Fertility issues in patients with prostate cancer

Abstract

OBJECTIVE To describe fertility issues, only rarely discussed with patients with prostate cancer, although paternity after treatment might be an important component of quality of life for some, as exemplified by two of our patients. PATIENTS During pretreatment counselling two patients with newly diagnosed prostate cancer initiated the discussion of paternity after treatment. Patient 1 then opted for radiotherapy as the treatment least likely to damage fertility, whereas patient 2 had semen cryopreservation before external beam radiotherapy combined with 6 months adjuvant hormone treatment. RESULTS Patient 1 became a father to a healthy child 9 months after starting radiotherapy, with conception two days after he had received one session of brachytherapy with 192Ir (total dose 10 Gy, testicular dose, 0.1 Gy). Patient 2 fathered a child 36 months after completing external beam radiotherapy (total dose 74 Gy, testicular dose 1.2–2.3 Gy), which was combined with medical castration of 6 months’ duration. CONCLUSION Fertility issues should be considered in patients before curative treatment of prostate cancer.

Androgen Deprivation Therapy for Prostate Cancer: Recommendations to Improve Patient and Partner Quality of Life

“…As testicular function and spermatogenesis cease, infertility results. Healthcare professionals should discuss options for accommodating post‐ADT infertility (e.g., sperm‐banking) with patients of all ages rather than only young patients [95,96]. The Working Group noted that this primary side effect of diminished ejaculate volume and subsequent sterility with ADT is largely ignored in the urological and popular literature, perhaps because of the often advanced age of patients or because of the association, historically at least, of ADT with advanced disease.…”

Male infertility and urological tumors: Pathogenesis and therapeutical implications

“…Modern radiotherapy techniques including image-guided treatments, testis shielding, and even brachytherapy have partially reduced these complications 64 –66…”

“…After external radiotherapy on the prostate area, decreases in total and free testosterone levels of 27% and 31% respectively and increases of 52.7% in LH compared to pre-treatment levels have been reported. 63 Modern radiotherapy techniques including imageguided treatments, testis shielding, and even brachytherapy have partially reduced these complications [64][65][66] Hormone therapy is often associated with radiotherapy in the treatment of prostate tumors and the combined effect of androgen and radiant deprivation produces very negative effects on fertility. 61 Hormone therapy alone, especially in regimens with prolonged total androgen blockade, generally produces azoospermia or severe oligospermia.…”

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

“…discussed the case of three spontaneous conceptions following prostate brachytherapy in men with organ confined disease (Grocela et al ., ). Similar to our patient, Steinsvik and colleagues also reported a case in which a 60‐year‐old man fathered a child four years after EBRT with concomitant ADT (Steinsvik et al ., ).…”