For men facing cancer treatment, the risk of infertility is a major concern that is often overlooked. While fertility preservation options exist, studies consistently show that a significant proportion of patients are not adequately informed or offered these choices by their healthcare providers before undergoing potentially sterilizing cancer treatments.
The main barriers to men being aware of fertility preservation include limited knowledge and training among providers, discomfort discussing the sensitive topic, low referral rates to reproductive specialists, logistical challenges, time constraints before treatment initiation, perceptions about appropriateness based on prognosis, and patient-related factors like lack of awareness and financial concerns.
It is crucial for men to understand their options for preserving fertility, which include:
Sperm Cryopreservation (Sperm Banking)
This standard and most effective method involves collecting and freezing sperm samples before treatment for future use through assisted reproductive techniques like intrauterine insemination (IUI) or in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). It is well-established and successful for post-pubertal males.
Testicular Tissue Cryopreservation
An experimental approach where testicular tissue is removed and frozen before cancer treatment. The frozen tissue may potentially be used later to extract sperm stem cells for reimplantation or to induce in vitro spermatogenesis. However, no live births from this method have been reported in humans yet.
Gonadal Shielding
Protecting the testicles from radiation damage by using lead shields during radiotherapy. Its effectiveness is limited by patient anatomy and radiation field requirements.
Sperm Retrieval
For males who cannot produce a semen sample, sperm can be surgically retrieved from the testicles or epididymis through techniques like testicular sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA). Retrieved sperm can then be used for IVF/ICSI. This invasive option is appropriate when a male cannot produce a semen sample due to conditions like anejaculation, obstructive azoospermia, or prior to puberty.
While sperm cryopreservation is the most established and successful fertility preservation method, sperm retrieval combined with IVF/ICSI can be an option when cryopreserved sperm is unavailable or inadequate. However, IVF/ICSI is more invasive, costly, and has lower success rates compared to using cryopreserved sperm for insemination.
Overcoming barriers to awareness and utilization of fertility preservation options requires improved education and adherence to clinical guidelines from organizations like the American Society of Clinical Oncology (ASCO) and the American Society for Reproductive Medicine (ASRM). Establishing formal fertility preservation programs with multidisciplinary teams, patient navigators, and educational initiatives can help ensure that men with cancer have the opportunity to make informed decisions about preserving their fertility before undergoing cancer treatments.
For questions, please contact Mark Perloe at mperloe@outlook.com
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Novartis, Telix & Blue Earth Diagnostics.
WELOME all to our newly recorded Low/Intermediate Prostate Cancer Group. To receive notice when new recordings are posted, either follow us on this YouTube Channel or sign up to our Blog via https://ancan.org/contact-us/ – check New Blog box.
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AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime!
Editor’s Pick: You rarely get out of cancer Scott-free; and treatment decisions complicated by other chronic conditions (rd)
Topics Discussed
Evaluating treatment plan options (radiation, surgery, and hormone therapy) and quality of life issues associated with treatments; Participating in the RTIRE trial for treatment; Understanding different medical reports and tests for prostate cancer; Getting a third opinion to decide between surgery and radiation while seeking the best quality of life outcomes; Life after treatment and having the right mindset; Choosing a treatment option when other chronic conditions/diseases exist; What makes focal treatment a good option.
Chat Log
Jim Stewart Reno, NV sent: 6:25 PM
have to pick up grandkids so signing off….see you all next time!!
Hi-Risk/Recurrent/Advanced PCa Video Chat, April 9, 2024
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Novartis, Telix & Blue Earth Diagnostics.
View AnCan’s patient-centered selection of papers and presentations from ASCO GU 2024, one of the top conferences on prostate cancer treatment: https://youtu.be/YweU8hjA0Lw
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime! You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Editor’s Pick: A night of abi abundance — plenty of advice and observations on abiraterone. (bn)
Topics Discussed
Going from Lupron to Orgovyx, he sees fewer hot flashes; what causes our hot flashes, anyway?; uptick in lactate dehydrogenase — should I worry?; starting abiraterone — what to look out for?; when everything else has failed, a Hail Mary on abiraterone vs a clinical trial; ask Dr. Sartor why Pluvicto didn’t work despite loads of PSMA; we suspect the darolutamide trial he’s being offered is flawed; Jim Marshall emerges from complex heart surgery; overseas trip for lutetium and actinium treatment ends in disappointment stateside — might be time to look for neuroendocrine; stay vigilant with scans even if PSA is low.
