Medical castration vs actual castration.

[Drphil1938]

I have been reading about Lupron and other medical treatments and it raises the question of why not just remove the testicles. I understand why not for a younger man but I am 80 yrs old and sex is on the back burner as a reason to keep them. It is cost effective but is it as effective as the medicine?

[Hidden]

It's very effective, it was the standard since the early 40s until the chemical versions came along. It's also more reliable, typically lowering the testosterone to around 15 within a few hours of the surgery. Drugs like Lupron only guarantee testosterone levels below 50 and research has shown you need to be under 20.

By the way, the side effects are the same. There is a myth floating around that the side effects are better for surgery.

[Tall_Allen]

There are some differences, favoring GnRH agonists/antagonists, but the orchiectomy is certainly more convenient.

ncbi.nlm.nih.gov/pmc/articl...

onlinelibrary.wiley.com/doi...

For men who will need lifelong treatment (starting at any age), orchiectomy makes sense. But for men who choose intermittent ADT, they have to use chemicals.

[CalBear74 in reply to Tall_Allen]

TA, how does an orchiectomy affect the treatment regimen for the patient? Obviously, it supplants the drugs like Lupron that seek to suppress testosterone as their main effect. And I assume you can go off Lupron. Besides, being able to give up those drugs, what would the patient typically do next for effective treatment? I'm referring to the chemical side of treatment; I am ignoring issues related to RT in this question. Also, I am interested in your opinions regarding side effects post-orchiectomy. Will brain fog, etc., from Lupron go away?

[sjc2 in reply to CalBear74]

TA, I am interested in your opinion on CalBear74's question also!

[Tall_Allen in reply to CalBear74]

The bulk of the side effects of castration (chemical or physical) are caused by reduced testosterone and will not disappear with orchiectomy. All the other medicines (e.g., Xtandi, Zytiga) work just as well with either. After orchiectomy, it's impossible to do intermittent ADT, although BAT is still possible.

[CalBear74 in reply to Tall_Allen]

TA,

Though it is not new, would Casodex/bicalutamide work with a physical castration to get the job done at a significantly lower cost? Any other lower cost drugs that are effective? I should add that I am still hormone sensitive after seven years? How does that alter a post-surgery regimen of chemicals, if at all?

[Tall_Allen in reply to CalBear74]

Yes, any anti-androgen (like Casodex, Xtandi, etc.) is complementary to castration.

[Magnus1964]

Even with an orchiectomy There will still be some testosterone produced by the pituitary gland. ADT drugs block the receptacles in cancer cell from receiving the testosterone. Each approaches this in a different way.

[Shooter1 in reply to Magnus1964]

On Xtandi since middle of chemo. No Lupron. PSA at 0.122 and steady. T was 7 at last check with DHT undetectable. So Megace 4 times a day and 86 mg average of Xtandi acct. all I can live with.

[CantChoose]

There's an ick factor. This is something my husband cannot even talk about.

[Shooter1 in reply to CantChoose]

Why not?? Very convenient and two jelly beans is a sack do no one any good. Mine are gone with no regrets.

[Kaliber in reply to Shooter1]

I'm on lupron - xtandi and mine are gone as well .... not much difference in that respect. T levels have been below detection ( less than 20 ) since I started xtandi - lupron. thats not all that has disappeared along with my new boobs that have appeared .... a yahay ahaya aha a PSA 1400 down to 0.2 and dropping in 6 months says it works in my case.

[CalBear74 in reply to Shooter1]

Kaliber,

After the surgery, how was the treatment regimen on the chemical side altered? What is added now that Lupron has become irrelevant? Why are you still on Lupron if there is very little to suppress? Are you saying your new boobs were a consequence of the surgery and not the chemicals? How much of your big PSA decline can you attribute to the surgery and not the drugs? How does the Xtandi work? Isn't it trying to suppress testosterone as the Lupron does?

I have just read your post below and am uncertain what "gone as well" means in the above post. I read it as a reference to surgical removal of testicles. If that hasn't happened, then much of what I ask above is not pertinent.

[Kaliber in reply to CalBear74]

I have chemical castration , not physical .... but ........ still my guys have disappeared up into my abdomen ( I guess , probably fighting for real estate with my baseball sized tumors ) nothing left there but some sack flesh ... nothing at all ( I used to be unusually large ... not bragging just say'in ) . so the fact that I have less than 20 T indicates castration the same as you expect with physical cutting. my guys are gone, my penis has almost retracted internally , nearly disappeared with little of it showing as well, and I have manboobs ... might be TMI ( too much information ) .... but it is what it is. no doubt others experience can be different .... like my doc says " everyone is different " when it comes to treatment outcomes. seems awful I guess but my enormous drop in PSA makes it all worth while for me ... at age 73 ... not all that big ( pun ) of a loss anyway ( sour grapes rationalization ..puns intended ) ay ahaya haay ahaya ayaah .

[CalBear74 in reply to Kaliber]

Kaliber,

Thank you for your frank response and the openness of your disclosures. Sorry about your wife's illness. Kaliber you and your wife will be in my evening prayers. God bless you both.

[Kaliber in reply to CalBear74]

" frank response " ?? .......... ayahay a ahaya ahah a yaha ayahay aha ah ( didja see this j-o-h-n ? ) we got this .... if life didn't have the bumps in the road it wouldn't be any fun. my wife is a tough ole bird . thank you.

