Prostate Cancer and Fertility: What You Should Know

Medically Reviewed by Nazia Q Bandukwala, DO on May 30, 2023
3 min read

Your prostate gland is about the size and shape of a walnut and sits below the bladder, in front of the rectum (part of your intestines), and the base of the penis. It helps make semen, the milky fluid that carries sperm through the penis and outside the body when you ejaculate.

Prostate cancer happens when cancer cells form in prostate tissue. Your chances of getting it go up after age 50 or if you have a family history of the disease. Black men run the highest risk, followed by white, Hispanic, then Native American men.

Advanced cancer can cause sexual problems, such as erectile dysfunction (ED). This could affect fertility (your ability to have children) because you may not be able to have sex as often. But treatment for prostate cancer is often the main cause of fertility issues.

Treatment for prostate cancer may affect your ability to have children for a period of time or forever. It depends on your age, health, and the nature of the treatment. Talk to your doctor before treatment starts if you have concerns about your fertility. There may be things you can do to prepare for the future.

Prostate cancer treatments include:

Surgery. This typically removes the prostate gland and two other small glands called seminal vesicles. They all work together to carry semen out of your penis. Without them, you can’t send sperm outside of your body to fertilize an egg. Surgery for bladder cancer often removes the prostate and seminal vesicles as well. Surgery for other pelvic cancers like colon and rectal cancer can damage the prostate, nerves, and other organs, leading to infertility or erectile dysfunction.

Radiation therapy. This treatment uses high-energy beams, like supercharged X-rays, to kill cancer cells. The area the cancer is in -- in this case the prostate -- is targeted. But radiation therapy anywhere around your sex organs or belly area (testicles, bladder, and lymph nodes) can lessen your sperm count and testosterone levels (a hormone linked to sex drive). It can even destroy sperm cells. The damage may be short, medium, or long term.

Chemotherapy. Drugs, typically given through a needle in your vein, are used to kill cells that divide quickly. Because sperm normally divide at a fast pace, chemo often affects them as well. This could lead to infertility. Your age, the type of chemo, and the dose all affect the risk of infertility.

Hormone therapy. Also known as androgen deprivation therapy (ADT), it stops your body from making male sex hormones like testosterone. Some hormones “feed” prostate cancer cells, helping them grow. Though ADT can slow tumor growth, it may also affect your ability to make sperm.

There are things you and your medical team can do to protect your sperm from damage or save it for future use. These include:

Sperm banking. If you have prostate cancer or another illness and you know treatment could impact your ability to have children, you can save sperm before treatment starts. A lab collects semen samples and checks them under a microscope for health. If they’re OK, the lab freezes the samples and stores them for later use.

Testicular shielding. This is when a protective lead cover is used to help protect testicles from radiation. This lowers the chance of treatment damaging your sperm. It’s also called gonadal shielding.

Testicular sperm extraction (TESE). Even if you’re not able to ejaculate and bank your sperm, your doctor may be able to get sperm from your testicles with this procedure. Your health care team will do minor surgery to remove pieces of testicle tissue. They’ll check it for possible sperm. If found, you and your health care team can use it to fertilize an egg or freeze for later use.