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Anti-Cancer Agents in Medicinal Chemistry

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ISSN (Print): 1871-5206
ISSN (Online): 1875-5992

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Systematic Review Article

The Effect of Prostate Cancer Radiotherapy on Testosterone Level: A Systematic Review and Meta-analysis

Author(s): Keywan Mortezaee, Elham Motallebzadeh, Alireza Milajerdi, Bagher Farhood*, Masoud Najafi* and Amirhossein Sahebkar*

Volume 20, Issue 6, 2020

Page: [636 - 642] Pages: 7

DOI: 10.2174/1871520620666200128112558

Price: $65

Abstract

Introduction: In the current study, a systematic search and meta-analysis were performed to evaluate the effect of prostate cancer radiotherapy on testosterone levels of patients.

Methods: To illuminate the effect of radiotherapy on the testosterone level of prostate cancer patients, a systematic search was conducted in accordance with the PRISMA guideline in electronic databases of Scopus, Embase, PubMed, Web of Science, and clinical trials up to December 2018 using relevant keywords. Based on a certain set of inclusion and exclusion criteria, 12 eligible studies that had data on the testosterone level following prostate cancer radiotherapy were included in the meta-analysis.

Results: According to the various techniques of prostate cancer radiotherapy, the dose values scattered to the testicular tissues ranged from 0.31 to 10 Gy. Combining the findings from 12 studies, it was found that prostate cancer radiotherapy leads to a significant reduction in the testosterone level (Weighted Mean Difference [WMD]: -51.38 ng/dL, 95% CI: -75.86, -26.90, I2=0.0%, P<0.05). Furthermore, subgroup analysis by the patient number showed a significant reduction in the testosterone level at patient number < 50 (WMD: -80.32 ng/dL, 95% CI: -125.10, -35.55, I2= 0.0%) and 50 < patient number < 100 (WMD: -46.99 ng/dL, 95% CI: - 87.15, -6.82, I2= 0.0%). Subgroup analysis based on treatment technique type revealed a significant reduction in testosterone level after conventional radiotherapy (WMD: -56.67, 95% CI: -100.45,-12.88, I2= 34.3%) and IMRT/SBRT technique (WMD: -57.42, 95% CI: -99.39, -15.46, I2= 0.0%) in comparison with the proton therapy (WMD: 0.00, 95% CI: -80.24, 80.24).

Conclusion: The findings showed a significant decrease in the testosterone level of prostate cancer patients after radiotherapy compared with pre-treatment levels.

Keywords: Prostate cancer, radiotherapy, testicular radiation dose, testosterone, meta-analysis, weighted mean difference.

