Radiation-induced erectile dysfunction in patients with prostate cancer: current methods of radiotherapy

Novikov, Roman; Новиков, С. Н.; Protoshchak, Vladimir V.; Джалилов, И. Б.

doi:10.17650/1726-9776-2020-16-3-143-152

Onkourologiâ

2020

DOI: 10.17650/1726-9776-2020-16-3-143-152

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Radiation-induced erectile dysfunction in patients with prostate cancer: current methods of radiotherapy

Roman Novikov¹,

С. Н. Новиков²,

Vladimir V. Protoshchak³

et al.

Abstract: In recent years, significant changes have taken place in the treatment of prostate cancer. Modern radiation treatment technologies are beginning to take a leading position not only in localized and locally-advanced forms of the disease, but also in the case of oligometastatic process. This encourages a natural interest in various aspects of radiation therapy of prostate cancer, in particular its effects on erectile function status. Analysis of domestic literature shows the complete absence of publications on t… Show more

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Cited by 3 publications

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PRIAPOS trial: new conception of pathogenesis of post-brahytherapy erectile dysfunction

2021

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Objective: to study the anatomical-topographical relationship between the prostate gland (PG) and the vascular structures responsible for erection, to justify the new concept of erectile dysfunction pathogenesis after brachytherapy of prostate cancer (PCa).Materials and methods. The study included 66 patients with verified or suspected PCa. All patients performed magnetic resonance imaging 1.5 T in accordance with the established protocol (hybrid method of visualization of internal pudendal arteries (IPA)). 16 patients simultaneously performed computed tomography on a topometric tomography. The resulting images were analyzed using the Eclipse 4.0 (Varian Medical System, USA) system, which provides 3D models of PG, pelvic bones and critical structures of interest: IPA, cavernous crura and penile bulb.Results. The average volume of PG was 44.9 ± 18.7 (14.4—98.0) cm3. The width of penile bulb was 1.83 ± 0.38 (1.1—2.93) cm. According to the implantation technique of in brachytherapy, the damage to penile bulb can be observed in less than a fifth of patients — 18.5 % of cases.Analysis of the 3D models showed that the overlay of the distal third of the IPA on the predominantly anterior and, in part, lateral aspects of the PG was noted in 58 (87.9 %) of 66 observations. The average value of PG in a group with no interference was 25.7 ± 3.9 (18.2—29.9) cm3, with its presence — 47.6 ± 18.4 (14.4—98.0) cm3. The average length of the IPA, coinciding with the projection of the PG on the right and left is virtually no different (p >0.05) and is about 2.5 cm, and the maximum remote point of this combination lies in relation to the outer contour of the gland within 1 cm. The correlation analysis showed a strong direct correlation between the volume of PG with all the parameters of mutual spatial anatomy of the prostate and IPA (R = 0.63—0.71; p <0.0001).Conclusion. The anatomical-topographical relationship between PG and critical structures, among which the IPA plays a special role, points to the likely predominantly traumatic genesis of erectile dysfunction after PCa brachytherapy, as well as a number of other invasive procedures performed by perineal access (saturation biopsy).

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PRIAPOS trial: new conception of pathogenesis of post-brahytherapy erectile dysfunction

2021

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Technologies to reduce radiation toxicity in prostate cancer patients: spacers - a simple and effective solution

Novikov

Новиков

2021

Onkourologiâ

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The basic principles of the treatment of prostate cancer patients have underwent significant revisions in recent years. Modern radiotherapy techniques, which have demonstrated high efficacy and safety in long-term randomized trials, are beginning to take a leading position in the treatment of prostate cancer in an overwhelming number of clinical scenarios (National Comprehensive Cancer Network, 2021). Despite the obvious successes of radiation oncology, a number of important problems remain unresolved, first of all - the need to reduce the rates of radiation complications. The topographical anatomy of the prostate gland determines the main profiles of post-radiation damage: rectal and genitourinary radiation toxicity. The previous five years have been marked by a significant intensification of research work abroad aimed at clinical testing of a number of biopolymer compositions and products for use as spacers between irradiated structures and normal tissues. The experience has made it possible for the first time to consider the possibility of using spacers in radiotherapy treatment of prostate cancer in the modern recommendations of the European Association of Urology (2021). The analysis of the national literature shows a complete lack of publications on the possibilities of optimizing the radiation treatment of prostate cancer through the use of specers. The purpose of this work was the need to highlight this important and perspective clinical problem.

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Methodological aspects of implantation of a Russian prostate-rectum spacer based on stabilized hyaluronic acid of non-animal origin

Novikov,

Zhivulina,

Sysoeva

et al. 2024

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Over the past few years, the use of spacers to optimize radiation treatment of prostate cancer has become increasingly popular in radiotherapy practice. In Russia, the experience of clinical application of this technology is small and limited to few trials at federal centers. The technique of perineal implantation of a biodegradable spacer is invasive and requires the participation of specialists with appropriate manual skills. Therefore, informing urologists, urologic oncologists, and interventional radiologists on the methodological aspects of this procedure has significant practical importance.The purpose of this work is to describe the methodology of using a new Russian medical device as a biodegradable spacer – a monophasic implantable gel (hydrogel) based on stabilized (cross-linked) hyaluronic acid of non-animal origin (EsteFILL intim), which makes it possible to reduce radiation exposure to the anterior wall of the rectum and has other positive effects (increased accuracy of radiation delivery, reduced risks of radiation-induced erectile dysfunction) in different radiotherapy methods of prostate cancer treatment. The described procedure was developed and approved at the Department of Radiotherapy of the N.N. Petrov National Medical Research Center of Oncology. The design of the study implying implantation of the stabilized non-animal hyaluronic acid (EsteFILL intim) was approved by the local ethics committee (protocol No. 16 dated 21.09.2023) and approved as a promising research work at the meetings of the Problem Commission (protocol No. 125 dated 25.09.2023) and the Academic Council of the N.N. Petrov National Medical Research Center of Oncology (protocol No. 8 dated 26.09.2023).

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Radiation-induced erectile dysfunction in patients with prostate cancer: current methods of radiotherapy

Cited by 3 publications

References 59 publications

PRIAPOS trial: new conception of pathogenesis of post-brahytherapy erectile dysfunction

PRIAPOS trial: new conception of pathogenesis of post-brahytherapy erectile dysfunction

Technologies to reduce radiation toxicity in prostate cancer patients: spacers - a simple and effective solution

Methodological aspects of implantation of a Russian prostate-rectum spacer based on stabilized hyaluronic acid of non-animal origin

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