I have an upcoming appointment at M D Anderson. I have bone and lymph node mets, as indicated by PMSA PET scan . I know ADT is pretty much what I will be offered. I also think it will be lifelong as I already have mets. From the posts I read I see the side effects can be substantial.
My question is this....if one chose orchiectmy instead, what side effects might be expected? I hope to hear responses from those who have chosen this as well as those who who did ADT.
Thanks, just trying to learn.
Jeffrey,
The elimination of testosterone via chemical ADT is as much an insult to the male body as orchiectomy, but I can understand why most seem to opt for the former. Perhaps there's a hope that one day there might be a cure & return to normalcy. There is something final about orchiectomy.
But I have always thought that orchiectomy might be more convenient, & cheaper (ultimately). & testosterone can be cheaply reintroduced if that ever became feasible.
What I never realized was that there might be subtle differences in the consequences of the two approaches. We know that there are profound metabolic effects when one becomes castrate, but I came across a new Danish paper [1] this week that stated that:
"Androgen deprivation therapy leads to adverse changes in body composition and increased insulin resistance and serum cholesterols with changes already observed after only 12 to 24 weeks of treatment. This study further demonstrates that orchiectomy causes greater increases in fat accumulation compared with GnRH agonists and that these increases are associated with an increase in insulin resistance."
In another Nordic paper from December [2]:
"In observational studies, men with prostate cancer treated with gonadotropin-releasing hormone (GnRH) agonists had a higher risk of cardiovascular disease (CVD) compared to men who had undergone orchiectomy. However, selection bias may have influenced the difference in risk."
"We found a similar risk of cardiovascular disease between medical and surgical treatment as androgen deprivation therapy for prostate cancer."
Yet, in contrast, from a U.S. paper (2016) [3]:
"Androgen-deprivation therapy (ADT) through surgical castration is equally effective as medical castration in controlling prostate cancer (PCa). However, the adverse effect profiles of both ADT groups have never been compared."
"A population-based cohort of 3295 men with metastatic PCa between January 1995 and December 2009 66 years or older was selected from the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database."
"Gonadotropin-releasing hormone agonist therapy is associated with higher risks of several clinically relevant adverse effects compared with orchiectomy."
"... patients who received a bilateral orchiectomy had significantly lower risks of experiencing any fractures (hazard ratio [HR], 0.77 ...)"
"... peripheral arterial disease (HR, 0.65 ...)"
"... and cardiac-related complications (HR, 0.74 ...)
"compared with those treated with GnRHa."
***
One gets the impression that there hasn't been a lot of interest in the subject until recently.
-Patrick
[1] ncbi.nlm.nih.gov/pubmed/303...
You may be able to do intermittent ADT in the future. Therefore I would not choose orchiectomy.
I was diagnosed in July 2012 with a Gleason 9 PCa that had metastasized to my bladder and pelvic lymph nodes. I started ADT right away and had external beam radiation at the end of 2012. My PSA dropped to undetectable about a month after the radiation therapy and stayed there. In October 2014 we stopped the ADT. I have been off all cancer meds since then and my PSA has been in the 0.1 to 0.2 range since stopping ADT.
Being off ADT has significantly improved my quality of life (though I actually tolerated it fairly well; I found it irritating but never horrible during the 26 months I was on ADT). Orchiectomy is permanent.
Dear Sir, with an orchiectomy you shall have the same side effects.. what different forms of adt have as far as side effects may differ some . The main side effects are from having 0 testatsterone.. that’s the goal. Castration symptoms are the same for either adt or orch.. the difference for me was no shots for life and no added chemical to my already altered stew.. my uro surgeon bragged to his pre op cohorts . He said prior to the snip . “This Guy here has decided to not come and see m every three months for a shot.. They all agreed. A good move for me.. I think we are a little better off heart wise choosing orch over adt. I’m still on a test adt until it fails . It’s a party...
I am in the same situation so i went for a 2nd opinion (my original url wanted to snip me) . I know that testosterone is not only produced in the testicles, but 2 or 3 other places (you can tell im not a doc!) so an orchi is not a sure bet. New url. said orchi is barbaric and he hasnt done one in a long time. Im gonna stick with adt for now. By the way lm stage 4 with mets to bones (knee feet shoulder spine skull ect.) & lymph nodes, gleason 9, test 56, psa 0.1 Good Luck Brother!
to Jeffreyo: Depends if you (or your significant other) like to play with them.
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 11/10/2018 8:04 PM EDT
I have been on ADT since my 2012 RP and salvage radiation. I did relatively well through 6 rounds of Taxotere. I have zero libido (since ADT has driven my total test. to <3; normal is >600) but this has been a small price to pay to slow down this disease (Gleason 9). I am keeping the family jewels...
Had the snip. T was at 7 (really low) before orchiectomy. Didn't want long term meds if they could be avoided. T this week 6 mo. after snip level at <3 so ADT was very effective but not quite as good as the snip.
I live in Orlando and for 9 months I have no more signs of cancer. God did not intervene! I had radiation in 2007, metastases in 2011, more radiation and 6 1/2 years of Lupron. I am on medicare and all I paid for was $50. for each appointment and $43. for second radiation. I had bone metastases but no lymph node involvement. I still have my junk (no snip). My testosterone is very low, but last week I awakened with an erection! I had 3 shots of Xgeva (for osteoporosis) 6 months apart after 3rd year. When a PCa cells enters the blood stream it circulates and attaches to bone or goes in to lymph nodes. It can attach elsewhere. On the bone it sinks into the bone leaving a pock mark and as long as there is no testosterone it can not divide. It is stuck there but can weaken the bone. I have other diseases, but not cancer. I wish you well.
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