It was not that long ago when it was widely held that prostate cancer (PCa) is an “old man’s disease.” No more. That belief is now only shredder-worthy. Wad up the paper, toss it in the recycle bin—but please don’t recycle the idea itself! PCa is now hitting men at younger ages, many of whom don’t yet have kids, but want them someday.

Here are the facts: Around the globe, PCa has increased in all groups ages 15-40, and is steadily rising at an average annual rate of 2%. As shocking as it is, PCa is increasing among adolescent and young adult males. While the actual number of cases is small compared with incidence in older men, many of these younger men will be diagnosed with aggressive disease that has started to spread. However, with luck, their PCa is still contained in the gland so they qualify for a potentially curative radical treatment.

The most common radical treatment is prostatectomy, or surgical gland removal. However, as the Prostate Cancer Foundation (PCF) clearly states, there’s a problem for those who still hope to bring kids into the world: “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.” That’s because in order to save the patient’s life, the surgeon removes the prostate structures that produce the fluid to carry his sperm out of the body. In other words, the patient cannot impregnate a woman because he will have “dry orgasms” that contain no sperm.

Another common whole gland treatment is radiation. As the PCF describes, after radiation “prostate cells and seminal vesicles tend to produce semen that cannot transport the sperm well.” Johns Hopkins medical information bluntly puts it, “Radiation therapy nearly always impairs fertility.”

There’s still hope

As bleak as it sounds, PCF identifies two fertility solutions for a newly diagnosed PCa patient who still hopes to have at least one kid:

1. Bank sperm – This involves collecting and freezing sperm. Since the sperm will be frozen and stored at -196° Celsius, your home freezer won’t help. However, fertility clinics have the facilities to offer a private room for you to ejaculate into a collection cup. They then test your semen, and prepare the sperm for the steps involved in freezing and storing them. The extreme cold shuts down their cellular activity, but about 50% of sperm regenerate during thawing, and are capable of fertilization when inserted in a woman’s uterus.
2. Extract sperm directly from testicles – This is typically done by administering a local anesthetic, then extracting the sperm with a needle. It is done the same day as eggs are surgically harvested from the female partner, so the fresh sperm and egg have the best chances for fertilization outside the body. If successful, the fertilized egg begins to form an embryo in a petri dish; a few days later it’s implanted in the woman’s uterus. This is a more complicated fertilization process and has lower success rates than banking/thawing sperm.

It is important for PCa patients who want to become fathers to know that fertility options are open to them before they undergo treatment. They should openly share their concerns and hopes with the doctor who will be treating them. Their wishes will be taken into account for planning treatment, and their doctor can refer them to a fertility clinic.

Prostate cancer does not have to be an end to fertility, but it may pose a detour. For those whose PCa is diagnosed at an early stage, a focal therapy that spares healthy prostate tissue may be feasible. If so, the patient’s fertility may be preserved because the untreated prostate tissue still manufactures fluid to carry sperm out of the body. If you or a loved one is at risk for PCa, and still wants to have children, contact the Sperling Prostate Center to learn if one of our three focal treatment approaches is right for you.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.