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26-09-2019 | Prostate cancer | News

Male infertility linked to increased prostate cancer risk

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medwireNews: The risk for prostate cancer is 30–60% higher in men who father children through assisted reproduction than in those who conceive naturally, shows a nationwide study conducted in Sweden.

The investigation, which included data for 1,181,490 men who fathered their first child between 1994 and 2014, also showed that the men who conceived via in vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI) were diagnosed with prostate cancer at a younger age, on average, than those who conceived naturally.

Writing in The BMJ, Yahia Al-Jebari (Lund University, Malmo, Sweden) and co-authors therefore suggest that men who achieve fatherhood through assisted reproduction techniques “constitute a risk group in which testing and careful long term follow-up for prostate cancer may be beneficial.”

Among the men studied through registry-based data, 20,618 (1.7%) conceived by IVF, 14,882 (1.3%) by ICSI, and 1,145,990 (97.0%) by natural conception.

Prostate cancer incidence in these groups was 0.37%, 0.42%, and 0.28%, respectively, with corresponding mean ages at diagnosis of 55.9, 55.1, and 57.1 years.

After adjustment for paternal age at childbirth and education level (as a surrogate for socioeconomic status), the researchers found that men who had conceived via IVF or ICSI had significant 1.33-fold and 1.64-fold increased risks, respectively, for prostate cancer relative to those who had conceived naturally.

Furthermore, the risk for early-onset disease (ie, diagnosis before age 55 years) was a significant 1.51-fold and 1.86-fold higher in the IVF and ICSI groups, respectively, than in the natural conception group.

Similar results were observed when the researchers excluded fathers who were diagnosed with any cancer before their child was conceived.

Al-Jebari and team say that their study, which included “virtually all men fathering a child in Sweden during two decades,” shows that men who achieve fatherhood through assisted reproduction – particularly ICSI – have “a remarkably high risk of prostate cancer.”

They conclude: “We would, therefore, welcome studies in other cohorts investigating the risk of prostate cancer in men being treated for infertility and studies on the efficacy and benefits of screening for this risk group, similar to what is currently offered for other high risk groups.”

In an accompanying editorial Aditi Sharma and Channa Jayasena, both from Hammersmith Hospital in London, UK, say the study findings “provide the strongest evidence to date that risk of prostate cancer may be increased in infertile men.”

They stress, however, that “a causal relation cannot be assumed.”

Therefore, “[i]n the absence of a plausible mechanism of action or proof of causation, justifying screening for prostate cancer in all infertile men is difficult,” Sharma and Jayasena remark. They add that “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.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

BMJ 2019; 366: l5214
BMJ 2019; 366: l5525

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