Advanced Prostate Cancer
5,177 members4,841 posts

Is Orchidectomy right for me?

I am considering surgical castration as an option to chemical treatment for PCa. I have been taking Lupron/Zytiga + prednisone for nearly a year. The results have been excellent--PSA undetectable--and I have grown used to the side effects, which, in my case, have not been unendurable. Still, I wonder if the surgery might be the most expedient option. Please see my profile for specifics. I will soon be 66, did not have my prostate removed, but received RP, seed implantation and one dose of cryo. I want to hear from men who have had surgery.

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I have had surgery (had to fight for as the cancer spread to the pelvic area), 38 rounds of radiation and I am currently on Lupron and Zytiga. So far so good, but the side effects are really wearing me down.

The main problem I see with surgical castration is that it will not touch the testosterone made from the adrenal gland. However if you and your medical team think that will not be an issue then I can see the advantages of not getting a shot every six months.

From what I have read they recommend that you be on Lupron with Zytiga for two years to get the maximum benefit. Again, you may want to ask your Medical Oncologist if you should wait before surgery till you reach the two year mark.

Hope this was of help to you. Please know this, any decision you make will be the right one for you. We will all support you as people like us we have to stick together.

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Dr. Who, I certainly appreciate your considered replies--as we all do. My MO frowned when I asked about a "vacation" from my drug regimen (same as yours). I would be willing to undergo another year or this treatment (one year anniversary in March). And you were so wise to reference production of T from the adrenals. More for me to look into. You have become a stalwart and mentor on this site, much appreciated. I will let you know what I decide. Be well and keep up the good fight!

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Know this, you fight your beast, I fight my own, but we all are with you. There is no magic answer to a cure that will fit us all. But we will kick the beast, we will spit in it’s eye. We will never go down without a fight!

But the most important thing to know, none of us are alone. We go to battle together! Do us proud!

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Here, here Dr. WHO. I will post as I make a decision.

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Had the surgery last July. I decided to do it because I’m going to have ADT for the rest of my life. The Elligard injection feels like battery acid going in and I’d rather not do that every 3 months. Glad I did it, don’t miss them at all.

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Gary94, did your MO talk about testosterone production from the adrenals? We are in the same boat, or so my MO says. No Vacations. This is perplexing as my scans show only two spots. I was diagnosed in 2005 and experienced no changes until my PSA jumped 13 months ago and I began Lupron/Zytiga.

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It’s my understanding that no ADT or orchiectomy affects testosterone production from the adrenal glands. Casodex and zytiga are supposed to lessen testosterone absorption by the cancer cells.

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Thanks, Gary94. So much to learn. Can be overwhelming,too.

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Ron:

With the orchiectomy there is no way to take a "vacation" as is possible with Lupron.

I also concur with Dr_WHO regarding the adrenal production of T.

Joe

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Joe, thanks for the reply. My MO says "NO VACATION," which I find perplexing since my scans show only two "possibles" in my pelvic region.

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It is not up to him.

It is up to YOU!

Joe

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Yes, Joe, that is so! But I want to approach this with full knowledge and a dedicated spirit. But I will not be deterred if I choose surgery.

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There was just an extensive post on this subject with lots of replies. It can be found here:

healthunlocked.com/advanced...

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Thanks, gregg57, I did read the entire post. I am leaning toward surgery at this point, primarily due to the fact that my MO wants me to stay on Lupron/Zytiga until I stop breathing. LOL. Also, I am concerned about the stress on liver and kidneys--an my emotional state of mind, always wondering if the drugs are keep my T low as it can go.

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I am considering doing the orchidectomy also. If I stay on ADT there will be no vacations. Chemo treatment makes the decision for me a little more difficult now. I should have done it before. Not easy decision. Best wishes to you.

