Horiguchi Yutaka, Tsukuda Fumio, Ogata Ayato, Hagiwara Kiichi, Sakamoto Noboru, Hama Yukihiro, Koga Shoji
Department of Urology, Edogawa Hospital, Tokyo, Japan.
Department of Radiology, Edogawa Hospital, Tokyo, Japan.
Adv Radiat Oncol. 2021 Nov 17;7(3):100851. doi: 10.1016/j.adro.2021.100851. eCollection 2022 May-Jun.
Concern about a long-term effect of the delivery of intensity modulated radiation therapy (IMRT) for prostate cancer on serum testosterone levels remains unelucidated. We evaluated how IMRT for localized prostate cancer affects serum testosterone levels during a follow-up period of up to 10 years.
We retrospectively evaluated data from 182 patients with localized prostate cancer who underwent definitive IMRT alone between 2007 and 2014. Serum total testosterone (TT) levels were measured by blood draws between 6 AM and 11 AM before treatment and at every posttreatment follow-up for 10 years. Pretreatment values and each posttreatment testosterone value were compared using a Wilcoxon signed rank test. The data set was stratified into 4 groups based on the pretreatment testosterone (pre-TT) values using quartiles.
The median absolute or relative changes in TT levels from pretreatment were -0.42 ng/mL or -12.0% at 3 months after radiation therapy ( < .0001). Subsequently, TT levels gradually recovered to nearly the pretreatment levels 24 to 36 months after IMRT. When analyzed according to the pre-TT quartile, median TT levels initially decreased at the 3- to 12-month period in all the quartiles; however, median TT levels increased from the 18-month period in the first and second quartile groups, whereas they were maintained at less than the pretreatment levels in the third and the fourth quartile groups throughout the entire decade after radiation therapy. The proportion of patients with hypogonadal status, defined as TT levels <3.00 ng/mL, did not increase over time.
A transient and modest decrease of TT levels after IMRT spontaneously recovered to the pretreatment levels at the 24- to 36-month period except in patients in the higher quartile of pre-TT. This might have been partly owing to a variable sensitivity of individual testicular function to scattered radiation. Patients with lower pre-TT did not demonstrate a progressive overall rate of hypogonadism until 10 years after radiation therapy.
调强放射治疗（IMRT）用于前列腺癌治疗对血清睾酮水平的长期影响仍不明确。我们评估了局限性前列腺癌的IMRT在长达10年的随访期内如何影响血清睾酮水平。
我们回顾性评估了2007年至2014年间仅接受根治性IMRT的182例局限性前列腺癌患者的数据。在治疗前上午6点至11点之间以及治疗后10年的每次随访时通过抽血测量血清总睾酮（TT）水平。使用Wilcoxon符号秩检验比较治疗前值和每次治疗后的睾酮值。根据四分位数将数据集按治疗前睾酮（pre-TT）值分层为4组。
放疗后3个月时，TT水平相对于治疗前的中位绝对或相对变化分别为-0.42 ng/mL或-12.0%（P<.0001）。随后，TT水平在IMRT后24至36个月逐渐恢复至接近治疗前水平。根据pre-TT四分位数分析时，所有四分位数组的中位TT水平在3至12个月期间最初均下降；然而，第一和第二四分位数组的中位TT水平从18个月时开始上升，而第三和第四四分位数组在放疗后的整个十年中均维持在低于治疗前水平。性腺功能减退状态定义为TT水平<3.00 ng/mL的患者比例未随时间增加。
IMRT后TT水平短暂适度下降，在24至36个月时自发恢复至治疗前水平，但pre-TT较高四分位数组的患者除外。这可能部分归因于个体睾丸功能对散射辐射的敏感性不同。放疗后10年，pre-TT较低的患者未表现出性腺功能减退的总体进展率。
