Mechanisms, mitigation, and management of urinary toxicity from prostate radiotherapy

Martin, Jarad; Richardson, Matthew; Siva, Shankar; Cardoso, Michael; Handmer, Marcus; Sidhom, Mark

doi:10.1016/s1470-2045(22)00544-7

Cited by 14 publications

(12 citation statements)

References 73 publications

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“…76 However, RT caused much less damage to the surrounding muscles and nerves. 77,78 As for sexual function, RP had been shown to cause erectile dysfunction by damaging the pelvic plexus, which provides autonomic innervation to the corpus cavernosum. 57,79 In addition, the surgical procedure is usually accompanied by extensive dissection of lymph nodes, including the internal iliac region and the common iliac region.…”

Section: Discussionmentioning

confidence: 99%

“…On the side, postoperative overactivity of the detrusor and shortening of urethral length postoperatively could also contribute to incontinence, 74,75 which occurs when the relative stiffness of the reconstructed urethra is insufficient and the biomechanical response is impaired 76 . However, RT caused much less damage to the surrounding muscles and nerves 77,78 …”

Section: Discussionmentioning

confidence: 99%

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Effects of surgery versus radiotherapy in patients with localized prostate cancer in terms of urinary, bowel, and sexual domains

Yao

et al. 2023

Cancer Medicine

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BackgroundThe health‐related quality of life (HRQoL) of patients with localized prostate cancer (LPCa) after treatment mainly surgery and radiotherapy (RT) has received increasing attention. The aim of this study is to compare the HRQoL of LPCa after surgery and RT.MethodsWeb of Science, Embase, PubMed and Cochrane databases were searched after January 2000 to observe the HRQoL scores after surgery and RT at different treatment time points.ResultsA total of 28 studies were included in this study, and the results showed that LPCa received surgery had better bowel scores than RT at ≤3 (weighted mean differences [WMD] = 4.18; p = 0.03), 3–6 (WMD = 4.16; p < 0.001), 6–12 (WMD = 2.99; p = 0.004), 24–60 (WMD = 1.87; p = 0.06), and ≥60 (WMD = 4.54; p = 0.02) months. However, LPCa received RT had higher urinary scores at ≤3 (WMD = −7.39; p = 0.02), 3–6 (WMD = −6.03; p = 0.02), 6–12 (WMD = −4.90; p < 0.001), 24–60 (WMD = −3.96; p < 0.001), ≥60 (WMD = −2.95; p < 0.001) months and had better sexual scores at ≤3 (WMD = −13.58; p = 0.09), 3–6 (WMD = −12.32; p = 0.06), 6–12 (WMD = −12.03; p = 0.002), 24–60 (WMD = −11.29; p < 0.001), and ≥60 (WMD = −3.10; p = 0.46) months than surgery. The scores difference between surgery and RT decreased over time.ConclusionOverall, for LPCa, surgery was associated with better HRQoL in the bowel domain, whereas RT was associated with better HRQoL in the urinary and sexual domains, with the difference between surgery and RT narrowing over time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of surgery versus radiotherapy in patients with localized prostate cancer in terms of urinary, bowel, and sexual domains

Yao

et al. 2023

Cancer Medicine

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“…[1][2][3] Studies have reported that a significant number of pelvic cancer patients develop acute bladder toxicity reactions during treatment, ranging from 29% to 50%. [4][5][6][7] In addition, the incidence of severe urinary radiation injury may be more than 20% in long-term survivors of pelvic cancer. [6][7][8] Therefore, it is essential to investigate the factors that cause urologic radiation injury and to reduce its incidence to improve the quality of life of pelvic cancer patients.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, exfoliation, ulceration, and necrosis of the urethral epithelium, along with dilation and fibrosis of the submucosal capillaries, can cause progressive and irreversible urologic damage approximately 6 months after radiotherapy 1–3 . Studies have reported that a significant number of pelvic cancer patients develop acute bladder toxicity reactions during treatment, ranging from 29% to 50% 4–7 . In addition, the incidence of severe urinary radiation injury may be more than 20% in long‐term survivors of pelvic cancer 6–8 .…”

Section: Introductionmentioning

confidence: 99%

Multiscale spatial relationship‐based model for predicting bladder wall dose in pelvic radiotherapy

Gao,

Ge,

Gao

et al. 2023

J Applied Clin Med Phys

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PurposeThis research aimed to develop a prediction model to assess bladder wall dosimetry during radiotherapy for patients with pelvic tumors, thereby facilitating the refinement and evaluation of radiotherapy treatment plans to mitigate bladder toxicity.MethodsRadiotherapy treatment plans of 49 rectal cancer patients and 45 gynecologic cancer patients were collected, and multiple linear regression analyses were used to generate prediction models for bladder wall dose parameters (, ). These models were based on the multiscale spatial relationship between the planning target volume (PTV) and the bladder or bladder wall. The proportion of bladder or bladder wall volume overlapped by the different distance expansions of the PTV was used as an indicator of the multiscale spatial relationship. The accuracy of these models was verified in a cohort of 12 new patients, with further refinement of radiotherapy treatment plans using the predicted values as optimization parameters. Model accuracy was assessed using root mean square error (RMSE) and mean percentage error (MPE).ResultsModels derived from individual disease data outperformed those derived from combined datasets. Predicted bladder wall dose parameters were accurate, with the majority of initial calculated values for new patients falling within the 95% confidence interval of the model predictions. There was a robust correlation between the predicted and actual dose metrics, with a correlation coefficient of 0.943. Using the predicted values to optimize treatment plans significantly reduced bladder wall dose (p0.001), with bladder wall and decreasing by 2.27±0.80 Gy (5.8%±1.8%) and 2.96±2.05 cm3 (7.9%±5.4%), respectively.ConclusionThe formulated prediction model provides a valuable tool for predicting and minimizing bladder wall dose and for optimizing and evaluating radiotherapy treatment plans for pelvic tumor patients. This approach holds promise for reducing bladder toxicity and potentially improving patient outcomes.

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“…There are two major considerations when making the optimum treatment option for prostate cancer, tumor control probability (TCP) and quality of life (QOL). Sexual function is a major factor to affect patients’ QOL ( Martin et al, 2022 ). The authors investigated a total of 2340 prostate cancer patients who received either EBRT or BT.…”

mentioning

confidence: 99%

Editorial: The development of lethal prostate cancer

Zhang

et al. 2023

Front. Cell Dev. Biol.

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Mechanisms, mitigation, and management of urinary toxicity from prostate radiotherapy

Cited by 14 publications

References 73 publications

Effects of surgery versus radiotherapy in patients with localized prostate cancer in terms of urinary, bowel, and sexual domains

Effects of surgery versus radiotherapy in patients with localized prostate cancer in terms of urinary, bowel, and sexual domains

Multiscale spatial relationship‐based model for predicting bladder wall dose in pelvic radiotherapy

Editorial: The development of lethal prostate cancer

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