Division of Urology, Princess Margaret Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada.
J Urol. 2012 Mar;187(3):987-9. doi: 10.1016/j.juro.2011.10.141. Epub 2012 Jan 20.
We determined the effects of prostatic brachytherapy on semen parameters and sperm DNA integrity, and the potential impact on fertility.
Five screened patients treated with brachytherapy participated in a pilot study visit to undergo early morning blood collection for serum hormone evaluation and semen collection for semen analysis and DNA integrity assay by sperm chromatin structure assay. Data on 7,617 infertile men, each with at least 1 semen analysis and sperm DNA integrity assay, were obtained from an institutional database for comparison. Published data on fertile men were compared to data on those with brachytherapy for DNA fragmentation analysis.
All brachytherapy cases had normal serum luteinizing hormone, follicle-stimulating hormone and testosterone. Specific semen parameters, such as semen volume (p <0.0005), total sperm concentration (p <0.0004) and percent sperm motility (p <0.004), were significantly lower than normal reference values. As measured by the DNA fragmentation index, the mean sperm DNA fragmentation of 46.4% in brachytherapy cases was significantly higher than in the fertile group (13.3%, p <0.0003), the total infertile group (20.4%, p <0.0002) and the age matched infertile group 45 to 53 years old (27.9%, p <0.03). All men with brachytherapy had an abnormal sperm DNA fragmentation index, indicating likely infertility in all.
Infertility may well be a long-term adverse effect of brachytherapy for localized, low grade prostate cancer. All men who undergo brachytherapy should be counseled about its potential impact on fertility.
我们旨在研究前列腺近距离放射治疗对精液参数和精子 DNA 完整性的影响，以及其对生育能力的潜在影响。
5 名接受近距离放射治疗的筛选患者参与了一项初步研究访问，进行了清晨血液采集以进行血清激素评估和精液采集，以进行精液分析和精子染色质结构分析的 DNA 完整性测定。为了进行比较，我们从一个机构数据库中获得了 7617 名不育男性的数据，每个男性都至少进行了 1 次精液分析和精子 DNA 完整性测定。我们将已发表的关于生育力正常男性的数据与接受近距离放射治疗的男性的数据进行了 DNA 碎片化分析。
所有近距离放射治疗病例的血清黄体生成素、卵泡刺激素和睾丸激素均正常。特定的精液参数，如精液量（p<0.0005）、总精子浓度（p<0.0004）和精子运动百分比（p<0.004），明显低于正常参考值。根据 DNA 碎片化指数，近距离放射治疗病例的平均精子 DNA 碎片化率为 46.4%，明显高于生育力正常组（13.3%，p<0.0003）、总不育组（20.4%，p<0.0002）和年龄匹配的 45 至 53 岁不育组（27.9%，p<0.03）。所有接受近距离放射治疗的男性的精子 DNA 碎片化指数均异常，表明所有男性都可能不育。
对于局限性、低级别前列腺癌，近距离放射治疗可能是导致不育的长期不良影响。所有接受近距离放射治疗的男性都应该被告知其对生育能力的潜在影响。
