For younger men, having children after a prostate cancer diagnosis is a frequent concern. The ability to conceive depends on the specific therapy used and whether steps were taken beforehand to preserve fertility. Most curative treatments severely impact the reproductive system, making proactive planning essential. While some treatments cause permanent sterility, modern reproductive technologies offer pathways to biological fatherhood. Fertility preservation and subsequent conception require coordination between the cancer treatment team and reproductive specialists.
How Prostate Cancer Treatments Affect Fertility
The three main prostate cancer treatments—surgery, radiation, and hormone therapy—impair fertility through different biological mechanisms related to either sperm delivery or sperm production. Understanding these mechanisms helps determine future options.
Radical prostatectomy, the surgical removal of the prostate gland and seminal vesicles, causes permanent infertility by eliminating the physical pathway for ejaculation. Although the testicles continue to produce healthy sperm, the removal of the prostate and seminal vesicles—which produce the majority of semen fluid—results in a “dry orgasm,” or anejaculation. Since sperm cannot be naturally expelled, conception through sexual intercourse is not possible after this surgery.
Radiation therapy, including external beam radiation and brachytherapy, affects fertility primarily by damaging the cells responsible for producing sperm. The testes are highly sensitive to radiation, and even scatter radiation from the target area can significantly reduce sperm count and quality. Damage to the spermatogonial stem cells may cause a temporary reduction in sperm count lasting months or years, or it may cause permanent sterility. Radiation also affects the accessory glands, leading to fibrosis in the ejaculatory ducts and resulting in dry ejaculation or severely reduced semen volume.
Hormone therapy, specifically Androgen Deprivation Therapy (ADT), impacts fertility by temporarily suppressing the hormonal signals required for sperm production. ADT lowers testosterone levels, which are necessary for prostate cancer cell growth but also for spermatogenesis to occur. This suppression drastically reduces sperm output, often resulting in azoospermia (zero sperm count) while the patient is on therapy. Unlike surgery or radiation, ADT effects are often reversible once treatment stops, though recovery time for sperm production varies widely depending on the duration of the therapy.
Fertility Preservation Before Treatment Begins
Sperm cryopreservation, or sperm banking, is the standard and most reliable method to preserve fertility before starting any cancer treatment. This simple, non-invasive process involves collecting and freezing semen samples for long-term storage. Banking must occur before the first dose of radiation, hormone therapy, or radical prostatectomy to ensure the highest quality sperm is preserved.
This process requires close coordination between the oncology team and a fertility specialist, often termed “oncofertility” care. Since treatment may need to begin quickly, consultation and sample collection must be expedited. Even if semen quality is low before treatment, cryopreservation is recommended, as a small number of viable sperm can be used successfully later with advanced assisted reproductive techniques. Banked sperm remains viable for many years, offering the opportunity for biological fatherhood after cancer treatment.
Assisted Reproductive Options After Treatment
Once treatment is complete, banked sperm is used for conception via assisted reproductive technologies (ART). The two main methods are Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF).
IUI is a simpler procedure where concentrated sperm is placed directly into the uterus, but it requires a high number of motile sperm, making it suitable only for good quality cryopreserved samples.
IVF is often necessary if sperm count or motility is reduced after thawing. IVF involves fertilizing the egg outside the body and is frequently combined with Intracytoplasmic Sperm Injection (ICSI). ICSI involves injecting a single sperm directly into an egg. Because ICSI requires only one functional sperm per egg, it greatly increases success rates when using cryopreserved or surgically retrieved sperm. Studies show that IVF combined with ICSI offers higher clinical pregnancy rates (around 34%) compared to IUI (around 9%) when using banked sperm.
Surgical Sperm Retrieval
For men who did not bank sperm before radical prostatectomy, surgical sperm retrieval is an alternative, as the testicles still produce sperm. Procedures like Vasal Aspiration (VA) or Testicular Sperm Extraction (TESE) collect sperm directly from the reproductive tract or testicular tissue. The retrieved sperm can be used immediately for IVF/ICSI or cryopreserved for later use. Research suggests that using sperm banked before treatment does not increase the risk of genetic abnormalities or birth defects in children compared to the general population.