Objective: To compare the options available for prostate cancer management and their consequences on fertility for men, in order to best advise these men to choose their treatment, especially if they are young, with no child with their current partner.
Methods: A literature review on prostate cancer and fertility over the last 26 years was carried out on PubMed database. The literature was based on evidence and practical considerations. Twenty-nine articles were selected according to their relevance.
Results: After prostatectomy, there is an obstructive infertility in 100% of the cases. In external radiotherapy, doses more than 15 cGy induced reduction in sperm count. Direct irradiation between 15 and 35 cGy caused oligozoospermia and doses between 35 and 50 cGy caused reversible azoospermia. The calculated projected doses on testicles were 196 cGy (± 145 cGy). The brachytherapy effects on fertility seems to be less harmful. The irradiation dose received by testicles is less important (less than 20 cGy) after brachytherapy than after external radiotherapy. Infertility induced by hormonal therapy alone should be reversible. Fertility and focal therapy have not been well evaluated yet. Active surveillance is the management of prostate cancer which allows to keep at best men's fertility.
Conclusion: Urologists should consider approaching the topic of infertility when discussing the pros and cons of various prostate cancer management with their younger patients. If a patient with prostate cancer expresses interest in future fertility, a semen analysis should be performed. Cryopreservation represents the only preemptive accompanying possibility to preserve fertility in young cancer patients.
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