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August 24, 2025Open Access

Asymmetry in neurovascular bundle blood flow in prostate cancer patients: A pre‐treatment doppler ultrasound study

Key Points

Substantial differences in blood flow were detected between bilateral neurovascular bundles in prostate cancer patients, affecting treatment planning.
In a sample of 57 patients, 40 showed less than 50% blood flow difference, while 10 had 50%-100% difference, and 7 had over 100% difference.
Pulsed wave Doppler ultrasound measured key parameters such as peak systolic velocity and resistive index to assess functionality.
The findings suggest the potential of Doppler ultrasound to guide individualized neurovascular-sparing treatment for better sexual outcomes.

Abstract

Abstract Background Neurovascular‐sparing treatment is believed to help preserve erectile function for localized prostate cancer, given the key role of the arterial supply of neurovascular bundles (NVBs) in potency recovery post‐treatment. While NVB‐sparing radiotherapy (RT) is emerging, imaging methods to assess NVB function are lacking. Purpose This study aims to evaluate the functional status of bilateral NVBs using pulsed wave Doppler ultrasound in patients undergoing prostate RT. Methods Fifty‐seven patients (mean age: 66.2 ± 7.1 years) were enrolled in this single‐institute prospective study. Each patient underwent a transrectal ultrasound scan in the lithotomy position. Bilateral blood flow in the NVBs was measured using pulsed wave Doppler ultrasound. A custom program was developed to automatically detect and analyze the Doppler spectral waveform. Five Doppler parameters were extracted: peak systolic velocity (PSV), end‐diastolic velocity (EDV), mean velocity (Vm), resistive index (RI), and pulsatile index (PI). Discrepancies in Doppler parameters between the left and right sides were calculated. Patient‐reported sexual outcomes were assessed using the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC‐CP). Results The Doppler pulsed waveform parameters for the 57 patients were: PSV = 11.0 ± 4.0 cm/s, EDV = 1.3 ± 1.9 cm/s, Vm = 4.0 ± 2.4 cm/s, RI = 0.89 ± 0.14, and PI = 3.46 ± 1.80. Analysis of PSV revealed differing blood flow between the left and right NVBs: 40 patients had 100% difference. Among patients aged 65 years or younger ( n = 11) with EPIC‐CP scores, blood flow was negatively correlated to erectile dysfunction (Spearman correlation coefficient of −0.71, p = 0.01). Conclusions Substantial differences in blood flow between bilateral NVBs were observed. The functional information obtained from NVB Doppler ultrasound may be valuable in guiding individualized NVB‐sparing treatment planning.

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