Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA; Agnesian Cancer Center, Fond du Lac, WI, USA.
Lancet Oncol. 2016 May;17(5):e198-208. doi: 10.1016/S1470-2045(16)00063-2. Epub 2016 Apr 27.
Treatment selection for men undergoing curative treatment for prostate cancer is often a challenging decision in view of the goal of maximising cure while maintaining quality of life. Previous quality-of-life comparisons suggest that specific outcomes are associated with type of treatment (surgery vs radiation); however, the functional anatomy approach, starting with nerve-sparing prostatectomy, assumes that quality-of-life outcomes are established by anatomic preservation. Emerging applications of the functional anatomy approach for prostate radiation will ultimately allow for individualised treatments that address the normal tissue variants visible on MRI. Such approaches will encompass all essential functions affected by treatment including genitourinary, rectal, and sexual functions. In this Review, we outline the current techniques in functional anatomy-based preservation related to sexual outcomes, and outline the capacity of vessel-sparing radiotherapy to preserve sexual function in 90% of patients at the 5 year follow-up while maintaining excellent cure rates.
对于接受根治性治疗的前列腺癌患者，治疗选择通常是一个具有挑战性的决策，因为需要在最大限度提高治愈率的同时保持生活质量。先前的生活质量比较表明，特定的治疗结果与治疗类型（手术与放疗）相关；然而，从保留神经的前列腺切除术开始的功能解剖方法假设，生活质量结果是由解剖结构的保留来确定的。前列腺放疗的功能解剖方法的新应用最终将允许采用个体化治疗方法来解决 MRI 上可见的正常组织变异问题。这些方法将包括所有受治疗影响的基本功能，包括泌尿生殖功能、直肠功能和性功能。在这篇综述中，我们概述了与性功能结果相关的基于功能解剖的保肛技术，并概述了血管保留放疗在 5 年随访时保留 90%患者性功能的能力，同时保持了优异的治愈率。
