Infertility after prostate cancer treatment:
After prostate cancer treatment, you may find it challenging to have children. This can be a tough adjustment. Learning why your fertility might be impacted and exploring available options can help you manage these changes.
The testicles
The testicles are two small, oval-shaped organs located below the penis, enclosed in a skin pouch called the scrotum.
Image of the testicles (cruk)
Starting from puberty, the testicles begin producing sperm. Inside the testicle, small tubes come together to form the epididymis, a single tube that becomes wider as it exits the testicle. This wider tube is known as the spermatic cord.
The spermatic cord leads to a short passage called the ejaculatory duct, which opens into the urethra, the tube that carries urine and semen out of the body through the penis.
Testosterone:
The testicles produce the hormone testosterone, which is responsible for developing male characteristics such as:- A deeper voice
- Facial hair growth
- Increased muscle mass
- The ability to achieve an erection
- Male sexual drive (libido)
Where does testicular cancer start:
The testicles consist of various cell types, and the kind of cancer you have depends on the specific cell where it begins. Most testicular cancers arise from germ cells, which are responsible for producing sperm. Doctors classify germ cell cancers into two main types:- Seminoma
- Non-seminoma
How prostate cancer surgery affects your fertility:
One standard approach to treating prostate cancer is a surgical procedure called a radical prostatectomy, where the prostate gland is completely removed.
During a radical prostatectomy, your surgeon removes the prostate gland and two glands called the seminal vesicles. Even though your testicles will keep producing sperm cells, the sperm won’t be able to travel through the tubes and exit your body. Instead, the sperm cells will be reabsorbed by your body.
As a result, after a radical prostatectomy, you won’t ejaculate semen anymore, but you can still experience orgasms. These are known as dry orgasms or retrograde ejaculation.
How radiotherapy, hormone therapy and chemotherapy affect your fertility:
After radiotherapy or hormone therapy for prostate cancer, you may produce less or no semen. These treatments can also damage sperm and lower your sperm count, making it harder to have children naturally.
Men can still be fertile during radiotherapy, hormone therapy, or chemotherapy. However, these treatments can harm a developing baby, so it’s important to use contraception to avoid pregnancy while undergoing treatment.
Sperm collection and storage (sperm banking):
If you might want children in the future, consider storing sperm before starting treatment.
Even after a radical prostatectomy, it may be possible to extract sperm directly from your testicles. This sperm can be used for direct fertilization or through in vitro fertilization (IVF).
Ask your doctor or specialist nurse for a referral to a specialist fertility clinic.
Talking about your sexual difficulties:
Your sex life is very personal, and discussing sexual issues caused by treatment can be tough.
Talking with your partner about these problems can bring you closer, as they might also be looking for the right moment to discuss it.
Doctors and nurses are experienced in handling such topics, so don’t hesitate to bring it up if they don’t mention it first. They are there to help you.
If needed, ask them to refer you to a specialist counselor or sex therapist.
Daignosis
If you have any symptoms, your first step is usually to visit your GP. They will discuss your symptoms with you and conduct an examination. Based on their findings,
Treatment options
A team of healthcare professionals (multidisciplinary team) will determine your treatment plan. Most people undergo surgery to remove the affected