Prostate Cancer Breakthrough Reduces Erectile Dysfunction Risk

Breakthrough in Prostate Cancer Treatment Offers Hope for Erectile Function

Men undergoing treatment for prostate cancer may soon avoid the common side effect of erectile dysfunction, thanks to a groundbreaking development. A recent study known as the ERECT trial has explored methods to preserve erectile function during treatment, using MRI-guided radiotherapy. This innovative approach targets the prostate precisely while avoiding the nerves and blood vessels essential for erections.

Erectile dysfunction is one of the most prevalent side effects of prostate cancer treatment, particularly after radiotherapy or surgery. These treatments can damage the nerves and blood vessels involved in achieving and maintaining an erection, leading to varying degrees of sexual dysfunction among patients.

The study, conducted by the University Medical Centre Utrecht, found that this targeted method significantly reduces the risk of erectile dysfunction compared to traditional techniques. The results showed less than half the risk of erectile dysfunction when using MRI-guided radiotherapy.

In the UK, prostate cancer is the most common cancer among men. Each year, approximately 55,000 men are diagnosed with the disease, and despite advances in detection and treatment, around 12,000 die from it annually. In England alone, about 10,000 people lose their lives to the condition each year. The incidence of prostate cancer has been increasing, partly due to greater awareness and the use of PSA testing.

However, survival rates have also improved significantly. Nearly 80% of men diagnosed with prostate cancer today are expected to live for at least 10 years. There is growing support for targeted screening for prostate cancer, with health advisers currently evaluating the evidence for implementing tests that focus on those at higher risk, such as black men or individuals with a family history of the disease.

Getting the focus right is crucial. Too many false positives can lead to over-treatment of slow-growing cancers, which may result in unnecessary and distressing side effects.

Dr. Jochem van der Voort van Zyp, the lead investigator, stated: “With MRI guidance, we limit radiation to erectile tissues but still treat the prostate effectively. With the enhanced precision of MRI guidance, we gain the confidence to limit the dose these erectile tissues receive. The prostate gets the therapeutic dose while the erectile tissues receive a much lower dose, thus preserving their function.”

The trial involved 70 men and found that, at six months, only 6% experienced erectile dysfunction, compared to 21% with conventional treatment. After 18 months, 16% had dysfunction, compared to 36% in the control group.

Experts believe this new technique could offer men a better chance of maintaining sexual function after prostate cancer treatment without compromising cancer control. It is estimated that more than 16,000 men a year—those with low to intermediate risk disease—who receive radiotherapy could benefit from such advancements.

So far, the technology is being used at The Royal Marsden NHS Foundation Trust and The Christie NHS Foundation Trust in Manchester, with plans to expand to two more sites. The device used, the Elekta Unity MR-Linac, combines MRI with radiation delivery for precise treatment. It allows doctors to see the prostate and surrounding tissues in detail and adjust treatment in real-time to avoid damaging healthy structures.

John Christodouleas, Elekta’s senior vice president of medical affairs, said: “These results add to growing evidence that minimizing radiation to normal tissues improves quality of life for men with prostate cancer.”

The Elekta Unity MR-Linac is the world’s first and only device to combine a high-field MRI with a state-of-the-art linear accelerator. Experts say this enables clinicians to use imaging to guide radiation delivery to tumor targets and avoid surrounding structures. Additionally, while treatment is ongoing, the system allows clinicians to non-invasively monitor the position of the target.

If, for example, the prostate shifts because of motion of the bowels or bladder filling, the radiation treatment can be paused to avoid unnecessary radiation to surrounding normal tissues.

The preliminary results were presented by clinicians from University Medical Centre Utrecht at the European Society for Radiotherapy and Oncology annual congress earlier this year.