When treating younger men with anal cancer do you consider dose to the prostate?

Given the proximity of the prostate to a typical anorectal target volume, it would be difficult to completely spare the prostate without increasing the risk of a marginal miss. I would not recommend compromising target coverage to spare the prostate

Clinical concerns about prostate dose could involve alterations in erectile function, decreased ejaculation, and infertility (related to radiation exposure to the testes). If a younger patient is interested in preserving fertility, he should be encouraged to sperm bank prior to beginning treatment.

With respect to delivering radiation to a younger patient - the risk of second malignancy is always a consideration, but I would not consider the prostate to be at higher risk of second malignancy than ...