Feasibility Testing of Transpelvic Magnetic Stimulation as a Novel Intervention toImprove Urogenital Function in Prostate Cancer Survivors

NIH RePORTER · VA · I21 · · view on reporter.nih.gov ↗

Abstract

The overall purpose of this SPiRE project is to assess the feasibility and acceptability of a novel intervention approach and to collect preliminary data for a future randomized clinical trial to rehabilitate urogenital function in prostate cancer survivors. Prostate cancer is most common in men over 50 years and this cancer incidence is especially high (29%) in the VA patients. With early diagnosis, patients can pursue potentially curative interventions that include surgical procedures (radical retropubic prostatectomy). However, these surgical treatments lead to problems with continence (urinary incontinence: UI) and sexual function (erectile dysfunction- ED, a major form of sexual dysfunction) in as many as 30-70% of these cancer survivors. Although it is recognized that the continence and sexual functions are critical issues affecting quality of life, there has been only limited research into methods to prevent these forms of dysfunction. These derangements are further impacted by age-related atrophy and fibrosis of corpus cavernosum, urethral sphincters, and that of supporting pelvic floor muscles (ischiocavernosus-ICM and puborectalis-PRM). Hence, there is an urgent need for non-invasive innovative approaches for urinary continence and sexual function rehabilitation to prevent this problem in cancer survivors. This proposed feasibility study takes a novel interventional approach, using repetitive Transpelvic Magnetic Stimulation approach (rTPMS) to prevent fibrosis and strengthen the PFM. We propose to recruit VA patients that are scheduled to undergo prostate cancer surgery and perform a randomized interventional study to determine the feasibility of rehabilitation potential of rTPMS. We will estimate number of potentially eligible patients, rate of consent of eligible patients consent rate, overall uptake rate (in relation to the number potentially eligible), retention rate, follow-up rates for questionnaires and adherence to the interventions and imaging protocols. We will first evaluate all the baseline physiological as well as morphological parameters of penis, urethra and pelvic muscles. Primary outcome measures for assessment of UI will be the extent of reduction (%) in the number of UI symptom scores. For assessment of ED, improvement in erectile function as measured by the International Index of Erectile Function (IIEF-5), a validated, 5-item symptom score, will be used. Secondary outcome measures will be pad weight and PFM changes that will be measured by MRI (UTE for fibrosis). For ED, penile blood flow and PFM changes measured by Doppler blood flow, laser speckle contrast imaging and MRI (UTE for fibrosis), respectively. Besides these therapeutic interventions, we also propose to test novel diagnostic tools to monitor blood supply to the penile tissues (by Laser Doppler imaging) and scarring of these muscles (by a new MRI technique, called ultrashort echo time-UTE). Next, we will test if TPMS will enhance blood flow and increase...

Key facts

NIH application ID
10249223
Project number
5I21RX003455-02
Recipient
VA SAN DIEGO HEALTHCARE SYSTEM
Principal Investigator
MAHADEVAN Raj RAJASEKARAN
Activity code
I21
Funding institute
VA
Fiscal year
2021
Award amount
Award type
5
Project period
2020-10-01 → 2022-09-30