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Prostate Cancer Risk May Be Increased in Fathers Using Assisted Reproduction

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Men who achieved fatherhood through assisted reproduction are at increased risk for early onset prostate cancer (PCa), according to new study results published in The BMJ.

Nearly 1.2 million men in
Sweden fathered a first born child during 1994 to 2014, including 97% by
natural conception, 1.7% by in vitro fertilization
(IVF), and 1.3% by intra-cytoplasmic sperm injection (ICSI). More men utilizing
IVF and ICSI (0.37% and 0.42%, respectively) were diagnosed with PCa than men
who fathered children naturally (0.28%). ICSI and IVF were associated with a
significant 64% and 33% increased risk of PCa, respectively, compared with
unassisted conception, Yahia Al-Jebari, a PhD candidate at Lund University in
Sweden, and colleagues, reported.

The average age at PCa onset was 55.9, 55.1, and 57.1 years for men fathering by IVF, ICSI, and unassisted means, respectively. But men utilizing ICSI or IVF had 86% and 51% higher risks for PCa onset before age 55. With respect to disease severity, PCa patients who conceived through ICSI were nearly twice as likely to receive androgen deprivation therapy as those conceiving naturally. Men with any previous cancer or testosterone replacement therapy were excluded from study. The team adjusted for patient age and education.

“Men who achieved
fatherhood through assisted reproduction techniques, particularly through ICSI,
are at increased risk for early onset prostate cancer and thus constitute a
risk group in which testing and careful long term follow-up for prostate cancer
may be beneficial,” Al-Jebari’s team concluded.

According to the
investigators, it may be the underlying level of male infertility that is
associated with PCa.

In an accompanying
editorial, Aditi Sharma, MBBCh, and Channa Jayasena PhD, of Imperial College and Hammersmith
Hospital in London, suggested microdeletions in the Y chromosome, which are
known to cause severe male infertility, and genes on the Y chromosome
associated with PCa as a possible link.

“In the absence of a
plausible mechanism of action or proof of causation, justifying screening for
prostate cancer in all infertile men is difficult,” Drs Sharma and Jayasena
wrote. “However, further research on the possible future complications of male
infertility would be welcomed by patients and will help clinicians to counsel
all infertile men about their future health.”

References

Al-Jebari Y, Elenkov A, Wirestrand E, et
al. Risk of prostate cancer for men fathering through assisted reproduction:
nationwide population based register study. BMJ.
2019;366:l5214. https://www.bmj.com/content/366/bmj.l5214

Sharma A, Jayasena CN. Male infertility
linked to risk of prostate cancer. BMJ
2019;366:l5525. doi:10.1136/bmj.l5525

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