Chat Log
John A · 6:40 PM
https://ancan.org/?s=dental
AnCan – rick · 6:41 PM
Prognostic Value of Lactate Dehydrogenase in Metastatic Prostate Cancer: A Systematic Review and Meta-analysis https://pubmed.ncbi.nlm.nih.gov/31558410/
John A · 6:43 PM
High LDH was associated with both worse OS (pooled hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.75-2.44) and PFS (pooled HR, 1.08; 95% CI, 1.01-1.16). In subgroup analyses of both patients with castration-resistant prostate cancer (CRPC) and those with hormone-sensitive prostate cancer (HSPC), LDH was associated with OS (pooled HR, 2.02; 95% CI, 1.69-2.42 and pooled HR, 2.25; 95% CI, 1.78-2.84, respectively). In patients with CRPC, LDH was associated with OS in those treated with docetaxel systemic chemotherapy and androgen receptor-axis-targeting agents (pooled HR, 2.03; 95% CI, 1.37-3.00 and pooled HR, 1.79; 95% CI, 1.25-2.57, respectively). Elevated serum levels of LDH were associated with an increased risk of mortality and progression in patients with metastatic PC. LDH was independently associated with OS in both patients with CRPC and HSPC. LDH could be integrated into prognostic tools that help guide treatment strategy, thereby facilitating the shared decision-making process.
A randomized, double-blind, placebo-controlled Phase 3 study of
darolutamide plus androgen deprivation therapy (ADT)
compared with placebo plus ADT in patients with high-risk
biochemical recurrence (BCR) of prostate cancer
BAY 1841788 / 21492
eric · 7:42 PM
just sent you the file rick
AnCan – rick · 7:43 PM
Eric – ‘m pretty sure this is the trial about which we objected to Bayer. The Standard of Care (placebo) arm is insufficient. Please point that out to Dr. Handy.
AnCan – rick · 7:46 PM
You need either LHRH + a 2nd line anti-androgen (like daro or abi). Don’t take the risk of only the LHRH.
AnCan – rick · 7:47 PM
CORRECTION…. You need LHRH + a 2nd line anti-androgen (like daro or abi). Don’t take the risk of only the LHRH.
Jim Marshall, Alexandria, VA · 7:57 PM
I would think about Chloesterol testing every 6 months and even though it says 200 or below is good, down in the 160s or lower is better with acceptabh HDL & LDL. Had no clue until I did 24 stairs. Jim
Chas Ryan · 8:03 PM
I’m on a statin and I have read that treatment with these ADT drugs can spike your cholesterol or reduce the efficacy of the statins. I will keep an eye on it. Thx
Jim Marshall, Alexandria, VA · 8:05 PM
Do you take it a bedtime? Liptor & Crestor was no good so I was put on Pravastatin and it kicked butt but too late.
Chas Ryan · 8:07 PM
I take atorvastatin at no particular time whenever during the day I remember to take it.
Hi-Risk/Recurrent/Advanced PCa Video Chat, Mar 26, 2024
AnCan is grateful to the following sponsors for making this recording possible: Bayer, Foundation Medicine, Janssen, Myriad Genetics, Myovant, Telix & Blue Earth Diagnostics.
View AnCan’s patient-centered selection of papers and presentations from ASCO GU 2024, one of the top conferences on prostate cancer treatment: • ASCO GU 2024 conference highlights https://www.youtube.com/watch?v=YweU8hjA0Lw&t=2s
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime! You can find out more about our 12 monthly prostate cancer meetings at https://ancan.org/prostate-cancer/ Sign up to receive a weekly Reminder/Newsletter for this Group or others at https://ancan.org/contact-us/
Editor’s Pick: The new hot flash drug for women works for one of our guys, too. (bn)
Chat Log
Unknown · 6:23 PM PROMISE link – just clck on this https://www.prostatecancerpromise.org/?utm_campaign=ANCAN&utm_medium=link&utm_source=Webinar
Steve Roux, MI · 6:31 PM Promise sent me a free DNA “Color” test kit and I sent the kit back. They say it will be 30 days to get results.
Jim Marshall, Alexandria, VA · 6:45 PM Did Abiraterone for 5 years with Prednisone & lupron and did aerobic exerices most days and tolerated it prety well as long as i exercised.
Unknown · 6:49 PM thanks for all your input and information, guys
Bob McHugh · 6:53 PM I had Axumin at .5 PSA . Found a quarter sized lesion in the prostate bed.
AnCan – rick · 6:57 PM To Join Solo Arts Heal with Beth Horner tomorrow at 7.30 pm Pacific Join from the link below https://themarsh.org/soloartsheal
Len Sierra · 7:02 PM Got to leave, Gents. See you next week.
