Your testicles, not your prostate, produce sperm, so sperm production continues after a radical prostatectomy. The catch is that the surgery severs the internal plumbing that carries sperm out of your body, meaning you will have no ejaculate despite still manufacturing sperm cells. That distinction between making sperm and delivering it is where most of the confusion lives, and the practical consequences for fertility, sexual function, and planning are more nuanced than a simple yes or no.
Where Sperm Comes From and What the Prostate Actually Does
Sperm cells are made exclusively in the testicles. They mature as they travel through a coiled tube called the epididymis, then move up through a long duct called the vas deferens toward the pelvis. Along the way, the seminal vesicles and prostate gland contribute fluid that mixes with sperm to form semen. One study quantifying these contributions found that the prostate supplies roughly 37 to 44 percent of the total ejaculate volume, while the seminal vesicles account for about 55 to 61 percent.1PubMed Central. A new method to estimate quantitatively seminal vesicle and prostate gland contributions to ejaculate The sperm cells themselves make up only a small fraction of the fluid.
Because the testicles sit well outside the surgical field of a prostatectomy, nothing about the operation directly stops them from doing their job. Sperm production is driven by hormones and by the testicular tissue itself. As long as those remain intact, sperm cells keep being made. The problem is what happens downstream.
What a Radical Prostatectomy Removes
A radical prostatectomy for cancer is not a minor trim. The surgeon removes the entire prostate gland, both seminal vesicles, and the lower portions of both vas deferens ducts.2PubMed Central. Vas deferens invasion: A neglected issue in the sampling of radical prostatectomy materials The bladder neck is then reconnected directly to the urethra, bypassing the space where the prostate used to sit. This means the entire junction where sperm once merged with seminal fluid and traveled toward the urethra no longer exists. The tubes that carried sperm now end in sealed stumps inside the pelvis.
Think of it like removing a highway interchange. The roads on either side still exist, but there is no way for traffic to flow between them. Your testicles keep producing sperm, and your urethra still works for urination, but the connection between the two systems has been permanently eliminated. This is fundamentally different from a vasectomy, where only a small segment of the vas deferens is cut. In a radical prostatectomy, the entire downstream infrastructure is gone.
The Reality of Dry Orgasm
After radical prostatectomy, men who are able to reach orgasm will experience what is called a dry orgasm: the sensation of climax with no fluid release. This happens because there is simply nothing left to ejaculate. The seminal vesicles that produced most of the fluid volume have been removed, the prostate that added the rest is gone, and the ducts that carried sperm have been cut.
Research into what orgasm feels like after radical prostatectomy reveals a mixed picture. In one study, none of the men who achieved orgasm after surgery experienced the distinct “point of no return” sensation that typically precedes climax. Half reported that orgasmic sensation was weaker than before, though a smaller group said pleasure felt essentially normal.3PubMed. Orgasm after radical prostatectomy A complication that surprised many patients in that study was involuntary urine leakage during orgasm, which was distressing enough for some to avoid sexual contact entirely.
Whether orgasm is possible at all depends partly on the surgical technique. A larger study found that about 73 percent of men who had both nerve bundles preserved during surgery retained orgasmic function, compared with about 54 percent of men whose nerves were not spared.4Oxford Academic (The Journal of Sexual Medicine). Orgasmic Dysfunction After Open Radical Prostatectomy: Clinical Correlates and Prognostic Factors Younger men fared better, with about 77 percent of those under 60 retaining orgasm versus roughly 61 percent of those 60 and older.
How Cancer Treatments Can Damage Sperm Production Itself
While the surgery alone does not stop your testicles from making sperm, additional cancer treatments often do. Prostate cancer is frequently treated with a combination of therapies, and several of them attack sperm production through entirely different mechanisms than surgery.
