Prostate Cancer and Fertility: A Review of the Implications of the Different Therapeutic Options


  • Rita Fonseca Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental,Lisboa, Portugal; Nova Medical School – Universidade Nova de Lisboa, Lisboa, Portugal
  • Renato Mota Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental,Lisboa, Portugal; Nova Medical School – Universidade Nova de Lisboa, Lisboa, Portugal
  • I. Peyroteo Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisboa, Portugal
  • J. C. Santos Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental,Lisboa, Portugal; Nova Medical School – Universidade Nova de Lisboa, Lisboa, Portugal
  • Andreia Silva Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental,Lisboa, Portugal
  • Frederico Gaspar Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental,Lisboa, Portugal
  • Luís Abranches-Monteiro Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental,Lisboa, Portugal



Infertility, Male/therapy, Prostatic Neoplasms/complications


Introduction: Prostate cancer is the second most common neoplasm in men, and its incidence is higher in the group aged 50-69 years. It is estimated that about 5% of cases are diagnosed in men under the age of 50. Given the current demographic developments, the desire for paternity is often postponed. Thus, it is relevant that the urologist can explain the different repercussions that the existing therapies for malignant prostate cancer have on male fertility. The purpose of this systematic review is to compare the repercussions that the diverse therapeutic options used in prostate cancer have on male fertility.

Methods: a qualitative review of the scientific literature published between 1987-2019, according to the ENTREG guidelines and PRISMA methodology, through PubMed database. All articles written in English and covering the topics described were consi- dered, including randomized controlled studies, meta-analyses and systematic reviews. All the abstracts of the publications were read by two authors, with the consequent selection of those that met the defined criteria, after evaluating its quality using the CASP qualitative checklist. In case of divergent opinions, a third urologist was consulted to decide on inclusion.

Results: According to the defined criteria, 436 references were identified and 10 publications were included as they refer directly to the defined objective. Despite the few published studies, there is evidence that active surveillance alone has no implications for fertility. Although there are no comparative studies, according to the currently available data, focal therapy and brachytherapy seem to be the therapeutic options with the least likelihood of permanent impairment of the capacity for natural fertilization as opposed to radical prostatectomy, radiotherapy, hormonotherapy and chemotherapy.

Conclusion: Nowadays, with increased survival after prostate cancer treatment, it is relevant to evaluate the repercussions on fertility of the existing therapeutic options for prostate cancer, so that patients can make an informed decision and, if necessary, resort to gametes preservation measures prior to therapeutic intervention. Although there are no comparative studies, focal therapy and brachytherapy appear to have less effect on male fertility. Active surveillance is currently the only option with no consequences on fertility.


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