Effects of Cancer and its Therapy on Male Fertility
The most common reproductive cancers affecting men include prostate cancer, testicular cancer, and penile cancer. Men may also be affected by cancer of the lung, colon, or skin. Finding out about cancer enhances your chances of survival and improves your quality of life.
How Cancer Affects Male Fertility
Cancer may affect men in different ways. They may suffer from a malfunction of their system in terms of abnormal hormone production, and damage to testicles leading to little or no sperm production. Sometimes, problems may occur during ejaculation. Older men over 65 years have the maximum risk of prostate cancer. Your doctor may request a test for prostate-specific antigen (PSA) or a digital rectal exam (DRE) to determine the exact cause. Another prevalent cancer condition affecting men above 55 years is penile cancer. Smoking, HPV, AIDS, and sun exposure are common risk factors. Further, men who have not undergone circumcision have a higher risk of developing penile cancer. Testicular cancer rates are on the rise with a peak age around 30 years. Exposure to pesticides, chemicals in the firefighting, aircraft repair, and synthetic leather manufacturing industry raise the risk of testicular cancer. Other risks include cannabis smoking and a history of AIDS or HIV.
Cancer and related treatment affect male fertility in different ways depending on the type, duration and dosage of treatment. Other factors that may directly affect the chances of retaining fertility include age when the treatment was administered and time-lapse following the treatment.
Cancer Treatment and Male Fertility
Your doctor may advise different therapies depending on where the cancer occurs and how far it has spread. The following sections describe how therapy affects male fertility.
Chemotherapy
A common treatment option for cancer is chemotherapy. It targets cells that divide quickly. These cells may be either normal or cancerous. Rapid cell division in sperm, hair follicles, and bone marrow often makes them targets of chemotherapy leading to fertility problems. During treatment, men may experience diarrhea, hair loss, mouth sores, and infertility.
Over the course of treatment, the type and dosage of drug administered may affect fertility temporarily or permanently. Sometimes, older men may be unable to recover their normal sperm production.
Immunotherapy
Men may also be prescribed targeted immunotherapy drugs such as tyrosine kinase inhibitors, elevating the risk of complications during pregnancy for their partner. Certain drugs such as thalidomide raise the risk of birth defects as their constituents stay in the semen for sometime after the treatment ends. In such situations, most oncologists recommend birth control.
Hormone Therapy
Another treatment choice is hormone therapy that may lower sex drive, decrease sperm production, and cause problems with erections. Further, bone marrow or stem cell therapy may have permanent effects such as preventing sperm production.
Radiation Therapy
When cancer occurs in other parts of the body requiring radiation therapy, therapists shield testicles by a process called gonadal shielding to protect them from scatter radiation. However, when testicles receive radiation as part of the treatment plan, sperm production may stop completely. If the brain has to receive radiation therapy, the pituitary gland and the hypothalamus may no longer function normally, and the body may not be able to signal the testicles to produce testosterone and sperm. Procedures such as brachytherapy (implanting radioactive material in the tissue) offer better alternatives to external radiation as they can kill cancerous tissue while retaining the body’s ability to produce sperm.
Cancer Surgery
Surgery has the maximum likelihood of treating cancer that has not spread inside the body. Fertility is only affected when the surgeon has to operate directly on the reproductive system such as performing orchiectomy for testicular cancer, prostatectomy for prostate cancer, or radical cystectomy to remove the bladder and prostate. Men have varying risks from surgery depending on the extent, and malignancy of cancer. They may no longer be able to produce semen or testosterone. Men may also suffer from nerve damage, erectile dysfunction, and retrograde ejaculation (backward flow of semen).
Collecting and Preserving Sperm
To be able to have a child after your treatment, your doctor may advise you to preserve sperm. You may have to test for HIV and hepatitis before collecting several sperm samples for a few weeks. When enough sperm is not available in the semen, sperms may be removed from the testicles using procedures such as epididymal sperm aspiration or testicular sperm extraction.
Sperm banking or cryopreservation is a technique available at specialized fertility clinics to freeze and store healthy sperm. During the storage term, a substance protects the sperm when they remain frozen, and at the time of thawing. When couples decide on having a child, the woman’s egg is fertilized using in-vitro fertilization (IVF) or implantation in the uterus. Sperms stay frozen for many years, although the exact duration is not known.
It is important to ask the right questions before commencing treatment for cancer such as its effects on male fertility, risks involved, available sperm preservation options, birth control methods, and restoration of fertility after treatment. Finally, emotional concerns are distressing for most men and support from family, friends, your healthcare team, and other professional support groups promote positive outcomes during your course of therapy.
