About Prostate Cancer

Prostate cancer affects one in each 6 men living in the US. Treatment of prostate cancer can markedly reduce fertility potential. Approximately, 217,000 men are expected to be diagnosed with prostate cancer in the US in 2010. Prostate cancer is diagnosed in 1 in 10,000 men before the age of 39 and 1 in 40 between the ages of 40 and 59. Screening for prostate cancer using a blood tests-prostate specific antigen (PSA) resulted in increased diagnosis in younger men. Many men diagnosed with prostate cancer are interested in future fertility. Except in cases of distant spread, survival after prostate cancer approaches 100%. Prostate cancer is more common in men carrying BRCA2 mutations and occurs in younger age.

Cancer in men, before treatment, may affect sperm count and quality, although this is controversial. In general 10% of men diagnosed with cancer are expected to have no ejaculated sperm-azospermia. Up to 50% may have abnormal sperm quality.

Prostate cancer treatment and future fertility. Treatment options for prostate cancer include
1. Radical prostatectomy. This procedure can be performed through a large incision or via minimally access surgery-laparoscopy. Surgery can be modified to preserve the nerve fibers responsible for erection thus reducing erectile dysfunction after surgery. Surgery causes block of the vas deferens on both sides leading to obstruction and azospermia.
2. Radiation. External beam radiation affect sperm production from the testes as scattered radiation can damage the sperm producing cells. Placing a radioactive seed inside the prostate-brachytherapy, has minimal effect on sperm production.
3. Observation on;y is possible for selected men diagnosed with prostate cancer.

Fertility preservation options in young men
1. Sperm Cyopreservation. Less than 50% of men diagnosed with cancer preserve their sperm before treatment due to lack of information or counseling. This is a very available and low cost option. One or more samples can be frozen depending on time and initial sperm counts and quality. Sperm can be frozen indefinitely. If multiple samples were frozen, they can be used for intrauterine insemination. If limited amount of sperm is available or low quality -movement or sperm shape, IVF with injection of sperm into the egg-ICSI is required. Sperm freezing has a good psychological impact on men during cancer treatment.
2. Electro-ejaculation. For men who have erectile dysfunction or inability to ejaculate after surgery, electrical stimulation can induce ejaculation. Sperm quality in this case is likely abnormal favoring the use of sperm for IVF-ICSI.
3. Testicular Sperm Extraction-TESE. Form men with no ejaculated sperm-azospermia, sperm can be surgically obtained from the testes. This is also an option for men who cannot produce sperm and no sperm could be aspirated without surgery. This procedure can be performed during the surgical treatment for cancer. Sperm are obtained in 50-60% of men with azospermia. Sperm obtained are used for IVF with ICSI. Sperm can also be obtained from the duct that convey sperm outside the testes-Microsurgical epididymal sperm aspiration-MESA. The success rate of achieving pregnancy using frozen ejaculated sperm or surgically obtained viable sperm is not different from fresh sperm.

Checklist for fertility preservation in prostate cancer

1. Discuss with your oncologist different cancer treatment options-radical prostatectomy, external beam radiation and brachytherapy or even observation only.
2. If radical prostatectomy is planned inquire about the technique of surgery-open or laparoscopy, nerve sparing procedures and incidence of erectile dysfunction in the surgeon’s hands
3. Ask for more information about the effects of prostate cancer treatment and fertility preservation options from the oncologist or reproductive endocrinologist.
4. If interested in fertility preservation a reproductive endocrinologist or urologist can refer you for semen analysis and freezing (in the same time), interpret the semen analysis and advice about the number of samples to be frozen.
5. If no sperm found-azospermia, surgical sperm retrieval can be performed at the time of surgery for cancer or after cure.

Amr Azim is a board certified reproductive endocrinologist and fertility specialist in New York City IVF and author of many scientific publication in the area of fertility treatment and fertility preservation. I specialize in fertility counseling, testing,male factor infertility, PCOS, endometriosis and infertility treatments including IUI and IVF.
I published my work on fertility preservation and treatment of low responders to ovarian stimulation in major scientific journals.
I am very passionate about helping women, men and children diagnosed with cancer and other diseases understand the impact of disease and its treatment on future fertility.

