Fertility after prostate “seed” therapy possible

Contrary to popular belief, men with prostate cancer who have tiny radioactive seeds implanted in the prostate to destroy the cancer, a treatment called brachytherapy, are not always rendered infertile, according to the results of small case series.

Prostate brachytherapy has become a very popular way to treat prostate cancer that has not spread to other organs. While it is still a preferred treatment for older men, increasingly many younger men are now being treated with this approach.

Prostate brachytherapy has been shown to reduce the volume of semen and alter its viscosity. Moreover, men treated with this modality often experience erectile dysfunction. For these reasons, many researchers have assumed that these men are infertile.

However, in the medical journal BJU International, Dr. Joseph A. Grocela and colleagues, from Massachusetts General Hospital in Boston, describe three unintended pregnancies that occurred after the male partner was treated with prostate brachytherapy.

Two of the pregnancies were carried to term, resulting in two healthy infants. The other pregnancy resulted in a spontaneous miscarriage in the first trimester.

Although the men had low semen volumes and slightly decreased total sperm counts, the morphologic features of their sperm met most or all of the World Health Organization’s criteria for normal.

“These three cases provide a cautionary tale and suggest that all men being treated with prostate brachytherapy should be counseled about possible continued fertility,” the authors state.

SOURCE: BJU International, October 2005.

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