Fertility Issues In Patients With Prostate Cancer

With PSA screening, men are being diagnosed with prostate cancer (CaP) at younger ages. In the online issue of the BJU International, Dr. Steinsvik and colleagues address the issues of fertility as related to prostate cancer therapies. In Norway, the percentage of patients aged <60years has increased from 4% in 1986 to 11% in 2006.

Patients experience scattered testicular irradiation during pelvic external beam radiotherapy with short-term androgen-deprivation therapy that causes transient azoospermia. However, data on sperm counts following radiotherapy are lacking. Brachytherapy may preserve spermatogenesis but reduce seminal fluid volume. Options for infertility following these treatments or radical prostatectomy include semen cryopreservation prior to therapy or sperm extraction from the epididymis or testes afterwards. This can then be used for intracytoplasmic sperm injection.

The authors present two cases of prostate cancer patients desiring fertility following therapy. One was a 57 year old man with intermediate risk CaP. He and his partner had failed to conceive for the previous 8 years. ICSI has resulted in 7 spontaneous abortions. He underwent brachytherapy with a radiotherapy boost. Incredibly, he impregnated his partner 2 days following brachytherapy and prior to the onset of radiotherapy. His testicular dose after brachytherapy was estimated to be 0.1Gy based upon the treatment planning scheme. The second patient was 56 years old with high-risk prostate cancer. He underwent radiotherapy with 3 months of ADT. He remained sexually active and had a sperm count 4 years after therapy of 225x106/ml sperm cells with a semen volume of 1.7ml. Five years post-therapy he fathered a child without use of cryopreserved sperm cells. His testicular dose was estimated to be 1.2-2.3Gy.

Despite these remarkable outcomes, the authors recommend that younger patients be advised of the option to cryopreserved sperm prior to CaP therapies.