Spermatogenesis and sexual function in patients after high-dose brachytherapy for prostate cancer

Introduction. Prostate cancer (PCa) is the most frequently diagnosed oncological disease in men in Russia. In the early stages of localized low- and intermediate risk PCa, radical prostatectomy or various methods of radiation therapy are performed, both approaches demonstrate similar oncological results. The number of cases of PCa at a younger age is increasing, which makes functional outcomes increasingly relevant issues when choosing a treatment approach, in particular, preserving erectile function, and according to some data, fertility. The aim of this review is to evaluate and compare the effect of high-dose-rate brachytherapy with other methods of radical treatment of prostate cancer on sexual function and fertility. Materials and methods. A search and analysis of publications in scientific databases PubMed, Scopus, Web of Science, eLibrary was performed using the following keywords: prostate cancer, high-dose-rate brachytherapy, low-dose-rate brachytherapy, functional outcomes, erectile function, dysfunction, fertility. A total of 65 publications were selected for this review. Results. The article presents data on the mechanisms of radiation-induced impairment of spermatogenesis, the state of spermatogenesis in patients with PCa after brachytherapy, and the effect of high-dose and low-dose brachytherapy on the sexual function of patients. Conclusions. According to a number of studies, systematic reviews and meta-analyses, high-dose-rate brachytherapy demonstrates the best functional indicators in terms of erectile function and fertility.