Background We sought to identify determinants of health-related quality of life after primary treatment of prostate cancer and to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners. Methods We prospectively measured outcomes reported by 1201 patients and 625 spouses or partners at multiple centers before and after radical prostatectomy, brachytherapy, or external-beam radiotherapy. We evaluated factors that were associated with changes in quality of life within study groups and determined the effects on satisfaction with the treatment outcome. Results Adjuvant hormone therapy was associated with worse outcomes across multiple quality-of-life domains among patients receiving brachytherapy or radiotherapy. Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function. Adverse effects of prostatectomy on sexual function were ...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa074311

Quality of life and satisfaction with outcome among prostate-cancer survivors.

Oxidative stress occurs when the production of potentially destructive reactive oxygen species (ROS) exceeds the bodies own natural antioxidant defenses, resulting in cellular damage. Oxidative stress is a common pathology seen in approximately half of all infertile men. ROS, defined as including oxygen ions, free radicals and peroxides are generated by sperm and seminal leukocytes within semen and produce infertility by two key mechanisms. First, they damage the sperm membrane, decreasing sperm motility and its ability to fuse with the oocyte. Second, ROS can alter the sperm DNA, resulting in the passage of defective paternal DNA on to the conceptus. This review will provide an overview of oxidative biochemistry related to sperm health and will identify which men are most at risk of oxidative infertility. Finally, the review will outline methods available for diagnosing oxidative stress and the various treatments available.

/pdf/oxidative-stress-and-male-infertility-a-clinical-perspective-2nu3kdi0jn.pdf

Oxidative stress and male infertility—a clinical perspective

Infertility affects approximately 15% of couples trying to conceive, and a male factor contributes to roughly half of these cases. Oxidative stress (OS) has been identified as one of the many mediators of male infertility by causing sperm dysfunction. OS is a state related to increased cellular damage triggered by oxygen and oxygen-derived free radicals known as reactive oxygen species (ROS). During this process, augmented production of ROS overwhelms the body's antioxidant defenses. While small amounts of ROS are required for normal sperm functioning, disproportionate levels can negatively impact the quality of spermatozoa and impair their overall fertilizing capacity. OS has been identified as an area of great attention because ROS and their metabolites can attack DNA, lipids, and proteins; alter enzymatic systems; produce irreparable alterations; cause cell death; and ultimately, lead to a decline in the semen parameters associated with male infertility. This review highlights the mechanisms of ROS production, the physiological and pathophysiological roles of ROS in relation to the male reproductive system, and recent advances in diagnostic methods; it also explores the benefits of using antioxidants in a clinical setting.

/pdf/effect-of-oxidative-stress-on-male-reproduction-gwr7v3koqi.pdf

Effect of oxidative stress on male reproduction.

Spermatogenesis is an extremely active replicative process capable of generating approxi mately 1,000 sperm a second. The high rates of cell division inherent in this process imply correspondingly high rates of mitochondrial oxygen consumption by the germinal epithelium. However, the poor vascularization of the testes means that oxygen tensions in this tissue are low1 and that competition for this vital element within the testes is extremely intense. Since both spermatogenesis2 and Leydig cell steroidogenesis3,4 are vulnerable to oxidative stress, the low oxygen tension that characterizes this tissue may be an important component of the mechanisms by which the testes protects itself from free radical-mediated damage. In addition, the testes contain an elaborate array of antioxidant enzymes and free radical scavengers to ensure that the twin spermatogenic and steroidogenic functions of this organ are not impacted by oxidative stress. These antioxidant defence systems are of major importance because peroxidative damage is currently regarded as the single most important cause of impaired testicular function underpinning the pathological consequences of a wide range of conditions from testicular torsion to diabetes and xenobiotic exposure. This chapter sets out the specific nature of these antioxidant defence systems and also reviews the factors that have been found to impair their activity, precipitating a state of oxidative stress in the testes and impairing the latter’s ability to produce viable spermatozoa capable of initiating and supporting embryonic development.

/pdf/antioxidant-systems-and-oxidative-stress-in-the-testes-54n1pge1q7.pdf

Antioxidant systems and oxidative stress in the testes.

Male factor has been considered a major contributory factor to infertility. Along with the conventional causes for male infertility such as varicocele, cryptorchidism, infections, obstructive lesions, cystic fibrosis, trauma, and tumors, a new, yet important cause has been identified: oxidative stress. Oxidative stress (OS) is a result of the imbalance between reactive oxygen species (ROS) and antioxidants in the body, which can lead to sperm damage, deformity and eventually male infertility. This involves peroxidative damage to sperm membrane and DNA fragmentation at both nuclear and mitochondrial levels. OS has been implicated as the major etiological factor leading to sperm DNA damage. OS-induced DNA damage can lead to abnormalities in the offspring including childhood cancer and achondroplasia. In this article, we discuss the need of ROS in normal sperm physiology, the mechanism of production of ROS and its pathophysiology in relation to male reproductive system. The benefits of incorporating antioxidants in clinical and experimental settings have been enumerated. We also highlight the emerging concept of utilizing OS as a method of contraception and the potential problems associated with it.

