Farhood Bagher, Mortezaee Keywan, Haghi-Aminjan Hamed, Khanlarkhani Neda, Salehi Ensieh, Nashtaei Maryam Shabani, Najafi Masoud, Sahebkar Amirhossein
Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran.
Department of Anatomy, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
J Cell Physiol. 2019 Sep;234(9):14828-14837. doi: 10.1002/jcp.28283. Epub 2019 Feb 10.
Prostate cancer is the second most common malignancy in men in the world, and radiotherapy is used as a standard treatment modality for this cancer. Although this treatment modality effectively kills prostate cancerous cells, it unavoidably irradiates the organs/tissues that are away from the treatment site. In this regard, radiation-induced testicular toxicities following prostate radiotherapy can affect sexual function, reproduction, and quality of life in cancer survivors. This review summarizes the available data on testicular exposure to radiation during prostate radiotherapy and the consequences on testicular function.
To illuminate the radiation-induced testicular toxicities following prostate radiotherapy, a systematic search was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in PubMed, Web of Science, Scopus, Embase, and clinical trials electronic databases up to September 2018. According to a set of prespecified inclusion and exclusion criteria, 31 eligible articles providing data on testicular function following radiotherapy in patients with prostate cancer were included in the study.
According to the different radiotherapeutic techniques used for prostate cancer treatment, the total tumor dose and scattered testicular dose values were ranging from 36.25 to 78.00 Gy and 0.06 to 6.48 Gy, respectively. Luteinizing hormone and follicle-stimulating hormone levels after prostate radiotherapy were significantly higher in comparison with the pretreatment levels. Around 60% of the studies showed that testosterone levels after prostate radiotherapy were significantly lower than the pretreatment levels. Furthermore, erectile dysfunction (ED), as an adverse side effect resulting from prostate radiotherapy, was reported and this complication is significantly correlated with lower satisfaction with sexual life. Testicular atrophy following prostate radiotherapy has also been observed and its frequency in patients with prior prostate radiotherapy is 2.5 times more than that in the patients without prior radiotherapy.
The data revealed that the scattered dose to testicular tissues during prostate radiotherapy can lead to testicular atrophy, variation of the male sex hormones, and quality of sexual life.
前列腺癌是全球男性中第二常见的恶性肿瘤，放射治疗是这种癌症的标准治疗方式。尽管这种治疗方式能有效杀死前列腺癌细胞，但不可避免地会照射到远离治疗部位的器官/组织。在这方面，前列腺放疗后辐射诱发的睾丸毒性会影响癌症幸存者的性功能、生殖能力和生活质量。本综述总结了前列腺放疗期间睾丸受辐射的现有数据以及对睾丸功能的影响。
为阐明前列腺放疗后辐射诱发的睾丸毒性，根据系统评价和Meta分析的首选报告项目指南，于2018年9月前在PubMed、科学网、Scopus、Embase和临床试验电子数据库中进行了系统检索。根据一组预先设定的纳入和排除标准，31篇提供前列腺癌患者放疗后睾丸功能数据的合格文章被纳入研究。
根据用于前列腺癌治疗的不同放射治疗技术，总肿瘤剂量和散射到睾丸的剂量值分别为36.25至78.00 Gy和0.06至6.48 Gy。前列腺放疗后促黄体生成素和促卵泡生成素水平显著高于治疗前水平。约60%的研究表明，前列腺放疗后睾酮水平显著低于治疗前水平。此外，勃起功能障碍（ED）作为前列腺放疗导致的不良副作用也有报道，且这种并发症与性生活满意度较低显著相关。前列腺放疗后也观察到了睾丸萎缩，既往接受过前列腺放疗的患者中其发生率是未接受过放疗患者的2.5倍。
数据显示，前列腺放疗期间睾丸组织的散射剂量可导致睾丸萎缩、男性性激素变化和性生活质量下降。