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[1]
Ferlay, J.; Soerjomataram, I.; Dikshit, R.; Eser, S.; Mathers, C.; Rebelo, M.; Parkin, D.M.; Forman, D.; Bray, F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int. J. Cancer, 2015, 136(5), E359-E386.
[http://dx.doi.org/10.1002/ijc.29210] [PMID: 25220842]
[2]
Bray, F.; Lortet-Tieulent, J.; Ferlay, J.; Forman, D.; Auvinen, A. Prostate cancer incidence and mortality trends in 37 European countries: an overview. Eur. J. Cancer, 2010, 46(17), 3040-3052.
[http://dx.doi.org/10.1016/j.ejca.2010.09.013] [PMID: 21047585]
[3]
Sadjadi, A.; Nooraie, M.; Ghorbani, A.; Alimohammadian, M.; Zahedi, M.J.; Darvish-Moghadam, S.; Fakheri, H.; Babai, M.; Semnani, S.; Mansour-Ghanaei, F.; Mohagheghi, M.A. The incidence of prostate cancer in Iran: results of a population-based cancer registry. Arch. Iran Med., 2007, 10(4), 481-485.
[PMID: 17903053]
[4]
Farhood, B.; Geraily, G.; Alizadeh, A. Incidence and mortality of various cancers in Iran and compare to other countries: A review article. Iran. J. Public Health, 2018, 47(3), 309-316.
[PMID: 29845017]
[5]
Wiechno, P.J.; Sadowska, M.; Kalinowski, T.; Michalski, W.; Demkow, T. Does pharmacological castration as adjuvant therapy for prostate cancer after radiotherapy affect anxiety and depression levels, cognitive functions and quality of life? Psychooncology, 2013, 22(2), 346-351.
[PMID: 22081540]
[6]
Heidenreich, A.; Bellmunt, J.; Bolla, M.; Joniau, S.; Mason, M.; Matveev, V.; Mottet, N.; Schmid, H.P.; van der Kwast, T.; Wiegel, T.; Zattoni, F. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur. Urol., 2011, 59(1), 61-71.
[http://dx.doi.org/10.1016/j.eururo.2010.10.039] [PMID: 21056534]
[7]
Mottet, N.; Bellmunt, J.; Bolla, M.; Joniau, S.; Mason, M.; Matveev, V.; Schmid, H.P.; van der Kwast, T.; Wiegel, T.; Zattoni, F.; Heidenreich, A. [EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer]. Actas Urol. Esp., 2011, 35(10), 565-579.
[http://dx.doi.org/10.1016/j.acuro.2011.03.011] [PMID: 21757258]
[8]
Bagheri, H.; Rabie Mahdavi, S.; Shekarchi, B.; Manouchehri, F.; Farhood, B. Measurement of the contralateral breast photon and thermal neutron doses in breast cancer radiotherapy: A comparison between physical and dynamic wedges. Radiat. Prot. Dosimetry, 2018, 178(1), 73-81.
[http://dx.doi.org/10.1093/rpd/ncx076] [PMID: 28591863]
[9]
Onal, C.; Arslan, G.; Dolek, Y.; Efe, E. Dosimetric analysis of testicular doses in prostate intensity-modulated and volumetric-modulated arc radiation therapy at different energy levels. Med. Dosim., 2016, 41(4), 310-314.
[http://dx.doi.org/10.1016/j.meddos.2016.07.004] [PMID: 27623736]
[10]
Bucci, M.K.; Bevan, A.; Roach, M., III Advances in radiation therapy: conventional to 3D, to IMRT, to 4D, and beyond. CA Cancer J. Clin., 2005, 55(2), 117-134.
[http://dx.doi.org/10.3322/canjclin.55.2.117] [PMID: 15761080]
[11]
Rowley, M.J.; Leach, D.R.; Warner, G.A.; Heller, C.G. Effect of graded doses of ionizing radiation on the human testis. Radiat. Res., 1974, 59(3), 665-678.
[http://dx.doi.org/10.2307/3574084] [PMID: 4428015]
[12]
Tomić, R.; Bergman, B.; Damber, J.E.; Littbrand, B.; Löfroth, P.O. Effects of external radiation therapy for cancer of the prostate on the serum concentrations of testosterone, follicle-stimulating hormone, luteinizing hormone and prolactin. J. Urol., 1983, 130(2), 287-289.
