Loss of semen

Semen contains many components from different glands which is mixed at ejaculation. The prostate produces a clear watery fluid which contains PSA, accounting for about 40% by volume. Seminal vesicles produce the thick white component which accounts for about 50%. The remaining 10% is from the Vas Deferens which includes the sperm, and from cowpers glands (which produce precum).

If you stick loads of needles in the prostate and make it bleed, it's not surprising if you disrupt the workings for a while. In your case, it may be that the ejaculatory ducts which carry the seminal vesicle contribution are still swollen or blocked, so that component is missing. It would likely recover given enough time, but that might not happen before the prostatectomy, after which you'll lose all semen except the cowpers gland contribution.

Bicalutamide does appear to shut down the seminal vesicles more so than the prostate (or maybe just sooner), resulting in watery semen. (It is probably the case that the watery contribution from the prostate no longer contains PSA too.) The hormone therapy injections shut down production of all the semen components.

As to erectile dysfunction caused by biopsies, it does seem like this is a potential issue, although relatively rare and minor, and for just one biopsy, not usually noticed. I've seen the suggestion that men who do a long time on active surveillance might gradually accumulate ED from the multiple biopsies, a tiny amount each time. The ProtecT trial showed that those randomised to Active Surveillance initially had same decline in erectile function by 10 years as those on active treatments, and this was significantly worse than men of a similar age never diagnosed with prostate cancer. However, the Active Surveillance arm includes those who had to switch to active treatment due to disease progression, so it's difficult to tell if this is only in the men who had active treatment, or if it also applies to those who were able to stay on Active Surveillance for most of the 10 years and hence had the most biopsies over time.

Edited by member 04 Jul 2024 at 08:33  | Reason: Not specified

Pretty much the same here - pre-existing ED got worse after my biopsy (48 cores taken under general anaesthetic) and after the blood in semen was flushed out, what little I produced was very watery.  I was on 150 mg bicalutamide (with a side of 20 mg tamoxifen to mitigate against moobs) whilst waiting for surgery, so that may also have had an impact.

Best of luck with your treatment.

Ian