As the number of cancer survivors increases, so does the demand for preserving male fertility after radiation. It is important for healthcare providers to understand the pathophysiology of radiation-induced testicular injury, the techniques of fertility preservation both before and during radiation, and their role in counseling patients on the risks to their fertility and the means of mitigating these risks. Impaired spermatogenesis is a known testicular toxicity of radiation in both the acute and the late settings, as rapidly dividing spermatogonial germ cells are exquisitely sensitive to irradiation. The threshold for spermatogonial injury and subsequent impairment in spermatogenesis is ~ 0.1 Gy and the severity of gonadal injury is highly dose-dependent. Total doses < 4 Gy may allow for recovery of spermatogenesis and fertility potential, but with larger doses, recovery may be protracted or impossible. All patients undergoing gonadotoxic radiation therapy should be counseled on the possibility of future infertility, offered the opportunity for semen cryopreservation, and offered referral to a fertility specialist. In addition to this, every effort should be made to shield the testes (if not expected to contain tumor) during therapy.
Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology. 2024 Feb 16*** epublish ***
Marigdalia K Ramirez-Fort, Mehdi Kardoust-Parizi, Ryan Flannigan, Phil Bach, Nicholas Koch, Casey Gilman, Paula Suarez, Digna V Fort, Shearwood McClelland, Christopher S Lange, John P Mulhall, Migdalia Fort, Peter N Schlegel
Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Weill Cornell Medicine, New York, NY, United States., Department of Medical Physics, CONE Health, Greensboro, NC, United States., Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, United States., Department of Sexual and Reproductive Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.