Preservation of neurovascular bundles during high dose rate brachytherapy in patients with localized prostate cancer

Objective of the study: to evaluate erectile function (EF) in patients suffering from prostate cancer after high-dose rate brachytherapy using nerve-sparing technology.Materials and methods. The study included 97 patients with prostate cancer (PCa) who underwent high dose rate brachytherapy (HDR-BT) using a 192Ir source. Brachytherapy was carried out in mono mode in the form of two fractions in a single focal dose of 15 Gy with a two-week break between fractions up to a total focal dose of 30 Gy. The majority of patients included in the study belonged to the group of low and intermediate risk of prostate cancer progression according to NCCN stratification. Five patients were in the high-risk group. Median age was 65.2 years (44-80 years, 95%CI = 63.7-66.7 years). Most patients underwent androgen deprivation therapy before brachytherapy. All patients included in the study group were interested in maintaining erectile function.To evaluate the effect of neurovascular bundle (NVBs) irradiation dose on the degree of erectile dysfunction (ED) after brachytherapy, we selected 26 patients from the total group of patients who received HDR-BT in mono mode. There were no significant differences between this group and the main group of patients in terms of MIEF-5 (International Index of Erectile Function) before brachytherapy. In all patients, immediately before each irradiation session, 20 ml of 0.9% saline solution was transperineally injected into the NVB area on both sides under the control of TRUS (transrectal ultrasound) with Doppler ultrasonography in order to create a hydro-cushion between the lateral edge of the prostate gland and the NVB and to maximally withdraw the NVB from the high irradiation zone.Results. 3 years and more after brachytherapy in the main group, 37.3% of patients noted the absence of EF abnormalities or the presence of mild abnormalities (16-20 points - 16.1%, 21-25 points - 21.2%). At the same time, we noted a significant decrease in EF before and after brachytherapy taking into account the time factor ( p Conclusion. The technology of nerve-sparing brachytherapy in our study showed encouraging results and, importantly, the use of this technology does not require significant costs for the patient.