Patient Anatomy Can Help Predict Prostate Cancer Side Effects

Dr. Kiran Nandalur (left), a radiologist with Corewell Health and principal investigator of a new study that could help predict radiation side effects for prostate cancer, reviews the MRI scans of a patient with his colleague Dr. James Relle.

Before choosing a prostate cancer treatment, patients with the disease should discuss possible long-term side effects from their therapies, according to an expert.

While late and long-term effects of radiation for prostate cancer have traditionally been difficult to predict, recent research published in the journal Academic Radiology showed that for every one-centimeter increase in prostatic urethra, patients were 60% more likely to experience chronic urinary issues such as experiencing urgency to urinate, as well as feeling the need to urinate more frequently.

CURE® recently spoke with study author, Dr. Kiran Nandalur, a radiologist at Corewell Health in Michigan, about the findings.

CURE®: Can you provide an overview of your study, and what patient factors were analyzed?

Nandalur: What we specifically looked at on our prostate MRIs is that there's a tube which carries the urine from the bladder to the to the penis, and we want to see if that area which is within the prostate, called the prosthetic urethra, is longer can you predict if patients are going to have symptoms of side effects of radiation afterwards?

We look at a whole bunch of factors their age, their race, what kind of radiation they had, even if they had symptoms before — like, if you already had symptoms, urinary symptoms, before you had radiation, is that going to translate into symptoms? And after?

What we basically found is none of those factors predicted in terms of clinical symptoms, and that's what previous reaches about there, it's very, difficult to predict who's going to have symptoms.

But what our study did find, which was novel is that this length of the urethra, the intra-prosthetic urethra, the longer it gets, the greater chance you're going to have symptoms, which are after 180 days, which is called chronic symptoms. Before 180 days is called acute symptoms. Typically people who have radiation will have some degree of acute symptoms, but they go away. It's problematic, but we really worry about patients who are going to have symptoms long term because, you know, that's what patients are going to deal with on a long term basis. Our basic findings were that the longer that this tube in the prostate is, a greater chance you're going to have symptoms. The reason is we think that that area is very prone to radiation damage. And that that now that we can measure this on an MRI, which is actually really easy to measure, it only takes like 10 seconds to measure, this could be a good metric for patients to know, a general basis if they're going to have some degree of side effects or urinary side effects.

If patients and providers have this information about increased risk, what can be done?

It's twofold. We always want to prevent (side effects) first, anything that we can prevent is probably the key. Because once you have the problem, it's always harder to treat it. Prevention here is on the radiation oncology side is if this area in the prostate, which is the urethra can be have less radiation, what's called radiation-sparing, that will decrease their chances of having side effects late. If we can use that, not really that area as much, maybe people will have less than two months later on. That's something we can do in terms of prevention.

Also what we want to do for patients, we always want to advise them, what's your best therapy in terms of your best ontological outcome, meaning you don't have any prostate cancer death, but also what's your best outcome in terms of your quality of life? Quality of life for prostate cancer patients is critically important, again, because they live long. And so that's obviously really important to have good quality of life. We want to tell them ahead of time, if you have surgery. There's some metrics and MRI, they can ask you tell him about the quality of life on MRI, after surgery. But if you're going to choose radiation, hey, you might be at higher risk of having these kinds of symptoms. Would you rather than have surgery? Would you rather have focal therapy? Would you rather have watch it? We want patients to be aware of that before they choose their therapy.

If they undergo radiation, and if they have a longer urethra, we place an increased risk. Should we follow them up more closely? Every right now we call them every six months, and we do it every three months? Should they be treated prophylactically? Those are questions we have that will help with this study, prevention, and then choice of therapy and then how to follow them off in terms of intensity of therapy by the ratio ecologist.

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