[http://dx.doi.org/10.1016/S0022-5347(17)51110-6] [PMID: 6410084]
[13]
King, C.R.; Maxim, P.G.; Hsu, A.; Kapp, D.S. Incidental testicular irradiation from prostate IMRT: it all adds up. Int. J. Radiat. Oncol. Biol. Phys., 2010, 77(2), 484-489.
[http://dx.doi.org/10.1016/j.ijrobp.2009.04.083] [PMID: 19733013]
[14]
Nicholas, S.; Chen, L.; Choflet, A.; Fader, A.; Guss, Z.; Hazell, S.; Song, D.Y.; Tran, P.T.; Viswanathan, A.N. Pelvic radiation and normal tissue toxicity. Semin. Radiat. Oncol., 2017, 27(4), 358-369.
[http://dx.doi.org/10.1016/j.semradonc.2017.04.010] [PMID: 28865519]
[15]
Ahmadloo, N.; Bidouei, F.; Mosleh-Shirazi, M.A.; Omrani, G.H.; Omidvari, S.; Mosalaei, A.; Ansari, M.; Ahmadi, H.K.; Mohammadianpanah, M. Impact of scattered radiation on testosterone deficiency and male hypogonadism in rectal cancer treated with external beam pelvic irradiation. Middle East J. Cancer, 2010, 1(3), 115-122.
[16]
Bruheim, K.; Svartberg, J.; Carlsen, E.; Dueland, S.; Haug, E.; Skovlund, E.; Tveit, K.M.; Guren, M.G. Radiotherapy for rectal cancer is associated with reduced serum testosterone and increased FSH and LH. Int. J. Radiat. Oncol. Biol. Phys., 2008, 70(3), 722-727.
[http://dx.doi.org/10.1016/j.ijrobp.2007.10.043] [PMID: 18262088]
[17]
Dueland, S.; Guren, M.G.; Olsen, D.R.; Poulsen, J.P.; Magne Tveit, K. Radiation therapy induced changes in male sex hormone levels in rectal cancer patients. Radiother. Oncol., 2003, 68(3), 249-253.
[http://dx.doi.org/10.1016/S0167-8140(03)00120-8] [PMID: 13129632]
[18]
Hermann, R.M.; Henkel, K.; Christiansen, H.; Vorwerk, H.; Hille, A.; Hess, C.F.; Schmidberger, H. Testicular dose and hormonal changes after radiotherapy of rectal cancer. Radiother. Oncol., 2005, 75(1), 83-88.
[http://dx.doi.org/10.1016/j.radonc.2004.12.017] [PMID: 15878105]
[19]
Grigsby, P.W.; Perez, C.A. The effects of external beam radiotherapy on endocrine function in patients with carcinoma of the prostate. J. Urol., 1986, 135(4), 726-727.
[http://dx.doi.org/10.1016/S0022-5347(17)45831-9] [PMID: 3083117]
[20]
Daniell, H.W.; Clark, J.C.; Pereira, S.E.; Niazi, Z.A.; Ferguson, D.W.; Dunn, S.R.; Figueroa, M.L.; Stratte, P.T. Hypogonadism following prostate-bed radiation therapy for prostate carcinoma. Cancer, 2001, 91(10), 1889-1895.
[http://dx.doi.org/10.1002/1097-0142(20010515)91:10<1889:AID-CNCR1211>3.0.CO;2-U] [PMID: 11346871]
[21]
Oermann, E.K.; Suy, S.; Hanscom, H.N.; Kim, J.S.; Lei, S.; Yu, X.; Zhang, G.; Ennis, B.; Rohan, J.P.; Piel, N.; Sherer, B.A.; Borum, D.; Chen, V.J.; Batipps, G.P.; Constantinople, N.L.; Dejter, S.W.; Bandi, G.; Pahira, J.; McGeagh, K.G.; Adams-Campbell, L.; Jha, R.; Dawson, N.A.; Collins, B.T.; Dritschilo, A.; Lynch, J.H.; Collins, S.P. Low incidence of new biochemical and clinical hypogonadism following hypofractionated stereotactic body radiation therapy (SBRT) monotherapy for low- to intermediate-risk prostate cancer. J. Hematol. Oncol., 2011, 4, 12-20.
[http://dx.doi.org/10.1186/1756-8722-4-12] [PMID: 21439088]
[22]
Golfam, M.; Samant, R.; Eapen, L.; Malone, S. Effects of radiation and total androgen blockade on serum hemoglobin, testosterone, and erythropoietin in patients with localized prostate cancer. Curr. Oncol., 2012, 19(4), e258-e263.
[http://dx.doi.org/10.3747/co.19.963] [PMID: 22876154]
[23]
