Prostate Cancer and Pregnancy - Question and Answers

Q: A woman who wants to get pregnant and have another child recently asked, “If my husband had prostate cancer and surgery, can we still have a baby? 

A: The question is quite pertinent, since of 200,000 newly diagnosed prostate cancer patients each year, one-third are Boomers, namely men between age 45 and 64. A number of Boomers, and some Seniors as well, may include those who are married to younger women who are still in their child-bearing years at the time their husbands get prostate cancer.

Before surgical removal, or prostatectomy, of a cancerous prostate, it’s quite likely a man with prostate cancer can impregnate his wife, but not afterward. After all, the prostate is part of a man’s reproductive system, not only because of its location in the pelvic area at the base of the penis, but because it produces about 2/3 of male semen,-  with the other 1/3 produced by the seminal vesicles. As a result once a man’s prostate is surgically removed, he can no longer ejaculate and impregnate his wife. This is true for all men, including those who, due to nerve sparing, can continue to have erections, whether spontaneously (25 to 50%), or with the help of erectile devices, pills or injections.

Putting it differently men’s erectile nerves are generally spared in the course of some 50,000 prostate cancer surgeries a year in the United States alone, and most men can regain the capacity for erections, often sufficient for penetration. But the absence of seminal fluid means they can no longer impregnate their wives or partners.

These are the facts, contrary to another recent response to this question posed at another web site. There a commentator correctly states that, “Prostate cancer doesn’t usually affect fertility, however the treatment can.”  However he is wrong in going on to suggest that, “If it was just surgery, he should be okay (in terms of retaining his fertility).” 

That same commentator adds that a husband who wants his wife to conceive should get a fertility workup with his urologist, implying he should do so after his prostatectomy. My objection to this comment should be obvious: Without the capacity to produce semen, no man can be fertile!  For the sake of the patient and his wife who want more children, I wish that were feasible, but it just isn’t!

A better suggestion for men with prostate cancer who want more children with their wives, is to plan ahead.  Clearly, when faced with prostate cancer, family planning can go a long way! For example after a diagnosis we need to recall that there’s no need to rush to surgery, since prostate cancer is slow-growing. As such a couple that wants more children should hold off having a prostatectomy until the child is conceived. Again, it’s clear that most men who have prostate cancer and good erectile functioning, will still be able to produce semen.

But what if a husband is so nervous about his cancer that he insists on proceeding immediately to his prostatectomy? Even then it’s possible to take a day or two  to first go to a fertility clinic which has a sperm bank. Under a doctor’s direction he can provide several sperm samples that can be frozen and later on injected into his wife’s egg before or even after her husband goes ahead with his operation. With several frozen sperm samples in the ready, the couple will raise their chances of having a new baby.

This approach allows a man who has decided to have a prostatectomy to go ahead and have his cancerous prostate removed, while assuring him and his wife that they can still have a new baby. Planning ahead in this manner will allow a man with prostate cancer to contribute his share of the procreative process, while enjoying the fruits of his wife’s labor!