Kiserud Cecilie E, Magelssen Henriette, Fedorcsak Peter, Fosså Sophie D
Nasjonalt kompetansesenter for langtidsstudier, etter kreft, Radiumhospitalet Rikshospitalet, 0027 Oslo.
Tidsskr Nor Laegeforen. 2008 Feb 14;128(4):461-5.
Surgery, chemotherapy and radiation, but also long-term hormonal treatment may cause reduced gonadal function in male cancer patients. The germinal epithelium is more vulnerable to cytotoxic damage than the Leydig cells, which implies that subfertility/infertility is a more frequent side effect of cancer treatment than endocrine hypogonadism.
This review article is based on clinical experience and literature retrieved from PubMed.
The degree of gonadal damage depends on the type of chemotherapy and the cumulative dose; with alkylating substances and procarbazine being the most gonadotoxic agents. The testicle is one of the most radiosensitive organs, and the damage depends on the radiation dose. Testicle damage may be caused by direct radiation of the testicles or scattered radiation from radiated adjacent tissue. Freezing of semen should be discussed with and offered to all men below 55 years that are about to undergo cancer treatment that may cause reduced fertility. Men surviving cancer who experience unwanted childlessness should be offered examination, advice and possibly assisted fertilization as part of the rehabilitation. Especially after intensive chemotherapy and high dose cranial radiation therapy the patient should be examined regularly throughout life with respect to premature endocrine hypogonadism.
手术、化疗、放疗以及长期激素治疗都可能导致男性癌症患者性腺功能减退。生精上皮比睾丸间质细胞更容易受到细胞毒性损伤，这意味着与内分泌性性腺功能减退相比，生育力低下/不育是癌症治疗更常见的副作用。
这篇综述文章基于临床经验以及从PubMed检索到的文献。
性腺损伤的程度取决于化疗类型和累积剂量；烷化剂和丙卡巴肼是性腺毒性最强的药物。睾丸是对辐射最敏感的器官之一，损伤程度取决于辐射剂量。睾丸损伤可能是由睾丸直接受辐射或邻近受辐射组织的散射辐射所致。对于所有55岁以下即将接受可能导致生育力下降的癌症治疗的男性，都应与其讨论并提供精液冷冻服务。癌症幸存者若出现非意愿性无子女情况，作为康复治疗的一部分，应接受检查、咨询，必要时可接受辅助生殖。特别是在强化化疗和高剂量颅脑放疗后，患者应终生定期接受检查，以筛查是否过早出现内分泌性性腺功能减退。
