Conceiving Children After a Prostate Cancer Diagnosis

Conceiving Children After a Prostate Cancer Diagnosis

Curve balls are great for Cy Young pitchers—not for a 27-year-old soldier just back from Afghanistan. Imagine making it home safely from a war zone only to learn that you have prostate cancer—a diagnosis that you only learned about because your doctor accidentally ordered a PSA test during your annual physical. Imagine the twilight-zone moment when two PSA tests, one biopsy and a second opinion later you realize it’s not a fluke; it’s not a mistake—aggressive prostate cancer is growing inside your otherwise young, healthy body.

Suddenly, you’re trying to decide which treatment option is best, if you should accept the new job you’ve just been offered out-of-state, and whether you should bank your sperm so you can be a father one day.

At first blush, a seemingly healthy 27-year-old man with prostate cancer might seem like an anomaly. While it’s true that most men diagnosed with prostate cancer are 50 and older, physicians are seeing younger men in their 30s and early 40s with prostate cancer. United States military stats confirm that active duty servicemen have double the rate of prostate cancer as men in the civilian population. Their increased risk could be due to exposure to toxic chemicals. (We’ll cover this issue in more detail soon in an upcoming blog). With scores of soldiers having served multiple tours of duty in Afghanistan, aggressive prostate cancer could become much more common in younger men.

That brings another important consideration into play for men of reproductive age who are diagnosed with prostate cancer. Along with emotional and physical changes, many men diagnosed with prostate cancer worry about their ability to have children. It’s an important issue that requires candid discussion with your cancer physician before any treatment begins.

“The good news is, conceiving a child following a prostate cancer diagnosis isn’t impossible,” says Rich Bevan-Thomas, M.D., medical director of USMD Prostate Cancer Center. “Depending on a man’s age, cancer stage and treatment options, there are several methods we can use to help preserve a man’s ability to become a father. For a man with low or lower intermediate-grade prostate cancer who meets the criteria for active surveillance, there is a window of time where he and his partner can try to conceive naturally while his sperm production and ejaculatory function remain unaffected. We have followed several men with these types of cancers with the understanding that we will treat them in the very near future after they have conceived.

“Men whose cancer requires an intervention such as a radical prostatectomy, radiation or other life-saving treatment that poses a threat to their reproductive abilities, may want to bank their sperm before treatment. Men can remain fertile after radiation therapy, but we always recommend banking sperm ahead of time to give men the best odds to conceive."

With sperm banking, semen containing sperm is frozen in liquid nitrogen—a process known as cryopreservation—for future use during in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI). Although the cells are technically still alive, all cellular activity stops. When a couple is ready to undergo IVF or ICSI, the semen is thawed and made ready for use. Roughly 50 percent of the sperm in the thawed semen will regenerate and be viable for artificial insemination.
After prostate cancer treatment, conceiving is a little more complicated.

“As we all know, we can’t always control the timing of things that happen in our lives. For a man who meets the love of his life after a radical prostatectomy or radiation treatment, conception is no longer a simple matter of putting on a Barry White album and letting nature take its course,” says Dr. Bevan-Thomas. “During a radical prostatectomy, the prostate and the seminal vesicles at the base of the bladder are removed. Because the prostate and seminal vesicles are vital to the production of semen and its flow down the urethra and out the penis during climax, their removal makes ejaculation impossible. Without ejaculate, sperm can’t reach or fertilize a woman’s egg. There is also a chance that radiation therapy will affect a man’s fertility. Radiated prostate cells and seminal vesicles still produce semen, but their ability to transport the sperm is diminished. In both cases, extracting sperm directly from the testicles—or in some cases from the vas deferens—may be an option.”

Sperm can be harvested a couple of ways. Your doctors will determine which method is best for you.

With testicular sperm extraction (TESE), one or more small incisions are made in the testes after a nerve block or general anesthesia has been administered. The collected sperm can be used immediately or frozen for future IVF and ICSI treatments.

Minimally invasive testicular sperm aspiration (TESA)—also known as testicular fine needle aspiration (TFNA)—retrieves sperm from the testicles without making an incision in the scrotum. After a nerve block has been administered, a needle punctures the skin and testes so sperm can be extracted with a syringe.

“My colleagues and I understand that a prostate cancer diagnosis can impact many aspects of a man’s life—including fertility. We will do everything in our power to ensure that you understand all of your options before making any decisions regarding treatment. And we certainly will do our best to help you find a way to preserve your ability to have children if that is a goal or concern,” Dr. Bevan-Thomas says.

If you or someone you love has been diagnosed with prostate cancer and would like to know more about options for preserving fertility, please contact USMD Prostate Cancer Center online or at 1-888-PROSTATE (1-888-776-7828).

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