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Prostate radiotherapy may cause fertility issues: a retrospective analysis of testicular dose following modern radiotherapy techniques.
Kissel, M; Terlizzi, M; Giraud, N; Alexis, A; Cheve, M; Vautier, J; Bossi, A; Morice, P; Blanchard, P.
Affiliation
  • Kissel M; Radiotherapy Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France. manon.kissel@curie.fr.
  • Terlizzi M; Radiation Therapy Department, Institut Curie, 26 rue d'Ulm, 75005, Paris, France. manon.kissel@curie.fr.
  • Giraud N; Radiotherapy Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.
  • Alexis A; Radiotherapy Department, CHU Bordeaux, Avenue de Magellan, 33604, Pessac, France.
  • Cheve M; Radiophysics Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.
  • Vautier J; Radiophysics Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.
  • Bossi A; Radiophysics Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.
  • Morice P; Radiotherapy Department, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.
  • Blanchard P; Gynecologic Surgery Department, Gustave Roussy, Villejuif, France.
Radiat Oncol ; 19(1): 101, 2024 Aug 01.
Article in En | MEDLINE | ID: mdl-39090684
ABSTRACT

BACKGROUND:

Prostate cancer in younger men is rare but not exceptional. Radiotherapy is a cornerstone of prostate cancer treatment and yet, its impact on fertility is scarcely reported in literature. Given the radiosensitivity of testicular tissue, this study aimed to determine the testicular dose using modern radiotherapy techniques for definitive prostate irradiation.

METHODS:

One hundred radiotherapy plans were reviewed. Testicles were contoured retrospectively without dosimetric optimization on testicles.

RESULTS:

The median testicular dose was 0.58 Gy 0.18 Gy in stereotactic plans, 0.62 Gy in Volumetric Modulated Arc Therapy plans and 1.50 Gy in Tomotherapy plans (p < 0.001). Pelvic nodal irradiation increased the median testicular dose to 1.18 Gy versus 0.26 Gy without nodal irradiation (p < 0.001). Weight and BMI were inversely associated with testicular dose (p < 0.005). 65% of patients reached the theoretical dose threshold for transient azoospermia, and 10% received more than 2 Gy, likely causing definitive azoospermia.

CONCLUSION:

Despite being probably lower than doses from older techniques, the 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 consider the impact on fertility and gonadal endocrine function, counseling men on sperm preservation if they wish to maintain fertility. TRIAL REGISTRATION retrospectively registered.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Prostatic Neoplasms / Radiotherapy Dosage / Testis / Radiotherapy Planning, Computer-Assisted / Radiotherapy, Intensity-Modulated Limits: Adult / Aged / Humans / Male / Middle aged Language: En Journal: Radiat Oncol / Radiat. oncol / Radiation oncology Journal subject: NEOPLASIAS / RADIOTERAPIA Year: 2024 Document type: Article Affiliation country: Francia Country of publication: Reino Unido

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Prostatic Neoplasms / Radiotherapy Dosage / Testis / Radiotherapy Planning, Computer-Assisted / Radiotherapy, Intensity-Modulated Limits: Adult / Aged / Humans / Male / Middle aged Language: En Journal: Radiat Oncol / Radiat. oncol / Radiation oncology Journal subject: NEOPLASIAS / RADIOTERAPIA Year: 2024 Document type: Article Affiliation country: Francia Country of publication: Reino Unido