/pdf/clinical-relevance-of-oxidative-stress-in-male-factor-4iu0fbr4ry.pdf

Clinical relevance of oxidative stress in male factor infertility: an update.

Numerous factors influence male fertility. Among these factors is oxidative stress (OS), which has elicited an enormous interest in researchers in recent period. Reactive oxygen species (ROS) are continuously produced by various metabolic and physiologic processes. OS occurs when the delicate balance between the production of ROS and the inherent antioxidant capacity of the organism is distorted. Spermatozoa are particularly sensitive to ROS as their plasma membrane contains polyunsaturated fatty acids (PUFA), which oxidizes easily. They also lack cytoplasm to generate a robust preventive and repair mechanism against ROS. The transition metal ions that are found in the body have a catalytic effect in the generation of ROS. Lifestyle behaviours such as smoking and alcohol use and environmental pollution further enhance the generation of ROS and thus, cause destructive effects on various cellular organelles like mitochondria, sperm DNA etc. This article analyzes the detrimental effects of OS on male fertility, measurement of OS and effective ways to decrease or eliminate them completely. We have also provided information on oxidative stress in other systems of the body, which may be applied to future research in the field of reproductive biology.

/pdf/mechanism-measurement-and-prevention-of-oxidative-stress-in-29h5m5se58.pdf

Mechanism, measurement, and prevention of oxidative stress in male reproductive physiology.

The greatest paradox of aerobic respiration is that oxygen, which is essential for energy production, may also be detrimental because it leads to the production of reactive oxygen species (ROS) (Saleh and Agarwal, 2002). When levels of reactive oxygen species (ROS) overwhelm the body’s antioxidant defense system, oxidative stress (OS) occurs. OS is a condition in which the elevated levels of ROS damage cells, tissues, or organs (Moller et al, 1996; Sharma and Agarwal, 1996; Saleh et al, 2003). ROS are free radicals that play a significant role in many of the sperm physiological processes such as capacitation, hyperactivation, and sperm-oocyte fusion (Aitken et al, 2004; Allamaneni et al, 2004; de Lamirande et al, 1998). However, they also trigger many pathological processes in the male reproductive system, and these processes have been implicated in cancers of the bladder and prostate, as well as in male infertility (Bankson et al, 1993; Hietanen et al, 1994; Agarwal and Saleh, 2002). Spermatozoa are sensitive to OS because they lack cytoplasmic defenses (Donnelly et al, 1999; Saleh and Agarwal, 2002). Moreover, the sperm plasma membrane contains lipids in the form of polyunsaturated fatty acids, which are vulnerable to attack by ROS. ROS, in the presence of polyunsaturated fatty acids, triggers a chain of chemical reactions called lipid peroxidation (Agarwal et al, 1994; Kobayashi et al, 2001; Zalata et al, 2004). ROS can also damage DNA by causing deletions, mutations, and other lethal genetic effects (Moustafa et al, 2004; Tominaga et al, 2004). It is difficult to block the OS-

https://onlinelibrary.wiley.com/doi/pdf/10.2164/jandrol.05016

Prevention of oxidative stress injury to sperm

http://www.ccf.org/ReproductiveResearchCenter/docs/agradoc236.pdf

Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis

Varicocele is one of the leading causes of male infertility, and is present in almost 40% of infertile males. Recent understanding of the role of oxidative stress in male reproduction has led some researchers to postulate oxidative stress as the possible cause of sperm dysfunction in varicocele patients. The objective of the present study was to examine the published literature on the role of oxidative stress in patients with varicocele as the aetiology of their infertility. Twenty-three human studies were identifi ed after an extensive search dealing with the role of oxidative stress in varicocele-associated infertility. Out of these studies, four were selected that measured similar types of reactive oxygen species (ROS) by a similar method of measurement. The data were then entered in the RevMan software for analysis. The overall estimate showed that patients have signifi cantly higher concentrations of ROS than controls, with the mean difference being 0.73 (95% CI 0.40, 1.06, P < 0.0001). This translated to an ROS concentration of 4.37 × 10 4 cpm/20 × 10 6 spermatozoa/ml on the linear scale. Total antioxidant capacity levels were found to be signifi cantly lower in the infertile varicocele patients, with 386 fewer trolox equivalents than the controls (95% CI −556.56−216.96, P < 0.00001). From the results, it can be concluded that there is increased oxidative stress in varicocele patients; however, more studies are needed to confi rm this fi nding.

https://www.clevelandclinic.org/reproductiveresearchcenter/docs/agradoc209.pdf

Relationship between oxidative stress, varicocele and infertility: a meta-analysis.

https://www.clevelandclinic.org/reproductiveresearchcenter/docs/agradoc307.pdf

Sushil Prabakaran

Papers

Mechanism, measurement, and prevention of oxidative stress in male reproductive physiology.

Prevention of oxidative stress injury to sperm

Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis

Relationship between oxidative stress, varicocele and infertility: a meta-analysis.

Role of Oxidative Stress in Pathogenesis of Varicocele and Infertility