Sperm cryopreservation before definitive therapy for early-stage prostate cancer: A single institution experience.

Abstract

Male-fertility preservation—sperm cryopreservation is a gold standard for male-fertility preservation—has been paid attention for cancer patients over the past two decades because significant cancer treatment increasing cancer survivors and leading demand for future parenthood.1 Unfortunately, prostate cancer (PC) patients are not adequately informed about treatment-induced infertility before PC treatment although there were certain patients who hope fertility preservation.2 In this study, we report real-world data about sperm cryopreservation before definitive therapy for early-stage PC at our institution. We assessed eight PC patients who visited Reproduction Center of Yokohama City University Medical Center (YCUMC) for purpose of male-fertility preservation before definitive therapy for early-stage PC between 2013 and 2017. It is estimated that about 1.6% (8/500) of PC patients received definitive therapy could hope male-fertility preservation before treatment. We obtained the data of the PC status (prostate-specific antigen [PSA] levels, clinical stage, and Gleason scores), patients' age, type of definitive therapy for PC, sperm concentration, motility, whether to perform sperm cryopreservation, and whether to use of preserved sperm for pregnancy from the electronic medical record. Semen specimens were collected by masturbation after 48–120 h of sexual abstinence. Semen analysis was performed according to WHO guideline.3 Median age of the patients was 57 (range: 45–61). Median PSA levels were 6.1 (range: 4.1–8.6) ng/ml. Of the eight patients analyzed, one, six, and one patient were clinical stage T1c, T2a, and T2c, respectively. Gleason scores distributions were 3 + 3 in two, 3 + 4 in three, 4 + 3 in two, and 4 + 5 in one patient. Planned definitive therapy for PC was radical prostatectomy in one, seed implantation in four, and external beam radiation in three patients. Semen analysis was performed in all eight patients. Four out of eight patients were married and median age of their wife was 44 (range: 37–45). Median sperm concentration and motility were 46.5 × 106/ml (range: 5.3–110.1) and 4.9% (range: 1.3–23.3), respectively. Ejaculatory volume and normal morphology ratio of sperm were not evaluated. Sperm cryopreservation was performed in all patients except one. One patient did not hope cryopreservation because his own will. One patient who received seed implantation used preserved sperm for pregnancy and obtained a healthy baby. Boyd et al. reported that only 8.7% of localized PC patients were informed about the possibility of future male-infertility before PC treatment.2 Most PC patients are relatively aged and most physician tend to avoid about discussing it with their patients. Indeed, Boyd et al. reported that no patients with 55 years or older concerned about future infertility due to PC treatment among localized PC patients. However, patients who concerned about future male-infertility due to PC treatment are existing definitively, especially in young patients.2 Salonia et al. reported that 20% of PC patients hope for preoperative sperm cryopreservation.4 Especially, patients with younger, childless, and intense desire for fatherhood tend to hope for it. In addition, patients with early-stage PC have favorable prognosis. Therefore, physician should inform about possibility of male-infertility due to PC treatment and discuss about sperm cryopreservation before PC treatment with patients who hope male-fertility preservation. For young cancer patients, sperm cryopreservation might play a role not only for male-fertility preservation but also encourage of battle against cancer.5 Although there is no question that the sperm cryopreservation is a gold standard for male-fertility preservation, sperm preservation by testicular sperm extraction (TESE) is also useful. Especially, for the patients with ejaculatory dysfunction, for example, the patients received prostatectomy, radiation therapy for the prostate,6 or androgen ablation therapy,6, 7 TESE might be recommended instead of the sperm cryopreservation. Our study included only small number of patients. Therefore, definitive statement was not established from this study. However, we revealed that PC patients who hope male-fertility preservation before PC treatment were certainly exist. Physician should inform about male-infertility due to PC treatment and discuss about male-fertility preservation with patients. If the patients hope it, semen cryopreservation should be offered. Conceived and designed the study: Takashi Kawahara, Hiroji Uemura, and Yasuhide Miyoshi. Analyzed the data: Shinnosuke Kurodsa, Teppei Takeshima, Yasushi Yumura and Yasuhide Miyoshi. Wrote the paper: Yasuhide Miyoshi. All authors have read and approved the manuscript. None declared. Institutional review board approval of this study was obtained from YCUMC (R20002). Written informed consent was obtained from all patients for this study. N/A. N/A.