Efeitos da radioterapia e hormonioterapia na espermatogênese de pacientes com câncer de próstata

Abstract

Objectives: This study aims to evaluate parameters of the spermatogenic process of elderly men with advanced prostate cancer who underwent radiotherapy and hormonal treatment, compared with those who did not suffer any of these treatments before performing bilateral orchiectomy. Method: We evaluated testicular histopathological scores in spermatogenesis under high resolution light microscopy and light microscopy morphology and morphometry, all correlated with the hormonal profile and clinical data. It were included 22 patients with ages between 59 and 90 years and with mean of 74.3 years. Eleven patients from them underwent bilateral orchiectomy, which had not undergone any previous treatment or had been previously treated with radical prostatectomy (control group). Six patients underwent bilateral orchiectomy and were exclusively submitted to hormonal treatment with testosterone blockers of central or peripheral action. Five other patients underwent bilateral orchiectomy and had been previously treated with external beam radiotherapy, not getting any more treatment or they were treated subsequently with central or peripheral testosterone blockers. Results: The Classic Five testicular histopathological patterns score showed a significant reduction in the value of the score between the control group compared with the group treated with radiotherapy, but it was not significant compared to the group treated with hormone therapy. On the other hand, scores of Johnsen and Bergmann showed significant reduction in scores between the control group and the two treatment groups. The morphometric analysis of tubular parameters showed that there was significant reduction in tubular diameter and height of the seminiferous epithelium in individuals who were subjected to hormonal and radiotherapy. This lower height of the seminiferous epithelium was due to a reduction in the number of germ cells in stage III of the seminiferous epithelium cycle, mainly from preleptotene, when meiotic phase started. The indices of the efficiency of spermatogenesis showed that no significant deleterious effect on the process of spermatogonial mitosis, mainly of Adark and Apale, spermatogonia which correspond to spermatogonial stem from human testis. However, regarding meiotic process, support capacity of Sertoli cells and the overall efficiency of spermatogenesis, the hormone therapy and radiotherapy were significantly detrimental. Specifically after hormone treatment, spermiogenesis was completely blocked, with no formation of elongated spermatids. Conclusions: We conclude that treatments for prostate cancer, using hormones and radiotherapy, cause deleterious effects on human spermatogenesis process, with significant changes in several qualitative and quantitative parameters of spermatogenesis. Testicular histopathological scores of Johnsen and Bergmann demonstrated more accurately compared to the classic five-score patterns and the radiotherapy and hormonal treatments were harmful to spermatogenesis. Morphometric parameters showed that radiotherapy has been more damaged to spermatogonial proliferation than hormone therapy, but only hormone therapy blocked spermiogenesis.