A comparison of radiation dose to the bulb of the penis in men with and without prostate brachytherapy-induced erectile dysfunction

Merrick, Gregory S.; Wallner, Kent E.; Butler, Wayne M.; Galbreath, Robert W.; Lief, Jonathan H.; Benson, Mark L.

doi:10.1016/s0360-3016(01)01475-4

Cited by 110 publications

(39 citation statements)

References 23 publications

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“…18,[42][43][44] Radiation dose to the penile bulb has been the subject of several studies concerning radiation-induced ED. 9,10,[30][31][32] Although the results of these reports are often conflicting, there is at least some evidence to suggest that by minimizing radiation dose to the proximal penile structures, the risk of radiation-induced ED may be significantly decreased. Zelefsky et al 27 reported a 5-year actuarial risk of post-radiation ED of 60% following three-dimensional conformal beam radiation therapy (3DCRT).…”

Section: Discussionmentioning

confidence: 99%

“…Those patients who were potent before IMRT were asked to complete a second SHIM survey at least 24 months after completing treatment. ED was categorized into five categories of ED severity based on the patient's SHIM score: no ED (22)(23)(24)(25), mild ED (17-21), mild to moderate (12)(13)(14)(15)(16), moderate (8)(9)(10)(11) and severe (1-7). Patients without pretreatment SHIM scores, SHIM p10 before initiating therapy, or who received anti-androgen therapy within the last 24 months were excluded from analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Rates of ED after radical prostatectomy have been reported in the literature ranging from 29 to 91%. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The rates of ED after conventional radiation therapy range from 40 to 65%, [22][23][24][25][26][27] and the rates of ED after brachytherapy range from 16 to 50%. 28 The true etiology of ED after radiation therapy remains controversial.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

An analysis of erectile function after intensity modulated radiation therapy for localized prostate carcinoma

Brown

Brooks

Albert

et al. 2006

Prostate Cancer Prostatic Dis

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Radiation therapy for prostate cancer can cause erectile dysfunction (ED). Intensity Modulated Radiation Therapy (IMRT) can reduce the amount of radiation to surrounding tissues associated with ED. We characterize the incidence of and factors associated with ED in prostate cancer patients after IMRT at the National Naval Medical Center (NNMC). Patients potent by definition of the Sexual Health Inventory for Men (SHIM) before treatment completed the specific erectile questions of the SHIM after IMRT. Statistical analyses were performed to examine the relationships between several factors and ED. Thirty-two of 45 patients with mean age of 68.2 years (50-86 years) completed the SHIM. The median follow-up was 36.8 months (16-63.6 months) as defined by the time from completion of therapy to reassessment with the SHIM. Eight of 32 patients (25%) had no post-treatment ED (SHIM score 22-25), three of 32 (9%) had mild post-treatment ED (SHIM score 17-21), five of 32 (16%) had mild to moderate ED (SHIM score 12-16), five of 32 (16%) had moderate ED (SHIM score 8-11) and 11 of 32 (34%) had severe post-treatment ED (SHIM scoreo8). Posttreatment potency was significantly associated with the pre-treatment SHIM score (P ¼ 0.001) and history of hypertension (P ¼ 0.03). The mean radiation dose to the penile bulb and volume of penile bulb treated were not associated with post-treatment potency (P ¼ 0.38, 0.76, respectively). IMRT maintains potency in the majority of patients. This analysis compares favorably in preserving erectile function to previously reported series using conventional external beam radiation therapy techniques. The dose of radiation received by the penile bulb and volume of penile bulb were not associated with post-treatment ED in this analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An analysis of erectile function after intensity modulated radiation therapy for localized prostate carcinoma

Brown

Brooks

Albert

et al. 2006

Prostate Cancer Prostatic Dis

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“…Recent studies confirm that existing procedures can result in acute side-effects such as edema in tissue, incontinence and impotence [2,3,4]. Most of these side-effects are a result of excessive radiation and needle penetration through sensitive structures (urethra, bladder, rectum, penile bulb, cavernous veins, and neurovascular bundles) [5,6,7,4,8] In the clinical procedure for prostate HDR-BT, hollow needles are inserted one at a time into the prostate through the perineum (the region between the testicles and anus). The insertion is made manually by a physician under the guidance of a trans-rectal ultrasound probe which provides real time imaging.…”

Section: Introductionmentioning

confidence: 94%

Initial experiments toward automated robotic implantation of skew-line needle arrangements for HDR brachytherapy