Prostate cancer is the second leading cause of cancer death, second only to lung cancer and affects around 20.6 percent Americans and 17.6 percent of Caucasians. This type of cancer affects 50% – 80% of men over 80 years of age and is diagnosed in more than 80% of men older than 65 years. The cause of this type of malignant tumor is still unknown but is linked to advancing age, heredity, testosterone hormone secretion, and effect of substances such as toxins, chemicals and industrial products in the environment. Prostate cancer rarely metastasizes; it remains confined in the gland until certain conditions cause it to spread to other organs like the lungs and the liver.

Signs and Symptoms

The disease, during the early stage, usually does not cause appearance of signs or symptoms. In most cases, patients experience difficult urination, burning sensation during urination or blood in urine. Upon examination, physicians may detect the presence of a hard nodule in front of the rectum. This lump, nodule or cancer growth enlarges as time passes and presses on the urethra, diminishing urine output and making it difficult for the patient to urinate. Continuous enlargement of the tumor can completely block urine flow, resulting in painful urination and enlarged urinary bladder. Late stages of the cancer cause fatigue, body malaise and weight loss.

Detection Techniques

Early detection of prostate cancer depends on two important screening tests, which include the digital rectal examination and prostate specific antigen (PSA) testing. In digital rectal examination, urologists usually look for an abnormal tissue growth or lump in front of the rectum. On the other hand, prostate specific antigen testing requires the determination of PSA level in blood samples. A concentration of four nanograms per milliliter in tested samples is suggestive of prostate cancer. Confirmation usually requires prostate biopsy and correlation of PSA level with other available data, including family history, age as well as the observable signs and symptoms.

With the available diagnostic and treatment measures, the number of those dying from prostate cancer has slowly decreased. However, many of those affected are either misdiagnosed, undiagnosed or have not undergone testing; thus, the need to encourage more men age 40 and above to undergo regular physical and laboratory examinations.

Nobody wants to hear the one of the scariest words come out of their physicians mouth, “cancer”. The mere thought of having cancer itself can be one of the scariest prospects you will face but if you are diagnosed with prostate cancer take a breath as there are many treatments available.

After you have allowed yourself to allow the thought of having a cancer sink in, start to educate yourself on treatments as there are choices with great success. What prostate treatment is sight for you can only be decided by you, your family and your physician. Prostate surgery is one choice and includes treatments; such as, a radial protatectomy or radioactive seed implantation, which is not as scary as it sounds. Removing the prostate completely or using the iodine “seeds” placed in the prostate may be right for you.

If prostate surgery isn’t the answer, another prostate cancer treatment are injections. Some of these injections are Eligard, Lupron and Zoladex. These injections can be given on a three to six month basis and it is a hormone based injection as prostate cancer feeds off of the testosterone. There are also implant devices which can be put in during an office visit which goes under the first layer of the skin and are left there for a year. This is a great option if you do not wish to have surgery but can not make quarterly or biannual injection visits.

Explore your options and choose what specially fits you best.

Prostate cancer is most common in men over 50 years old. By age 80 it is estimated that 80% of men will have had prostate cancer.

Although these symptoms are not unique to prostate cancer they indicate that it is time for a check-up. These symptoms include trouble urinating or frequent urges, pain or burning when urinating, blood in the urine or semen, pain in the back, hips or pelvis or painful ejaculation.

When a positive diagnosis is made there are several common steps to prostate cancer treatment.

The first determination is to find if the cancer has spread to other parts of the body. Possible tests may include a bone scan, CT scan, MRI or a needle biopsy. These test help to determine the Gleason scale number which rates how likely the cancer cells are to spread. Prostate treatment will be determined by this score, your age and general health.

For tumors that have not spread beyond the prostate a wait and see approach may be indicated for a slow growing tumor. For a faster growing cancer radiation therapy or a type of prostate surgery call radical prostatectomy may be implemented. There is the possibility that the doctor will determine a less invasive surgery is possible.

A hormone treatment may be also be recommended. This lessens the amount of male androgens that are produced. This will eventually cause the tumor to shrink.

As with any cancer prevention is the best treatment. Know your risks and have regular check-ups to prevent the need for prostate cancer treatment.