Affiliation:
1. Institut Gustave Roussy
2. Centre Hospitalier Universitaire de Bordeaux
Abstract
AbstractBackground Prostate cancer in younger men is not infrequent. Radiotherapy is a cornerstone of prostate cancer treatment and yet, its impact on fertility is scarcely reported in literature. Since testis is one of the most radiosensitive tissue, we tried to determine testicular dose with modern radiotherapy techniques for a definitive prostate irradiation. Methods one hundred radiotherapy plans were reviewed. Testicles were contoured a posteriori without any optimization on testicles. Results Median testicular dose was 0.58 Gy: 0.18 Gy in stereotactic plans versus 0.62 Gy in Volumetric Modulated Arc Therapy plans versus 1.50 Gy in Tomotherapy plans (p < 0.001). Pelvic nodal irradiation increased the median testicular dose: 1.18 Gy versus 0.26 Gy (p < 0.001). Weight and BMI were inversely associated with testicular dose (p < 0.005). 65% of the patients reached the theoretical dose threshold to get transitory azoospermia and 10% received more than 2 Gy, that is likely to give definitive azoospermia. Conclusion although probably lower than what used to be delivered with older techniques, testicular dose delivered with modern prostate radiotherapy is not negligible and is often underestimated because the contribution of daily repositioning imaging is not taken into account and most Treatment Planning Systems underestimate the out of field dose. Radiation oncologists should be aware of the possible impact of prostate radiotherapy on fertility and gonadal endocrine secretion. Men should be counselled at first consult and offered a sperm preservation strategy if they have a paternity wish. Trial registration retrospectively registered
Publisher
Research Square Platform LLC
Reference57 articles.
1. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries;Sung H;CA Cancer J Clin,2021
2. Prostate cancer radiotherapy and incidental testicular irradiation: Impact on gonadal function;Guevelou J;Clin Transl Radiat Oncol,2023
3. Incidence of prostate cancer diagnosis in the eras before and after serum prostate-specific antigen testing;Jacobsen SJ;JAMA,1995
4. Hamilton BE. Births: Provisional Data for 2022. 2021.
5. Advanced maternal age and pregnancy outcomes: a multicountry assessment;Laopaiboon M;BJOG Int J Obstet Gynaecol,2014