Garg¹,

Siauw²,

Berenson³

et al. 2012

2012 IEEE International Conference on Automation Science and Engineering (CASE)

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Abstract-One of the goals of automation is to increase the reliability and quality of a given process. This study aims to automate high dose rate brachytherapy (HDR-BT), a radiation therapy that places radioactive sources at the site of the tumor using needles. Although HDR-BT has a high rate of clinical success in curing prostate cancer, it also has several side effects related to needle and dose trauma. A new planning algorithm from previous work optimizes needle arrangements using skewlines (non-parallel, non-intersecting lines). This paper presents initial experiments towards an automated system for implanting skew-line needle arrangements computed from a planning system. We describe the interface, calibration and integration of the robotic hardware with the planning system, and present experiments using our robotic system to implant needles into anatomically-correct tissue phantoms. Results suggest that this system can achieve HDR-BT treatment objectives with reduced trauma to organs and low demands on operator skill, thus making the procedure repeatable at lower cost. We believe that in the future, robotic HDR-BT will result in improved treatment quality with reduced dependence on physician skill.

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“…We focus on prostate treatment, where current approaches often result in side-effects such as incontinence and impotence [3], [4], [5]. Most side-effects result from needle penetration through sensitive structures (urethra, bladder, rectum, penile bulb, cavernous veins, and neurovascular bundles) [6], [7], [8], [5], [9].…”

Section: Introductionmentioning

confidence: 99%

Robot-Guided Open-Loop Insertion of Skew-Line Needle Arrangements for High Dose Rate Brachytherapy

Garg

Siauw

Berenson

et al. 2013

IEEE Trans. Automat. Sci. Eng.

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Abstract-We present a study in human-centered automation that has potential to reduce patient side effects from high dose rate brachytherapy (HDR-BT). To efficiently deliver radiation to the prostate while minimizing trauma to sensitive structures such as the penile bulb, we modified the Acubot-RND 7-axis robot to guide insertion of diamond-tip needles into desired skew-line geometric arrangements. We extend and integrate two algorithms: Needle Planning with Integer Programming (NPIP) and Inverse Planning with Integer Programming (IPIP) to compute skew-line needle and dose plans. We performed three physical experiments with anatomically-correct phantom models to study performance: two with the robot and one control experiment with an expert human physician (co-author Hsu) without the robot. All were able to achieve needle arrangements that meet the RTOG-0321 clinical dose objectives with zero trauma to the penile bulb. We analyze systematic and random errors in needle placement; total RMS error for the robot system operating without feedback ranged from 2.6 mm to 4.3 mm, which is comparable to the RMS error of 2.7 mm obtained in an earlier study for PPI-BT treatment using a robot with 3D ultrasound feedback.Note to Practitioners Brachytherapy treats cancer by delivering radioactive sources proximal to cancer sites via needles. Current methods use standardized fixed mechanical templates that force needles into parallel arrangements that may prevent needles from reaching prostate volumes blocked by the pubic arch and often require needles to puncture sensitive organs. Skew-line (non-parallel) arrangements of needles can reach targets under the pubic arch and avoid sensitive organs. However these arrangements cannot be achieved with standard templates, motivating the use of automation. We present a human-centered automation system that integrates state-of-the- Left: The current clinical approach to prostate high dose rate brachytherapy (HDR-BT) uses parallel needles guided by a mechanical template. This approach may prevent needles from reaching prostate volumes blocked by the pubic arch and often require needles to puncture sensitive organs (which can produce long-term side-effects). Right: Skew-line needle arrangements facilitated by robot guidance can avoid puncture by reaching under the pubic arch and can minimize trauma to sensitive organs such as the penile bulb which can produce side effects such as incontinence and impotence.art needle and dose planning algorithms with a modified needle insertion robot. Results suggest that the robot can achieve precision and accuracy comparable to that of expert human physician. This approach has applications to brachytherapy treatment for other organs and to other needle procedures such as biopsy and anesthetic injection.

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A comparison of radiation dose to the bulb of the penis in men with and without prostate brachytherapy-induced erectile dysfunction

Cited by 110 publications

References 23 publications

An analysis of erectile function after intensity modulated radiation therapy for localized prostate carcinoma

An analysis of erectile function after intensity modulated radiation therapy for localized prostate carcinoma

Initial experiments toward automated robotic implantation of skew-line needle arrangements for HDR brachytherapy

Robot-Guided Open-Loop Insertion of Skew-Line Needle Arrangements for High Dose Rate Brachytherapy

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