Fertility and Prostate Cancer

TODAY is Sept 11. It is also the 15th anniversary of the tragedy that saw a series of coordinated terrorist attacks by al-Qaeda on the United States in 2011.

The world was shocked on that fateful day, as most of us would remember vividly what we were doing at that time.

One and a half decades after the attack, although the pain is still felt by many, the resilience of the Americans in dealing with the tragedy is truly remarkable.

Jamais Cascio, a San Francisco Bay Area-based author and futurist, once said: “Resilience is all about being able to overcome the unexpected. Sustainability is about survival. The goal of resilience is to thrive.”

On this sombre day of remembering Sept 11, I would like to address a reader’s journey of resilience after the diagnosis of prostate cancer.

Dear Dr G,

My name is Johan. Like the Prime Minister of Singapore, Lee Hsien Loong, I am a prostate cancer survivor.

I went for a routine PSA blood test three years ago at the age of 55 and the biopsy revealed that I had prostate cancer.

I was lucky enough to undergo robotic radical prostatectomy at HKL soon after the diagnosis and the cancer is under controlled since the operation.

I confess, I was devastated after the diagnosis and the operation also negatively impacted my life.

Initially after the operation, I encountered problems of erectile dysfunction and mild urinary incontinence. Thankfully, all the issues resolved with medications and pelvic floor exercise.

I have recently built up my confidence in taking on full time work again after the initial setback. I am also glad I have started a new relationship with a younger partner.

Although we are able to achieve reasonable sexual intimacy following the operation, I am saddened by the fact that I have lost my ability to father a child.

I would like to ask whether men can still retain their reproductive function after prostate cancer. If so, how do we go about with that?

Warmest regards,

Johan

Prostate cancer is a common cancer and the number of men diagnosed with such disease is rising in many countries, affecting up to one in six men.

Many attribute the rise in the diagnosis of prostate cancer due to the prevalence of diagnostic tests with PSA (Prostate Specific Antigen), and increasing life expectancy.

Although the cancer is generally associated with men with advanced age, however, the detection of the cancer in younger men is becoming more common.

Such observation is thought to be genetic-linked cancers and sedentary lifestyle.

One of the common methods of complete eradication of prostate cancer is radical prostatectomy.

Such surgical intervention is performed with open or keyhole approaches, and in recent years, the robotic assisted removal of the prostate gland is also carried out to minimise the complications of the operation.

As part of the male reproductive system, the prostate gland’s primary function is to secrete a slightly alkaline liquid that forms part of seminal fluid.

The fluid carries and nurtures sperms, and together, that forms the ejaculated semen.

As the role of radical surgery is to completely remove the prostate gland including healthy tissues, sexual and reproductive health of the men will be affected after the operation.

Before the radical prostatectomy, most men are counselled pre-operatively for the potential complications of urinary incontinence, erectile dysfunction and sterility.

Although intra-operative care can be ensured to preserve the nerves that are responsible for continence and erections, the preservation of “naturally” fertility in men is impossible.

Radical prostatectomy sever the connection between the testicle and the urethral, which technically equivalent to performing vasectomies on the patients.

This results in men unable to provide sperms through natural ejaculation. A man may be able to have an orgasm, but there will be no ejaculate, hence all men who undergo the operation will be rendered sterile.

Many men do not consider reproductive health after 50 years old as top priority, however, the advent of Artificial Reproductive Technology now allows the direct retrieve of sperms from the source.

Operations such as PESA (Percutaneous Epididymal Sperms Aspiration), MESA (Microscopic Epididymal Sperms Aspiration) or TESE (Testicular Exploration and Sperm Extraction) can be carried out for men who still wish to father a child after radical prostatectomy.

The diagnosis and the treatment of cancer are often unexpected and frightening. The journey of treatment and recovery may often times leave undesirable and disappointing outcomes.

However, I hope to conclude this article with a quote from the New York Times best selling author and cancer survivor, Kris Carr: “Above all, cancer is a spiritual practice that teaches me about faith and resilience.”