Is There Still a Role for Bilateral Orchidectomy in ADT for Metastatic Prostate Cancer?

[pjoshea13]

Recent Egyption study [1] comparing physical castration to Degarelix [Firmagon].

(Degarelix is a GnRH [LHRH] antagonist. Traditional chemical castration drugs such as Lupron are GnRH receptor agonists.)

"Bilateral orchidectomy and degarelix showed comparable results for PSA reduction, but there was a statistically significantly lower castrate level of testosterone in the bilateral orchidectomy group. Using the EROTC QLQC-30, bilateral orchidectomy was associated with better HRQoL, better global health status, and better functional status."

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/320...

Arab J Urol

, 18 (1), 9-13 2019 Nov 13 eCollection 2020

Is There Still a Role for Bilateral Orchidectomy in Androgen-Deprivation Therapy for Metastatic Prostate Cancer?

Mohamed Adel Atta 1 , Ahmed Elabbady 1 , Wael Sameh 1 , Mohamed Sharafeldeen 1 , Mohamed Elsaqa 1

Affiliations expand

PMID: 32082628 PMCID: PMC7006720 DOI: 10.1080/2090598X.2019.1690270

Abstract

Objective: To compare bilateral orchidectomy, as the classical 'gold standard' androgen-deprivation therapy (ADT), and ADT using a luteinising hormone-releasing hormone (LHRH) antagonist (degarelix) for the treatment of metastatic prostate cancer regarding their short-term biochemical efficacy, testosterone castrate level, tolerability, and effect on health-related quality of life (HRQoL). Patients and methods: A total of 60 patients with newly diagnosed metastatic prostate cancer were managed by either bilateral orchidectomy or degarelix injection as ADT. Both groups were compared according to their prostate-specific antigen (PSA) nadir and testosterone level at the 6-month follow-up. HRQoL was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) after 12 months. Results: Bilateral orchidectomy and degarelix showed comparable results for PSA reduction, but there was a statistically significantly lower castrate level of testosterone in the bilateral orchidectomy group. Using the EROTC QLQC-30, bilateral orchidectomy was associated with better HRQoL, better global health status, and better functional status. Conclusion: Bilateral orchidectomy resulted in lower castrate levels of testosterone, which may be associated with better disease control, together with better HRQoL and general health status compared to LHRH antagonist (degarelix). These results indicate that we should consider revisiting bilateral orchidectomy as a valuable and effective treatment option for ADT. Abbreviations: ADT: androgen-deprivation therapy; EORTC (QLQ-C30): European Organisation for Research and Treatment of Cancer (Quality of Life Questionnaire-Core 30); HRQoL: health-related quality of life.

Keywords: LHRH antagonist; Prostate cancer; bilateral orchidectomy; health-related quality of life.

© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

[Shooter1]

Went with orchidectomy after chemo to get off 'Lupron for life' with Gleason 9/10 and mets,.

[pjoshea13 in reply to Shooter1]

Do you know how testosterone level was affected, if at all? How about quality of life, etc.

Thanks, -Patrick

[Shooter1 in reply to pjoshea13]

Two atrophied jelly beans in a bag with intermittent pain. Told by drs 'Lupron for life'. Rp so no sex. T went from 7 to undetectable, so not much change there. Quality of life didn't improve until Xtandi was cut.

[Hidden in reply to Shooter1]

I agree it’s the pill rather than the lupron that makes life so miserable. Mine was Zytiga. I stopped Zytiga on Jan 27 2020 and the 6 month lupron shots time was up end of feb 2020. One month in after stopping Zytiga I feel a lot more alive. May be short lived but I’m enjoying it and hope I continue to wake up.

[addicted2cycling in reply to Shooter1]

Went with orchiectomy IMMEDIATELY after being told diagnosis and before anything else was considered. Stopped the urologist before he could finish telling me about "his plans for my treatment."

Discussion was like >>>

Uro -- Are you sure?

Me-- YES!!!

Uro--OK, I'll schedule the pre-op now and see you tomorrow afternoon. for removal.

Me--GREAT!!! ONLY after orchie did I decide on Cryo for my GL10 and coming up on 5 years would do it all over again.

[Hidden in reply to addicted2cycling]

Go orch!!! We the few in this exclusive club! We’ve got nothing to lose , except the dreaded APC . Off with the juevos was my best call on this bon voyage! No regrets .

[Currumpaw in reply to addicted2cycling]

Hey addicted2cycling!

