Fertility preservation after prostate cancer treatment: mechanisms and clinical strategies

Qiancheng Shi^1,2,#, Siqi Li^3,#, Yanan Qian^4,#, Shengqian Wang^4,*, Nan Lu^1,5,*
1 State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, China
2 Department of Urology, SirRunRun Hospital, Nanjing Medical University, Nanjing, China
3 School of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
4 The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
5 Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
* Corresponding Author: Shengqian Wang. Email: email ; Nan Lu. Email: email
# These authors contributed equally to this work
(This article belongs to the Special Issue: Evidence-Based Urology: Bridging Clinical Controversies and Contemporary Practice)

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.084056

Received 20 April 2026; Accepted 12 June 2026; Published online 04 August 2026

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Abstract

With the rising incidence of early-onset prostate cancer and improved long-term survival rates, fertility preservation has become an increasingly important yet often overlooked aspect of survivorship care for men diagnosed with this disease. Despite growing recognition of this issue, clinical practice continues to lack standardized approaches to fertility assessment and preservation both prior to and following treatment. This review synthesizes current evidence regarding the mechanisms underlying treatment-induced infertility and evaluates available clinical strategies for fertility preservation in this patient population. Radical prostatectomy disrupts ejaculatory function primarily through loss of seminal vesicle contractility and disruption of the bladder neck mechanism; while Radiotherapy induces testicular damage in a dose-dependent manner, with declines in sperm quality detectable shortly after treatment, and partial recovery may occur in a substantial proportion of patients over time. Androgen deprivation therapy (ADT) suppresses spermatogenesis via inhibition of the hypothalamic-pituitary-gonadal axis. Sperm cryopreservation prior to treatment initiation remains the most reliable fertility preservation strategy; however, utilization rates among eligible patients remain low. Adjunctive approaches, including antioxidant supplementation and varicocele repair, have shown potential benefits in selected populations but lack validation from robust randomized controlled trials. In conclusion, prostate cancer treatments exert profound and modality-specific effects on male fertility, necessitating a multidisciplinary approach that integrates urologists, reproductive endocrinologists, and patients to optimize fertility preservation outcomes. Future research should prioritize the development of validated risk stratification tools, the enhancement of oncofertility education programs, and rigorous evaluation of novel fertility-sparing interventions.