PCa Radiation - Fertility confused

Before I decided on primary SBRT I was told by many people in our community including all URO's and RO's that I consulted, "it is extremely unlikely if not impossible you will be able to produce another child the old fashioned way, therefore as a younger man, you better go visit sperm bank now". Fast forward: it turns out just like having pca in my thirties, I may yet have overcome some super rare odds. FML

In a way I am sort of happy the option may still be there. But this certainly wasn't planned and I'm freaking out as the situation is less than ideal to say the least.

Does anyone have some kind of stats on fertility following pca rad? I pretty much hung my hat after taking everyones advice as "you cant have kids anymore". Maybe I should have DNA test on standby? Maybe go have my sperm count tested? My volume of ejac is still significantly less than before. No impact, no idea.

Frosty in daze

I don't have a reference, but the odds are very low (close to zero) of doing it 'naturally'. Mostly it's a delivery problem - the route out has been damaged, but there are ways to extract sperm with needles and stuff.

If you're motivated it's possible. Get the tests and call the clinic.

Who knows.

Wifeofpie,
Yes exactly that. Wish I could say with confidence that I can trust here but shamefully not the case (Its early in relationship... very). Was just curious to the actual odds of this before I consider anything going forward.

Frostypro-please, no shame! Your questions are fair. I don't know what the odds are, but it seems they aren't zero. I hope you get some clarity soon. Suggesting a DNA test makes scientific sense, but heading straight to that suggestion may not be the best way to nurture your budding relationship, so I understand the dilemma you're in. Perhaps a call to a genetic counselor could help you know your options with DNA testing (My boys are teens now, I am assuming prenatal tests are different than they used to be, but perhaps a prenatal DNA test is available if an amnio or other such test is already being performed?).

While prostate surgery makes it impossible to father children without heroic medical intervention, prostate radiation merely makes it difficult. I did a bit of Googling to see if I could find an actual answer to your question and, of course, I couldn't. I did find this recent article that comes close to addressing your question but not, actually, closer than my "difficult but not impossible" observation above.

Recovery of Spermatogenesis Following Cancer Treatment with Cytotoxic Chemotherapy and Radiotherapy

It does mention that fractionalization makes the damage to the testes worse so your hypofractionalized SBRT radiation should have less of an effect on your fertility than would normal IMRT. It talks about radiation doses and fertility but it is mostly discussing radiation dose directly to the testes so you'd have to ask your RO how much scattered dose he thinks the testes would have received.

But the bottom line is that as far as the effect of the radiation on your ability to father a child there is no way to know for sure one way or the other.

The treatment that would render one sterile is orchiectomy.

RP removes the prostate and seminal vesicles removing the plumbing that destroys the sperm delivery system. But it leaves the testes un-affected to go on producing sperm only to be absorbed by the body in much the same way that would take place if the untreated man never ejaculated.

Radiotherapy in the different forms of external beam and interstitial will leave the delivery system intact but with varying degrees of capability. If one can ejaculate, there is a strong probability of being able to impregnate the old fashioned way and also support sperm collection. Most radiotherapy guys have greatly diminished ejaculate, but some are nearly normal.

Other forms of focal treatment like nano-knife, HIFU and cryo would have effects similar to radiotherapy.

So, most treated men retain their fertility, but physically lose the ability to deliver the goods.

I would be so stunned I would ask for a different Dr.

I'd be somewhat concerned about radiation DNA damage to the stem cells used to make sperm. Before one proceeds, there might be a way to analyze the sperm for damage before attempting to father a child.

After prostatectomy, its still possible to father a child through Testicular Sperm Extraction (TSE) and IVF. Here's a link:

https://ivfminnesota.com/treatment-options/testicular-sperm-extraction/

WeightLoss said...
I'd be somewhat concerned about radiation DNA damage to the stem cells used to make sperm. Before one proceeds, there might be a way to analyze the sperm for damage before attempting to father a child.

Which is exactly the logical justification to request (demand) a prenatal DNA test with the woman. After which some soul searching decisions may be necessary.

Good luck!!!