Androgen deprivation therapy, the hormonal treatment commonly used alongside or after surgery, suppresses testosterone to near-zero levels. Since testosterone is the primary driver of sperm production, this effectively shuts down spermatogenesis for as long as the therapy continues and sometimes permanently.5PubMed Central. Prostate Cancer Treatments and Their Effects on Male Fertility: Mechanisms and Mitigation Strategies In one case report, a man’s ability to ejaculate did not recover even four months after stopping hormonal therapy, and he ultimately required a surgical procedure to extract sperm directly from his testicle.6PubMed Central. Testicular sperm extraction in a patient with ejaculatory dysfunction after combined androgen blockade therapy for prostate cancer
Radiation therapy poses its own threat. Even when radiation is aimed at the prostate, the testicles receive scatter dose. A study analyzing modern radiation techniques found that 84 percent of patients received enough testicular radiation to theoretically cause reduced sperm counts, and 65 percent exceeded the dose threshold associated with a complete absence of sperm in semen. About 10 percent received doses high enough to risk permanent loss of sperm production.7PubMed Central. Prostate radiotherapy may cause fertility issues: a retrospective analysis of testicular dose following modern radiotherapy techniques Much of this variation comes down to anatomy: the distance between the prostate and the testicles varies considerably between men, and a shorter distance means a higher dose to the testicles.8PubMed. Testicular dose in prostate cancer radiotherapy: impact on impairment of fertility and hormonal function
Chemotherapy, when used for advanced prostate cancer, can be directly toxic to the cells in the testicles that produce sperm. The combination of these treatments means that even though surgery alone leaves sperm production intact, the full course of cancer treatment may not.
Sperm Banking Before Surgery
Given all of this, banking sperm before treatment is the most reliable way to preserve fertility. This is straightforward in most cases: the man provides a semen sample before any surgery or therapy begins, and it is frozen and stored for potential future use with assisted reproduction.
Awareness of this option has been growing, though it is far from universal. A study of nearly 500 prostate cancer patients found that 20 percent expressed a wish for preoperative sperm banking. Those men tended to be younger and were more likely to be childless or to have a strong desire for future fatherhood. Relationship status and education level did not significantly affect interest, and willingness to bank sperm held even when men were told about costs. Perhaps most tellingly, 84 percent of all patients surveyed, whether they personally wanted to bank or not, felt that a dedicated sperm banking service should be available before surgery.9Fertility and Sterility. Sperm banking is of key importance in patients with prostate cancer
If you are facing a prostatectomy and future biological children matter to you, banking sperm before treatment starts is the single most important step. Once surgery is done and additional therapies begin, the options narrow considerably.
Retrieving Sperm After Surgery
If sperm was not banked before a radical prostatectomy, the picture is more complicated but not necessarily hopeless. Because the testicles continue producing sperm, it is possible to retrieve sperm cells directly from testicular tissue through a procedure called testicular sperm extraction. This involves either a needle aspiration or a small surgical incision into the testicle to collect sperm-containing tissue. The extracted sperm can then be used with in vitro fertilization.
This approach was successfully used in the case of the prostate cancer patient whose ejaculatory function did not recover after hormonal therapy. Micro-testicular sperm extraction yielded viable sperm that could be preserved for future use.6PubMed Central. Testicular sperm extraction in a patient with ejaculatory dysfunction after combined androgen blockade therapy for prostate cancer The success of this procedure depends heavily on whether sperm production has been damaged by additional treatments like radiation or hormone therapy. If the testicles are still making sperm, extraction has a reasonable chance of working. If long-term hormonal suppression or radiation has severely damaged the testicular tissue, the odds drop.
There is also an extremely rare biological curiosity worth mentioning. One case report documented sperm appearing in a patient’s urine after robotic radical prostatectomy, a condition called spermaturia. The researchers believe this happened because a small channel, a fistula, formed between the cut end of the vas deferens and the urinary tract, creating an unintended passage for sperm to reach the urine.10Case Reports in Urology. Spermaturia after radical prostatectomy: is surgical preservation of fertility possible? This is not a reliable fertility pathway, but it demonstrates that sperm production does continue and that sperm cells are still physically present in the body after surgery.
When Sperm Has Nowhere to Go
With the delivery route severed and the downstream structures removed, sperm produced by the testicles is gradually reabsorbed by the body, just as it is after a vasectomy. Occasionally, though, sperm can leak from the cut ends of the vas deferens and provoke an immune response. The body treats escaped sperm as foreign material and walls it off in a lump of inflammatory tissue called a sperm granuloma.
These are usually tiny and harmless, but in rare cases they can grow large enough to cause problems. One case report described a 72-year-old man who developed a large pelvic mass after radical prostatectomy that was pressing on his bladder and causing severe difficulty urinating. The mass turned out to be a sperm granuloma.11PubMed Central. Development of a Large Pelvic Sperm Granuloma Status Post Radical Prostatectomy: A Case Report Cases like these are unusual, but they are concrete proof that the testicles keep producing sperm long after the prostate is gone.