Ishiyama, H.; Teh, B.S.; Paulino, A.C.; Yogeswaren, S.; Mai, W.; Xu, B.; Butler, E.B. Serum testosterone level after intensity-modulated radiotherapy in low-risk prostate cancer patients: Does testicular dose correlate with testosterone level? J. Radiat. Oncol., 2012, 1(2), 173-177.
[http://dx.doi.org/10.1007/s13566-012-0007-1]
[24]
Nichols, R.C., Jr; Morris, C.G.; Hoppe, B.S.; Henderson, R.H.; Marcus, R.B., Jr; Mendenhall, W.M.; Li, Z.; Williams, C.R.; Costa, J.A.; Mendenhall, N.P. Proton radiotherapy for prostate cancer is not associated with post-treatment testosterone suppression. Int. J. Radiat. Oncol. Biol. Phys., 2012, 82(3), 1222-1226.
[http://dx.doi.org/10.1016/j.ijrobp.2010.12.025] [PMID: 21570206]
[25]
Kil, W.J.; Nichols, R.C., Jr; Hoppe, B.S.; Morris, C.G.; Marcus, R.B., Jr; Mendenhall, W.; Mendenhall, N.P.; Li, Z.; Costa, J.A.; Williams, C.R.; Henderson, R.H. Hypofractionated passively scattered proton radiotherapy for low- and intermediate-risk prostate cancer is not associated with post-treatment testosterone suppression. Acta Oncol., 2013, 52(3), 492-497.
[http://dx.doi.org/10.3109/0284186X.2013.767983] [PMID: 23477360]
[26]
Markovina, S.; Weschenfelder, D.C.; Gay, H.; McCandless, A.; Carey, B.; DeWees, T.; Knutson, N.; Michalski, J. Low incidence of new biochemical hypogonadism after intensity modulated radiation therapy for prostate cancer. Pract. Radiat. Oncol., 2014, 4(6), 430-436.
[http://dx.doi.org/10.1016/j.prro.2014.02.004] [PMID: 25407866]
[27]
Planas, J.; Celma, A.; Placer, J.; Maldonado, X.; Trilla, E.; Salvador, C.; Lorente, D.; Regis, L.; Cuadras, M.; Carles, J.; Morote, J. Hormonal changes after localized prostate cancer treatment. Comparison between external beam radiation therapy and radical prostatectomy. Actas Urol. Esp., 2016, 40(9), 549-555.
[http://dx.doi.org/10.1016/j.acuro.2016.02.010] [PMID: 27207596]
[28]
Pompe, R.S.; Karakiewicz, P.I.; Zaffuto, E.; Smith, A.; Bandini, M.; Marchioni, M.; Tian, Z.; Leyh-Bannurah, S.R.; Schiffmann, J.; Delouya, G.; Lambert, C.; Bahary, J.P.; Beauchemin, M.C.; Barkati, M.; Ménard, C.; Graefen, M.; Saad, F.; Tilki, D.; Taussky, D. External beam radiotherapy affects serum testosterone in patients with localized prostate cancer. J. Sex. Med., 2017, 14(7), 876-882.
[http://dx.doi.org/10.1016/j.jsxm.2017.04.675] [PMID: 28546065]
[29]
Zagars, G.K.; Pollack, A. Serum testosterone levels after external beam radiation for clinically localized prostate cancer. Int. J. Radiat. Oncol. Biol. Phys., 1997, 39(1), 85-89.
[http://dx.doi.org/10.1016/S0360-3016(97)00311-8] [PMID: 9300743]
[30]
Pickles, T.; Graham, P. What happens to testosterone after prostate radiation monotherapy and does it matter? J. Urol., 2002, 167(6), 2448-2452.
[http://dx.doi.org/10.1016/S0022-5347(05)65002-1] [PMID: 11992055]
[31]
Moher, D.; Liberati, A.; Tetzlaff, J.; Altman, D.G. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann. Intern. Med., 2009, 151(4), 264-269.
[http://dx.doi.org/10.7326/0003-4819-151-4-200908180-00135] [PMID: 19622511]
[32]
Farhood, B.; Mortezaee, K.; Haghi-Aminjan, H.; Khanlarkhani, N.; Salehi, E.; Nashtaei, M.S.; Najafi, M.; Sahebkar, A. A systematic review of radiation-induced testicular toxicities following radiotherapy for prostate cancer. J. Cell. Physiol., 2019, 234, 14828-14837.
[http://dx.doi.org/10.1002/jcp.28283] [PMID: 30740683]

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