Table of Contents

Chapter 3: Maximizing Quality of Life After Initial Treatment

d. Fertility

The loss of fertility after prostatectomy or radiation therapy might not be a side effect that comes to mind. However, the increasing rates of men being diagnosed with prostate cancer at younger ages coupled with the increasing rates of men fathering children at older ages makes fertility a growing area of concern.

Despite the best efforts of surgeons and radiation oncologists, it is nearly impossible for a man to retain his ability to father children through sexual intercourse after initial treatment. During prostatectomy, both the prostate and the nearby seminal vesicles are removed. The seminal vesicles are two small structures that lie at the base of the bladder. Together with the prostate, they provide semen that carries the sperm down the urethra and out the penis during ejaculation. The loss of semen following surgery makes ejaculation impossible, so the sperm cannot physically make it out of the body to reach the woman’s egg for fertilization. Note that the loss of ejaculation does not mean a loss of orgasm; without semen, men experience what is known as a "dry orgasm"—reaching a climax, but not ejaculating, or, in rare cases, ejaculating a small amount of semen.

With radiation therapy, fertility is nearly always impaired. Radiated prostate cells and seminal vesicles tend to produce semen that cannot transport the sperm well. In addition, the sperm, which is made and housed in the testicles, can be damaged, but this is seen far less frequently with more accurate dose planning.

For men who wish to father children after treatment for prostate cancer, the best chance for fertility is sperm banking. Semen containing sperm is frozen in liquid nitrogen and, although the cells are technically still alive, all cellular activity ceases. After thawing, up to 50% of sperm will regenerate and can be used for artificial insemination. To ensure that your sperm remain viable after freezing, most centers will run through a freeze-thaw cycle from a semen sample and examine the sperm that survive. Nearly all centers recommend that you bank three or more samples. Sperm can likely be frozen indefinitely, and studies have shown that efficacy rates of artificial insemination are essentially equivalent regardless of whether the sperm came from frozen or fresh semen samples.

As an alternative to banking sperm, extracting sperm directly from the testicles might be an option. Individual sperm are harvested from testicular tissue, and are prepared for use in a type of artificial insemination known as intracytoplasmic sperm injection. In this procedure, a single microscopic sperm is injected into a single microscopic egg. If an embryo forms, it is implanted into the woman’s uterine wall and allowed to grow. Although technical advances in assisted reproduction have dramatically improved the conception rates, the success rates for the two procedures combined—sperm extraction followed by intracytoplasmic sperm injection—is less than 50%. Note that if there has been radiation damage to the testicles, this approach will not be feasible as no viable sperm will be available for extraction.