The reproductive organs in a male include: the testicles, epididymides, vasa, prostate, seminal vesicles, cowpers (bulbourethral) glands, urethra and penis. Recently, there has been recognition that some men with poor sperm production may be at higher risk for testicular cancer. Given that link, there is question as to whether male infertility in general is associated with a higher risk of cancer in other reproductive organs such as the prostate.
Prostate cancer is the most common cancer of men, being diagnosed in about two hundred to three hundred thousand men every year. The risk of prostate cancer is low before age fifty. With increasing age, it is common for a man’s prostate to enlarge and sometimes cause issues with bladder emptying. Unfortunately, the risk of prostate cancer also increases with increasing age as well.
Recognized risk factors for prostate cancer include a family history of prostate cancer, particularly if a man has a first or second degree relative with prostate cancer (father, brother, and also uncles, cousins and grandfather). African American men are also at higher risk for prostate cancer than their Caucasian counterparts and, when diagnosed, the cancer may be more aggressive. Recently attention has also been focused on genetic markers for increased risk of prostate cancer including the same genetic abnormalities that cause an increase in breast cancer risk in women: BRCA1 an BRCA2.
A 2010 article in the journal Cancer by Walsh et al examined the potential for a link between prostate cancer and male infertility. The investigators examined a population of 22,562 men who were evaluated for infertility from 1967 to 1998 at 15 California infertility centers and linked to the California Cancer Registry. The risk of prostate cancer in men with and without male infertility was assessed using a mathematical model known as Cox proportional hazards regression. One hundred sixty-eight cases of prostate cancer that developed after infertility were identified. Men evaluated for infertility but not necessarily with male factors were found to have an increased risk of cancer compared with the general population and in particular the risk was found to be highest for men with male factor infertility who developed high–grade prostate cancer. On multivariate analyses, men with male factor infertility were found to be 2.6 times more likely to be diagnosed with high–grade prostate cancer. In addition, the study also showed that abnormal semen parameters signaled higher risk ten years before cancer was diagnosed. That finding suggests that men with male factor infertility may want to consider screening for prostate cancer at an earlier age.
In conclusion, men who undergo evaluation for infertility may want to consider circling back to their urologists when they are in their 50’s or even earlier for prostate cancer screening. Although there has not been an abundance of literature linking fertility and prostate cancer, in the future, as new genetic markers for prostate cancer become identified, screening for the disease may become more efficient in terms of early diagnosis of aggressive disease as well as potentially identifying men at higher risk for fertility issues.
