vessel sparing prostate radiation therapy

Conditions: Cancer of the PROSTATE

Summary: prostate cancer patients have a number of excellent treatment options to consider, and quality of life following treatment is often a consideration in treatment choice. one critical quality of life concern for patients diagnosed with prostate cancer is sexual function. previous studies point to a vascular mechanism of impotence post-radiation therapy, as opposed to a nerve-based mechanism following surgery. in this study, the critical vascular structures (internal pudendal artery and corpus cavernosum) are defined by mri-based imaging and included in treatment planning for radiation treatments, hopefully preserving critical artery function. this study will collect erectile function preservation rates at 5-years post-vessel-sparing radiotherapy with or without aids using the patient reported using the simplified three-question erectile function scale.

the vast majority of patients diagnosed with prostate cancer in the modern era of psa screening have localized and potentially curable disease. patients have a number of excellent treatment options to consider, and quality of life following treatment is often a consideration in treatment choice. one critical quality of life concern for patients diagnosed with prostate cancer is sexual function. studies of sexual function post-radiation therapy fall into three categories: incidence studies; correlative (dose and toxicity) studies; mechanism(functional) studies. all these studies point to a vascular mechanism of impotence post-radiation therapy, as opposed to a nerve-based mechanism following surgery. in this study, the critical vascular structures (internal pudendal artery and corpus cavernosum) are defined by mri-based imaging and included in treatment planning for radiation treatments. investigators propose that this technique will improve quality of life, sexual function, and relapse-free survival. this study's primary aim is to determine erectile function preservation rates at 5-years post-vessel-sparing radiotherapy with or without aids using the patient reported using the simplified three-question erectile function scale.

Eligibility criteria:
inclusion criteria: * histologically confirmed diagnosis of prostate cancer * patients must have measurable erectile function. patients with erectile function on viagra and drugs of the same class are eligible. patients who require 6 months of hormonal therapy or less are eligible, provided baseline erectile function is measured prior to or within 14 days of the start of hormonal therapy. * baseline psa (prostate specific antigen), tnm stage (a classification of malignant tumors in cancer), and gleason score (a system of grading prostate cancer tissue based on how it looks under a microscope): patients with low (psa less than 10, t2a or less, gleason 6 or less), intermediate, or high (gleason 8-10, t3a, psa over 20) risk disease are eligible for this protocol. patients on finasteride or drugs of the same class are eligible. * patients must be 18 years or older. no upper age restriction. * patients treated with external beam radiotherapy alone or external beam therapy plus implant therapy are eligible. * patients must have an ecog (eastern cooperative oncology group system of grading patient status that attempts to quantify cancer patients' general well-being and activities of daily life) performance status \<2. * the patient must sign study specific informed consent approved by the irb of u of m indicating they are aware of the investigational nature of the treatment. exclusion criteria: * patients who are impotent or have an iief (international index of erectile function) \<16. * patients who are medically ineligible for radiation therapy due to other medical conditions. * patients given hormonal therapy before baseline questionnaires filled out. * patients who receive implant only therapy. * patients unable to undergo mri (magnetic resonance imaging).