Successful sperm extraction and live birth after radiation, androgen deprivation and surgical castration for treatment of metastatic prostate cancer

Abstract

Fertility preservation has become an important aspect of cancer treatment given the gonadotoxic effects of oncologic therapies. It is now considered standard of care to offer sperm banking to men undergoing treatment for primaries that affect young individuals. Less is known regarding fertility preservation of patients afflicted with prostate cancer. This cohort has progressively expanded and grown younger in the post-PSA era. Prostatectomy, radiation, chemotherapy and androgen blockade all pose unique challenges to the infertility specialist. Optimum management becomes even more uncertain for those men with metastatic prostate cancer. Most of these individuals will have received multiple forms of therapy, each carrying a distinct insult to the patient's reproductive potential. We describe a case of successful ex vivo sperm extraction and live birth in a patient previously treated with radiation and chronic androgen deprivation for metastatic prostate cancer. The presented case demonstrates that conception after radiation therapy and chronic androgen deprivation is feasible. We propose that fertility counselling and sperm cryopreservation should be considered for all prostate cancer patients. Additionally, for those individuals undergoing external beam radiotherapy, testicular shielding should be routinely offered in the event further family building is desired.

Testicular sperm extraction (TESE) outcomes in the context of malignant disease: a systematic review

“…Eleven retrospective studies 26 29 30 31 32 33 34 35 36 37 38 and 8 case reports or case series 39 40 41 42 43 44 45 46 reported results for postgonadotoxic treatment TESE. The case reports and case series mainly reported TESEs that allowed for spermatozoa retrieval, while the retrospective studies reported between 33.3% and 76.2% positive TESEs ( Table 3 ).…”

Preservation of male fertility in patients undergoing pelvic irradiation

“…MicroTESE results in successful sperm retrieval for 45–63% of non-obstructive azoospermic men with 70-fold less tissue excised compared to conventional TESE [ 46 ]. Sperm retrieval is also possible for men that are azoospermic after having undergone radiation therapy, with sperm retrieval rates dependent upon the dose and temporal relationship with radiotherapy [ 47 ].…”

Sperm cryopreservation before definitive therapy for early‐stage prostate cancer: A single institution experience

“…Although there is no question that the sperm cryopreservation is a gold standard for male‐fertility preservation, sperm preservation by testicular sperm extraction (TESE) is also useful. Especially, for the patients with ejaculatory dysfunction, for example, the patients received prostatectomy, radiation therapy for the prostate, 6 or androgen ablation therapy, 6 , 7 TESE might be recommended instead of the sperm cryopreservation.…”