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Eggraj8, I know exactly what you mean--feel. Why, I wonder, did I not even consider surgery at the outset. The medical establishment does not present it as a frontline option. Perhaps it is best that way. We have time to reflect and make a wiser choice. Let's stay in touch.

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I opted for an orchiectomy. Was taking Firmagon and experienced severe discomfort and pain for 3 - 5 days right after getting the shot monthly. When consulting the urologist on pros and cons of an orchiectomy he listed all pros on the therapy side and the con was emotional attachment. That was about 18 months ago and I'm pleased with the decision. Saves me time from avoiding shots, saves me concerns about a drug workings, has overall improved my quality of life. For me it was a big improvement.

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Howard, Your post aids my thinking process. I am not emotionally attached to my dessicated testicles after a year of treatment--and years more to contemplate. I will discuss with my MO in April, which marks 13 months of drug castration. Can I contact you as I go forward? It helps to have a network of men who have risen to this challenge.

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My husband also had an orchiectomy about 2 years ago when he reached the point he would be taking lupron for life. He still has no regrets and is very happy with his decision--far fewer side effects, better quality of life. He has since failed casodex and is on zytiga (even though it isn't working very well) and his T level is 4, but the orchiectomy still means fewer drugs and fewer doctor appointments. That in itself is a positive for keeping your mind off your disease and enjoying life.

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Thanks, mtnwife, for sharing your husband's choice of treatment. I will continue researching.

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It's a tough decision to make. Isn't that typical of this disease? What other cancer or disease presents so many treatment options and decisions ... which all ultimately fall on the patient. You have our support whatever you go with.

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You nailed it, WSO. So many options, decision--which breed a sense of unease. I guess I wanted a way "out," meaning one without all those options. I really thank you for the response and the support. Only the afflicted understand!

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Hello Ronton2,

I have just joined this community as I see it has good communication and recent posts. I was diagnosed with stage 4 which which was wide spread in my bones/spine, 9 months ago. After chemo and two shots of Lupron, I opted for surgery in fear of the long term side effects of Lupron knowing I'd have to go on Zytiga after the chemo. It has been 5 months since my surgery. Fatigue and joint pain are my two biggest side effects. I don't think either of those are a result of surgery, they are a result of low testosterone. It was out patient surgery and I was a bit slow for the weekend, sore for a month but moving around pretty good within a few days.

I read several posts from families of patients taking Lupron for 5+ years and I really wasn't a fan of some of the things they had to say about some of the side effects it had, true or not, I didn't want to chance it and wasn't a fan of the shot either.

Is the Lupron shot 100% effective? I never could find a clinical trial showing evidence Lupron works 100% on everyone it is given to, but an orchiectomy is 100%, I promise. When I asked my oncologist should I get the surgery he said: "I won't try and talk you out of it". That was good enough for me.

I'm happy to hear the Zytiga has your PSA under control and I'm hoping it has the same effect on me.

Good luck on you decision, I'd do it again.

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TenscT, I see now that there is no magic bullet; however, there are ways to control the disease by different--less toxic--means. I will discuss with my MO in March. Thanks for the considered reply. Let's hear from you as your journey continues.

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Yea, I was trying the less toxic route but it didn't do enough, so now on to Zytiga. Hoping for few side effects and some positive results. Completed two CT's and a bone scan this morning, have to wait until Friday to see what's changed. (My PSA went up from 1.0 (end of chemo) to 6.7 in three months after chemo, can anyone tell me how bad that is?)

I think age has a lot to do with the decision for surgery, and for younger men with a future of a family, sure you'd want to postpone as long as possible, but there can be more to life than the twins.

Thanks and good luck.

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I must admit that all drugs are toxic. That said, some are less so than others. I sincerely hope you get a good news following the CT's and bone scan. I am still ignorant about chemo infusions (Zytiga is a pill form of it). No doubt others on the site can explain your fluctuating PSA. Sometimes, I've read, PSA can rise before taking a plunge. Good wishes, Tesnsc.

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