DEAR DR. ROACH: After blood analysis revealed elevated PSA levels, a urologist felt a lump on my prostate and arranged a biopsy. Of 12 samples taken, three were cancerous. The doctor recommends removal instead of radiation or any other therapy. I asked which type of cancer it is, and he replied that it is just cancer and won’t spread in a month or two but I should not wait too long to have the surgery.
I am concerned about negative physical consequences, but realize whatever they are it won’t be as bad as the cancer growing and spreading. At 61 I am not wanting to give up the prospect of being a father. I understand that there will be no ejaculate and freezing sperm is expensive. Is it possible to extract sperm from the testicle, and will my sex drive be diminished? — R.T.
ANSWER: If you are going to get surgery (and I have no information to recommend against it), I agree you shouldn’t wait too long. But let me answer your question about fertility.
Although the testes, which make sperm, are not usually removed in prostate cancer surgery, the loss of the prostate gland and the nearby seminal vesicles (which make most of the volume of semen) prevents sperm from being ejaculated during sexual intercourse, so fertility is usually impaired. Therefore, banking sperm prior to treatment is probably the best option. Sperm can be extracted from the testes, but the success rate is less than 50 percent. This is also a very expensive procedure, so your odds for fertility are better and you will probably have lower costs if you choose to have a child with the frozen storage method.
The LIVESTRONG Foundation has a discount program for freezing sperm, oocytes and embryos for people with cancer. You can find out more at www.livestrong.org/what-we-do/program/fertility or call 855-844-7777.
DEAR DR. ROACH: I am waking up really early these past few weeks. I have the ability to sleep in until 7 a.m., but am waking up at 5 a.m. and can’t go back to sleep. Why could this be? If I try to go back to sleep I just lie there in bed for about an hour and then finally get up. I’d like to sleep in but can’t. This seems so unusual. — C.S.I.
ANSWER: Waking up early can be part of a person’s normal pattern, but when a normal pattern is changed to waking up earlier than normal, I first consider depression. Anxiety disorders also can cause early awakening. There are simple screening tests for depression and anxiety that can be performed by your regular doctor, but a referral to an expert may be indicated in case the possible diagnosis is unclear.
Another possibility is that your sleep-wake cycle has been shifted so that you are ready to go to sleep earlier than you’d like as well as waking up too early. If you have no problem falling asleep early, that would suggest advanced sleep-wake phase disorder. This may often be treated with bright light therapy to reset the circadian rhythm, and a sleep specialist is the right person to consult with.
Although other conditions, such as Parkinson’s, may be associated with early-morning awakening, these occur generally in people with an established diagnosis.
Finally, some sleep hygiene advice may be useful: If you are in bed and unable to sleep for 15 minutes or so, or you know you aren’t going to get back to sleep, get out of bed. You don’t want to associate bed as a place to lay there frustrated.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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