Vessel-sparing radiation and functional anatomy-based preservation for erectile function after prostate radiotherapy

Qualidade de vida relacionada à saúde de pacientes com câncer de próstata

“…O tratamento para homens diagnosticados deve ser individualizado, levando em consideração a idade, a expectativa de vida, as comoborbidades, o estadiamento do tumor, os tratamentos disponíveis e os efeitos colaterais de cada tratamento na qualidade de vida relacionada à saúde (QVRS) 4,6 . Entre as modalidades terapêuticas disponíveis, estão a radioterapia e hormonioterapia, que podem ser utilizadas isoladamente ou em combinação, podendo causar efeitos colaterais, como problemas específicos nas funções intestinal, urinária, sexual, hormonal, além de fadiga, depressão, alteração no peso, dentre outros [3][4][5] .…”

“…Com o aumento da detecção precoce do CaP e das altas taxas de sobrevivência dos pacientes, a avaliação da QVRS vem oferecendo uma contribuição cada vez mais significativa para o seu atendimento, podendo ser medida objetivamente por instrumentos auto-aplicados e para comparar os efeitos de diferentes tratamentos sobre as funções essenciais 6 .…”

Advances in Prostate Cancer Magnetic Resonance Imaging and Positron Emission Tomography-Computed Tomography for Staging and Radiotherapy Treatment Planning

“…A recent review is available to learn more about the value and opportunities to avoid the internal pudenal artery and prescribe “vessel sparing radiation”. 43 Nascent strategies to define periprostatic nerve fibers have also emerged, namely using diffusion tensor imaging magnetic resonance tractography (DTI-MRI). 44 Ultimately, with ongoing efforts, there is promise that radiotherapy treatment planning will continue to shift the emphasis from severe complication avoidance (rectal fistulas, strictures), to toxicity limitation, with an eventual transition to emphasizing strategies that preserve baseline erectile function and quality of life.…”

How nerve-sparing technique has been applied to radiotherapy?

“…In a recent article published in Lancet Oncology in May, Lee et al 3. reviewed the concept of vessel-sparing and functional anatomy-based radiotherapy as well as outcomes with respect to erectile dysfunction, bringing to light a conceptual shift in the management of localized prostate cancer with radiotherapy, which parallels the shift in the surgical management of prostate cancer with the introduction of nerve-sparing technique.…”

“…The concept of vessel-sparing and functional anatomy-based radiotherapy is grounded in two advantages of MRI-based planning: first, MRI can map the anatomic variation that exists among men which either allows for or prevents more targeted use of radiotherapy, and second, MRI-based planning can improve delineation of the prostate, neurovascular bundles, and vasculature compared to CT-based planning 34. Historically, it has been understood that radiotherapy has direct arterial effects which contribute to erectile function in addition to its direct effects on nerves.…”