Bob McHugh · 7:17 PM Where was the cardiac cath done, if I may ask?
Bob McHugh · 7:18 PM Three stents here.
Richard Tolbert · 7:18 PM Jim Ma
Bob McHugh · 7:22 PM Is an EKG advisable?
Kirt Schaper · 7:31 PM I have to go.
Unknown · 7:32 PM An echocardiogram can test your hearts function and structure.. it can find many issues
Jim Marshall, Alexandria, VA · 7:34 PM Had the echocardiogram and it did not show anything. I went to the Nuc;lear Stress test which showed 2 Stents surely needed. Jim
Jim Marshall, Alexandria, VA · 7:36 PM Liptor did no good for me along with Crestar. But later and been on Pravastatin knocked it down to 142 with HDL up and LDL down below recommended. jim
Wang Gao Shan – PANAMA · 7:36 PM Thanks Everyone… I have to go.
Unknown · 7:40 PM Thanks Jim
Dr. Jeff · 7:42 PM Arterioscler Thromb Vasc Biol. 2020;40:e55–e64. DOI: 10.1161/ATVBAHA.119.313046
Unknown · 7:44 PM Statins make me weak, my cholesterol has always been low but my PCP recommended a statin, took me months to figure out how weak they made me. My oncologist figured out that the statin was the cause.
Steve Roux, MI · 7:54 PM yes. need to ask about firmagon. My insurance denied the orgovyx.
Dr. Jeff · 8:01 PM Russ Hoover: I had frequent hot flashes on Firmagon and Abiraterone. I eat tofu and ground flax seeds daily and the hot flashes are markedly reduced.
David M · 8:05 PM I have to roll guys.
David M · 8:06 PM Great meeting as always
marc valens · 8:07 PM I’m still getting Lupron shot in the butt every 3 months.
Unknown · 8:07 PM Thanks guys
Jim Marshall, Alexandria, VA · 8:14 PM May the Lupron Supply chain is stocked until it runs out. ABBvie stopped production last year. Jim
Larry Fish · 8:15 PM whats the name of the new drug for hot flashes?
Jim Marshall, Alexandria, VA · 8:15 PM Maybe UPS directly to Dr E.
Oh it’s not that kind of shot. It’s the other kind of shots, which require some modification for people with cancer. It just
so happens that ASCO (American Society of Clinical Oncology) has come out with new guidelines regarding vaccines for cancer patients.
The guidelines include a recommendation for doctors to take vaccination histories at the start of cancer treatment, followed by provision of recommended vaccines, re-vaccination after cancer treatments that wipe out immunity (for instance stem cell transplant), as well as vaccination of household contacts in order to protect the cancer patient.
We are more vulnerable to infection, because our immune system is injured by chronic inflammation, by the cancers, and by our treatments. Also, we don’t get as good an immune boost from some vaccines as people without cancer do.
If our immune system is “compromised” we can’t take live vaccines at all, and non-live vaccines aren’t as effective. Live vaccines contain weakened but still replicating virus or bacteria. They cause a mild infection in normal people, which triggers an immune
response. But for those of us with a weakened immune system, live vaccines, such as chicken pox/shingles, measles, mumps, oral typhoid, and German measles, can cause a real infection. Non-live vaccines are safe, including the new RNA vaccines. Non-live vaccines for different conditions can be given on the same day.
Here is a summary of recommendations, which I have shortened for prostate cancer:
“Clinicians should determine vaccination status and ensure that adults newly diagnosed with cancer and about to start treatment are up to date on seasonal vaccines as well as age- and risk-based vaccines
Vaccination should ideally precede any planned cancer treatment by 2-4 weeks. However, nonlive vaccines can be administered during or after chemotherapy or immunotherapy, hormonal treatment, radiation, or surgery
Adults with solid and hematologic cancers traveling to an area of risk should follow the CDC standard recommendations for the destination Note. Hepatitis A, intramuscular typhoid vaccine, inactivated polio, hepatitis B, rabies, meningococcal, and nonlive Japanese encephalitis vaccines are safe
It is recommended that all household members and close contacts, where feasible, be up to date on vaccinations “
Here are some specific recommended immunizations for adults with Cancer:
One dose of Tdap, followed by Td or Tdap booster every 10 years
Hepatitis B
19-59 years: eligible 60 years and older: immunize those with other risk factorsc
For adults 20 years and older, use high antigen (40 µg) and administer as a three-dose Recombivax HB series (0, 1, 6 months) or four-dose Engerix-B series (0, 1, 2, 6 months)18
Recombinant zoster vaccine
19 years and older
Two doses at least 4 weeks apart
Pneumococcal vaccine
19 years and older
One dose PCV15 followed by PPSV23 8 weeks later OR One dose PCV20d
HPV
27-45 years: shared decision making
Three doses, 0, 1–2, 6-monthsAbbreviations: HPV, human papillomavirus; PCV, pneumococcal conjugate vaccine; PPSV-23, 23 valent Pneumococcal polysaccharide vaccine; RSV, respiratory syncytial virus; Td, tetanus and diphtheria; Tdap, tetanus, diphtheria and pertussis.
