With the advent of modern brachytherapy several years ago, and with more and more data becoming available for outcomes of prostate cancer treatment, the number of cases of brachytherapy has skyrocketed in the United States.  For local treatment of prostate cancer, there are roughly the same number of brachytherapy procedures done every year as there are radical prostatectomies of all types, and these are about 50,000 cases each per year in the US.

 

It is often assumed that because part of a radical prostatectomy is a vasectomy, or because patients that receive external beam therapy have substantial radiation to the testicles, that a male will be sterile after these procedures.  However, because of both planned and unplanned pregnancies noted in Dr. Joseph Grocela of Urology and Dr. Anthony Zietman of Radiation Oncology's patient population at Massachusetts General Hospital in Boston, Massachusetts, we have studied semen analyses in the 3 men whose female partners have become pregnant. We found their sperm counts to be adequate or normal, and semen volume to be low.

 

Thomas Mauceri or Radiation Physics has calculated an approximate dose to the testicles for the entire treatment of a brachytherapy course, and found that the radiation dose may be quite small to the testicles on occasions. Indeed, the treatment may produce any result from azoospermia to no change in sperm counts.

 

Thus, while most of patients and their female partners will find that this is not an issue, with younger and younger men being treated, one may find that desired or undesired pregnancy may be an issue that one may need to discuss with their patients.

 

Reference:

Grocela J et al.: "New life after prostate brachytherapy? Considering the fertile female partner of the brachytherapy patient", BJU Int. 2005 Oct;96(6):781-2

 

 

Joe Grocela

Department of Urology, Massachusetts General Hospital, Boston, MA, USA