The Effect of Radiation on Semen Quality and Fertility in Men Treated With Brachytherapy for Early Stage Prostate Cancer

Abstract

We determined the effects of prostatic brachytherapy on semen parameters and sperm DNA integrity, and the potential impact on fertility. Five screened patients treated with brachytherapy participated in a pilot study visit to undergo early morning blood collection for serum hormone evaluation and semen collection for semen analysis and DNA integrity assay by sperm chromatin structure assay. Data on 7,617 infertile men, each with at least 1 semen analysis and sperm DNA integrity assay, were obtained from an institutional database for comparison. Published data on fertile men were compared to data on those with brachytherapy for DNA fragmentation analysis. All brachytherapy cases had normal serum luteinizing hormone, follicle-stimulating hormone and testosterone. Specific semen parameters, such as semen volume (p <0.0005), total sperm concentration (p <0.0004) and percent sperm motility (p <0.004), were significantly lower than normal reference values. As measured by the DNA fragmentation index, the mean sperm DNA fragmentation of 46.4% in brachytherapy cases was significantly higher than in the fertile group (13.3%, p <0.0003), the total infertile group (20.4%, p <0.0002) and the age matched infertile group 45 to 53 years old (27.9%, p <0.03). All men with brachytherapy had an abnormal sperm DNA fragmentation index, indicating likely infertility in all. Infertility may well be a long-term adverse effect of brachytherapy for localized, low grade prostate cancer. All men who undergo brachytherapy should be counseled about its potential impact on fertility.