a Live attenuated influenza vaccine, which is administered as a nasal spray, cannot be given to patients with cancer.
bTdap has lower amounts of diphtheria and pertussis toxoid and is only used for those 7 years and older. DTaP, the pediatric vaccine for prevention of tetanus, diphtheria, and pertussis, is only for children younger than 7 years.
cHIV, chronic liver diseases, intravenous drug use, sexual risk factors, incarcerated individuals.
dPatients who have previously received PCV13 only can receive one dose of PCV 20 after an interval of 1 year.
Abbreviations: HPV, human papillomavirus; PCV, pneumococcal conjugate vaccine; PPSV-23, 23 valent Pneumococcal polysaccharide vaccine; RSV, respiratory syncytial virus; Td, tetanus and diphtheria; Tdap, tetanus, diphtheria and pertussis.
a Live attenuated influenza vaccine, which is administered as a nasal spray, cannot be given to patients with cancer.
bTdap has lower amounts of diphtheria and pertussis toxoid and is only used for those 7 years and older. DTaP, the pediatric vaccine for prevention of tetanus, diphtheria, and pertussis, is only for children younger than 7 years.
cHIV, chronic liver diseases, intravenous drug use, sexual risk factors, incarcerated individuals.
dPatients who have previously received PCV13 only can receive one dose of PCV 20 after an interval of 1 year.
Now, a few further details about some common shots:
COVID
The COVID-19 vaccines protect patients with cancer, reducing the risk of severe COVID-19 illness and hospitalization. The recommendation is to receive at least one dose of the updated 2023-2024 COVID-19 vaccine. For those on therapies which diminish the immune response, ASCO recommends additional vaccine doses after 2 months. It is recommended to postpone immunization for 2-3 months for individuals who have recently had a COVID-19 infection.
FLU
It is safe to vaccinate during chemotherapy or while white cells are low. But the nasal spray flu vaccine should not be given to patients with cancer.
Pneumonia
Patients with cancer are at higher risk for pneumonia. (Blood cancers 50 times the risk!) Pneumonia vaccines reduce the chances of getting pneumonia and the need for hospitalization.
Shingles
There is a new vaccine called RZV. It is non-live so OK for us. (the previous vaccine, a live attenuated type, is not recommended for patients with cancer.) RZV should be made available to all adults with cancer. This vaccine remains immunogenic even after cancer treatment has begun.
RSV
Patients aged 60 years and older with cancer are eligible to receive the respiratory syncytial virus vaccine.
Our immunity to tetanus, diphtheria, and pertussis weakens as we age, and this decline may be accelerated after cancer treatment. It is strongly recommended that individuals diagnosed with cancer receive the Tdap vaccine if they have not been vaccinated as adults.
Why bother?
“Infections are the second most common cause of non–cancer-related mortality within the first year after a cancer diagnosis, with most of these deaths attributed to influenza and pneumonia, deaths that can be prevented throughimmunization. While patients with cancer have lower immune responses to influenza and pneumococcal vaccines, evidence supports the safety and benefits of vaccinations in reducing the severity of infections and associated hospitalizations.”
Often we will see the term “immunocompromised.” Does this apply to us? This term is not, to my knowledge, precisely defined. For those of us with prostate cancer, it usually means neutrophils (a type of white blood cell) are down below 1000 cells per microliter of blood, and is usually due to our treatments. The immune system is complex, and there are many ways to become “immunocompromised.” Anyone on chemotherapy could be considered to be immunocompromised. .Ask your oncologist if you fit this category, and if you know of a clear generally accepted definition, please write to me.
The authors sum up: “A cancer diagnosis can be overwhelming, and vaccination may not be an immediate priority in the treatment plan. However, numerous studies consistently highlight the best protection when vaccines are administered before starting cancer treatment, emphasizing the need for early vaccination.”
Oh it’s not that kind of shot. It’s the other kind of shots, which require some modification for people with cancer. It just