New life after prostate brachytherapy? Considering the fertile female partner of the brachytherapy patient

Abstract

RESULTSThree reported cases of pregnancy showed the men to have viable counts of within several or all of the parameters of the World Health Organisation criteria for normal semen analysis. CONCLUSIONSThese cases provide a cautionary tale and suggest that all men being treated with prostate brachytherapy should be counselled about the possibility of continued fertility. Documentation of this 'risk' on the consent form will allow for proper discussion of this issue in a clinical and medicolegal context. The key to addressing this problem is to propagate much better patient information. The topic should be addressed clearly in information booklets for the patients. Prostate brachytherapy may allow for pregnancy to be achieved in the fertile partners of patients, even after full radiation treatment of the patient. KEYWORDSprostate brachytherapy, fertility, pregnancy OBJECTIVESTo examine several cases of unusual and unexpected pregnancy in the female partners of men treated with brachytherapy for cancer of the prostate PATIENTS AND METHODSSelf-reported pregnancy of partners of patients who had had prostate brachytherapy was assessed. The dosimetry to the testicles and sperm counts were used to examine the feasibility of pregnancy in the partners.

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

“…Grocela et al . 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 ., ).…”

Sperm preservation and neutron contamination following proton therapy for prostate cancer study

“…As older men generally are not considering future fertility, there has been little impetus for formally evaluating sterility after treatment for prostate cancer. Although a few case reports and case studies have identified a few men who have procreated following definitive radiation, these studies never reported whether formal paternity testing was performed to confirm fatherhood [14,15].…”

Fertility issues in patients with prostate cancer

“…Based on studies in cancer survivors, high‐dose RT of the prostate has been assumed to affect fertility by arresting spermatogenesis and/or altered or discontinued production of the seminal fluid (low volume, changed composition) [6–8]. After implantation of 125 I‐seeds the reported doses to the testicles are 0.03–2.5 Gy [3,4]. The use of 125 I seeds implies low‐dose rate RT.…”

“…Scattered testicular irradiation during pelvic external beam radiotherapy (EBRT) and short‐term androgen ablation cause at least transient azoospermia, but there are no reports on sperm counts after EBRT in patients with prostate cancer. However, prostate brachytherapy is claimed to preserve spermatogenesis in some patients [3,4]. A reduction in the seminal fluid volume after RT might add to reduced fertility, due to arrest of spermatogenesis.…”