Radical Prostatectomy Versus Simple Prostatectomy
One source of confusion is that “prostatectomy” can mean very different things depending on the context. A radical prostatectomy, performed for cancer, removes the entire prostate along with the seminal vesicles and portions of the vas deferens. A simple prostatectomy, performed for benign prostate enlargement, removes only the inner portion of the prostate that is blocking urine flow. The outer shell of the gland and surrounding structures stay in place.
After a simple prostatectomy, the anatomy for ejaculation is mostly preserved, but the bladder neck has been opened up. This typically causes retrograde ejaculation, where semen flows backward into the bladder during orgasm instead of exiting through the penis.12PubMed Central. Retrograde Ejaculation-a Commonly Unspoken Aspect of Prostatectomy for Benign Prostatic Hypertrophy The man still produces a full complement of semen with sperm in it, but most of that fluid ends up in the bladder and is passed with the next urination. With classical surgical techniques, retrograde ejaculation is permanent in the vast majority of men, though newer approaches that try to preserve nerve function around the urethra may reduce the rate.
For men dealing with retrograde ejaculation after a simple prostatectomy who want to father children, sperm can sometimes be recovered from the bladder after orgasm. Techniques such as alkalinizing the urine beforehand or placing a special solution in the bladder before ejaculation can help preserve sperm viability so the recovered cells can be used for assisted reproduction.13PubMed Central. A Comprehensive Guide to Sperm Recovery in Infertile Men with Retrograde Ejaculation This option does not exist after a radical prostatectomy, because there is no ejaculate to flow backward in the first place.
Focal Therapy and Newer Alternatives
For men with early-stage, localized prostate cancer, the conversation about fertility and sexual function has started to shift. Focal therapy treats only the portion of the prostate containing cancer rather than removing the entire gland. Techniques include high-intensity focused ultrasound, cryotherapy, and laser ablation applied to specific areas while leaving the rest of the prostate intact.
Research comparing focal therapy with whole-gland treatment has found substantially better sexual function outcomes with the targeted approach, with focal therapy being the strongest predictor of preserved potency at both three and twelve months after treatment.14PubMed Central / The Journal of Urology. Impact of Focal Versus Whole Gland Ablation for Prostate Cancer on Sexual Function and Urinary Continence Because focal therapy preserves much of the prostate, seminal vesicles, and vas deferens, ejaculatory function is more likely to be maintained, at least partly. This could mean the difference between a man who can still ejaculate sperm naturally and one who cannot.
Focal therapy is not an option for every prostate cancer patient. It works best for small, well-defined tumors that have not spread beyond one area of the gland. Long-term cancer control data is still maturing compared with radical prostatectomy, which has decades of follow-up. But for men who are candidates, and especially younger men for whom fertility preservation matters, focal therapy represents a genuinely different set of tradeoffs.
What Doctors Sometimes Forget to Mention
Fertility counseling before prostate cancer treatment is inconsistent at best. Because prostate cancer is overwhelmingly diagnosed in men over 55, many clinicians assume fertility is not a concern and never bring it up. Yet the survey showing 20 percent of patients wanting sperm banking, including men who already had children, suggests the desire for future biological fatherhood is more common than practitioners expect.9Fertility and Sterility. Sperm banking is of key importance in patients with prostate cancer With prostate cancer increasingly being diagnosed in younger men, and with second marriages and blended families common, the assumption that fertility does not matter is outdated.
The other frequently neglected conversation is about what sex will actually feel like afterward. The dry orgasm itself is not a surprise to most men who read about prostatectomy, but the altered sensation, the loss of that pre-orgasmic “point of no return” feeling, and especially the possibility of urinary leakage during climax are details that catch many off guard.3PubMed. Orgasm after radical prostatectomy These are not rare complications. They are the expected experience for many men, and knowing about them in advance helps with both psychological adjustment and practical planning, like using pelvic floor exercises or timing fluid intake before sexual activity.
If you are facing a prostatectomy, asking your surgeon specifically about fertility preservation, ejaculatory changes, and orgasmic function before the operation is worth doing even if it feels awkward. These conversations happen far less often than they should, and the window for some options, particularly sperm banking, closes once treatment begins.