[j-o-h-n in reply to CantChoose]

ick factor? more like the dick factor....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 05/08/2019 2:41 PM DST

[Kaliber in reply to j-o-h-n]

ya ah aya ahayaayahah a yaah ayahayaahayahaaha well thats for sure ..... ( read the above )

[Kaliber in reply to j-o-h-n]

btw; my wife of 42 years and caregiver tanked Monday 2 a.m. morning at kaiser with emergency surgery for a ruptured appendix. we are alone so needless to say this has caused all new challenges for her and myself to deal with. I'm unable to walk farther than 100 ft ... maybe ( 50 ??? ) .... ( xtandi shuffle ) and am heavily dependent on her and now I have become the caregiver .. roles reversed. the good news is that she is home now ... I'm scrambling to set up some home delivery food resources and other necessities ... man seems like when it rains it pours !!! she is expected to be OK in 2 to 4 weeks if her massive internal infection responds to antibiotics as expected. I had another Zometa infusion this morning and I know I'll be TOTALLY out of service ( Zometa is UGLY for me ) ... probably until this weekend or a couple days more. yikes .......

[j-o-h-n in reply to Kaliber]

Wow when you fall in it... you fall in it deep.... Hopefully the Mrs. recovers quickly...Keep plugging along and don't forget Sunday is mother's day...

Take care of yourself....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 05/08/2019 7:33 PM DST

[Kaliber in reply to j-o-h-n]

up to my armpits ay aha ya ay aha and ................. and ........... the 6th was MY birthday ay ahay ahay a ah a.

[GeorgesCalvez]

If it looks possible that you might go into complete remission after ADT and you are relatively young then it is worth keeping the testicles.

Even after three years of ADT some men will recover some testosterone and this has significant cardiac and bone density benefits, etc even if the libido does not return.

Obviously men that have eighteen months or two years have an even better chance of recovering some testosterone and this can contribute to a significantly better quality of life for them.

Most of the symptoms of surgical castration are the same as ADT but as many people have remarked there are differences in the detail between Lupron, Firmagon, etc, so surgical castration produces the hot flushes, etc but not some minor effects, and as with the drugs this varies from one man to another.

Obviously it is irreversible and if you do not like it you cannot change as with the drugs.

[Pierreb]

Hi. We asked our MO the same question. I believe she stated that they don't have to remove the testicles. They remove a small gland in/near the testicles which produce testosterone. I recall she said it's just as effective as Lupron but is not reversible.

[dadzone43 in reply to Pierreb]

not anatomically correct, I am afraid. The testosterone is produced within the testis itself.

[Kaliber]

I'm 73 years old and basically chemically castrated with lupron - xrtandi. I prefer to avoid surgery of any kind if possible but would do whatever it takes to keep the bugs at bay if I had to I guess. like someone else here mentioned the ick actor is large with this subject. my T level remains below 20 so far which is undetectable on the tests my onc doc uses. chemical castration has been very effective for me to this point 6 months into treatment. of course I'm covered by insurance and only pay $100usd for my xtandi but there in lies an issue with the lupron shots being billed at $1500 for 3 months and the xtandi is roughly $10,000 a month. as you said, for people that lack this kind of coverage, cost could be a driving factor in which path you choose. lupron - xtandi treatment has an enormous baggage associated with it in strong debilitating side effects for many ( most ? ) people including myself. it can be a seriously tough row to hoe most of the time and wears on me even more as time progresses. I suspect that surgical castration would avoid many of the side effects, I don't know tho and others more knowledgeable than myself say they are similar - the same.

[Break60]

Since I stopped Lupron and switched to estradiol I have much fewer side effects than I’d have with medical or physical castration

[Herman_PSA in reply to Break60]

Would you be so kind to explain or point to information/links/post that explains the reason/benefits to stopping Lupron shot and switching to estradiol patch or creams? Does the estradiol increase your PSA or T? Thanks Break60.

[Break60 in reply to Herman_PSA]

See attached:

ctu.mrc.ac.uk/media/1282/c-...

Estradiol does the same as Lupron : reduces T and PSA.

Bob

[Herman_PSA in reply to Break60]

Thanks for your reply and link. Just starting to go on a ADT Lupron vacation with a PSA of <0.10 and your post and some others about the estradiol patch/cream caught my eyes.

[j-o-h-n]

80 years old and you're thinking of snipping them? Watcha gonna scratch when you wake up in the morning? You need an operation like you need a kick in the balls....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 05/08/2019 2:46 PM DST

[Kaliber in reply to j-o-h-n]

yaayaahaha ayaya ay ahaya ya ay thank goodness you are around buddy. we need this to lighten up a lot and you are good at it.

[j-o-h-n in reply to Kaliber]

Thank you.... We all need more laughter.......

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 05/08/2019 7:52 PM DST

[j-o-h-n]

Why do Leprechauns laugh when they run?

Because the grass tickles their balls.....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 05/08/2019 7:54 PM DST

[JimVanHorn]

You still make Dihydro-testosterone in your adrenal medullas and it is more potent than testosterone. I had 72 radiations, 6 1/2 years of Lupron and now I have no cancer. I am 74 years old. I can still have a dry orgasm and scratch my nuts! I wish you well.