more than 1-cm separation of internal pudendal arteries from the prostate.
These findings indicated that most patients have favorable anatomic patterns that would allow radiation oncologists to minimize radiation to structures involved in erectile function and help reduce patients’ risk for posttreatment erectile dysfunction.Erectile dysfunction is a common side effect for men with prostate cancer who undergo SABR. Radiation-related damage to critical nearby structures, such as the neurovascular bundles and internal pudendal arteries, likely contributes to this issue. Identifying these structures on MRI during radiation planning can minimize exposure during SABR and reduce the risk for erectile dysfunction. Researchers analyzed 160 consecutive patients with prostate cancer who underwent MRI-linear accelerator-based SABR between January and December 2024. Based on the MRI scans, researchers classified neurovascular bundle patterns into classic , adherent , or absent. Researchers also measured the shortest distance between internal pudendal arteries to the prostate capsule and the membranous urethral length and compared imaging features by prostate volumes, Prostate Imaging Reporting and Data System scores, lesion locations, and Gleason grade group.The classic neurovascular bundle pattern was the most common, present in 80% of right-sided and 85% of left-sided evaluations, while adherent neurovascular bundles were less common, observed in 18.1% of right-sided and 13.8% of left-sided scans. The median shortest distance between internal pudendal arteries and the prostate capsule was 2.3 cm on both sides, with only 3.1% to 3.8% of patients having a distance less than 1.0 cm. The median membranous urethral length was 1.5 cm, with only 2.5% of men having one shorter than 1.0 cm. Researchers found no significant association between these MRI features and prostate volumes of greater or less than 40 mL, PI-RADS scores, zonal location of the dominant intraprostatic lesion, and Gleason grade on pathology.“Most patients with prostate cancer undergoing SABR demonstrated favorable anatomy of the critical structures, potentially important for potency preservation,” the authors wrote, reflecting on the fact that real-time adaptive planning, especially with MRI-guided radiotherapy, has potential for helping “identify, define, and effectively dose-constrain these critical structures.”The study was conducted at a single institution, which may limit the generalizability of the findings. Additionally, the analysis excluded patients with prior prostate-directed treatments, artifacts on MRI scans, and extraprostatic extension or those without diagnostic multiparametric MRI scans, restricting applicability to patients with more advanced disease or suboptimal imaging.This study did not receive any specific funding. One author disclosed serving as a consultant for Boston Scientific. The other authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our
Malignant Prostate Neoplasm Prostate Cancer Cancer Of The Prostate Prostatic Arteries Cancer Malignant Neoplasia Carcinoma Malignant Neoplasm Scan Erectile Dysfunction Impotence Erectile Dysfunction (ED) Radiation Therapy Radiotherapy Radiation Oncology Urethral Adverse Effects Side Effects Anatomy Artificial Intelligence Deep Learning AI NPL Machine Learning
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