If I am ever on the street, confronted with a bad situation, I want someone like you beside me! No hesitation, just do it!

Currumpaw

[Hidden in reply to Shooter1]

I did the same shooter. I used to be a shot caller big baller . That’s a distant memory now . Se la ve los cajones . Best move that I made .. I’m happy that you love your new northern home. That’s awesome .There is more than potatoes in Idaho ! Like wide open spaces and few people . Nice ! 🥔

[cesces]

My objection is that this is a one way trip.

You can't alternate back and forth.

And eventually the cancer adapts to low testosterone anyway.

[Hidden in reply to cesces]

We shall see . But you’re right . No going back on that one. My balls were castrated already chemically . Painful and tiny . No more of that , I trimmed the dead wood . No more pain ... sleek and svelte .hahaha😂😂 I looked at it like I’d do just about anything to hang out a little longer with my sweet wife .. eventually c or something else will get us all. Nobody is getting out of here alive. Live for today !🌵🕊

[Magnus1964]

I had my orchiectomy back when there weren't as many other options. I think I have done quite well.

[Hidden in reply to Magnus1964]

Hell yes you have . ! If you were born in 64 ? I’ve got 3 yrs on you ? I’m 1961...either way , kids from the 60’s just trying to survive .🏋🏻🕊

[addicted2cycling in reply to Hidden]

1950 birth, 1978 free from sperm (vas. snipped), 2015 free from this endurance bicyclist's biggest discomfort(orchi-AWAY)

[Hidden in reply to addicted2cycling]

We be the svelte crews.. streamlined edition. To think of all of those years protecting the family jewels ? Now when I climb over a bobed wire fence I have to fear... Go ahead ! Kick me in the balls. I feel nothing . Life was more precious to me than balls . Each to their own ! Peace and keep biking and loving what you love .🚴🏿‍♂️🚴🚴‍♀️

[addicted2cycling in reply to Hidden]

I've crashed a number of times while riding with the worst in 2011 resulting in a little broken neck and clavicle plus nerve damage and got back on the steed ASAP. (after 16 weeks in a neck brace 24/7 but that was a whole lot better than a HALO, so I got away easy). Enjoyable 127 mile ride last Sunday feeling fine with the "BOYS" gone with riding till the PCa or a truck gets me. ;0) It's either ALL-IN or ALL-OUT and not gonna whither away like testicles from ADT.

[Hidden in reply to addicted2cycling]

I like your style! Just watch out for the semis .. I’ve never been able to ride a bike 127 miles. In this you are a super human . With APC and still rolling you’re a damed sensation . Andele!

[monte1111 in reply to Hidden]

I have a hard time driving a car 127 miles.

[Hidden in reply to monte1111]

I’ve driven over a million miles . I can drive 127 with my eyes closed. Haha😂

[monte1111 in reply to Hidden]

Woke up once headed for a telephone pole. Hit the brakes so hard the hood flew up and the brakes went out. Couldn't see, couldn't stop. Talk about crisis management. Ahh, the good ole days of $50 cars. Just follow the black oil road. Thing leaked like a sieve.

[j-o-h-n in reply to monte1111]

Next time fill it with gas.....that'll help........

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 02/24/2020 7:11 PM EST

[monte1111 in reply to j-o-h-n]

$2.00 would give me car gas and beer for the night. We had a helium canister one night. We all sounded like Donald Duck. It was hysterical. Maybe had long term issues? Like Pca or flat lips. Think most of us would say it was a wonder we lived through those days. This is gravy time for me. Need to go find some potatoes. Damn, it's a long drive to Idaho.

[j-o-h-n in reply to monte1111]

"It was hysterical." That's the kind of laughter I love.... crying with laughter....Sure is a long drive for spuds...

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 02/24/2020 8:44 PM EST

[Frigataflyer in reply to Hidden]

It worked well for Theon Greyjoy.

[Magnus1964 in reply to Hidden]

1964 is my high school graduation year. I think the orchiectomy was the beginning of a long list of monotherapies.

[Hidden in reply to Magnus1964]

Congrats on 64.. The orch was soley my idea. Wife agreed . She doesn’t like the shots. Neither did I. Take care

[timotur]

Is there a case for unilateral orchiectomy when one comes off ADT? My T was very high pre-DX (~1200), and wonder if it makes sense to have one of the jewels chopped to get T in the normal range after stopping ADT?

[Hidden in reply to timotur]

One? I don’t know? Sounds half assed to me . Why not do both? They’re running a special ( two for one) ? 😂✌️

[timotur in reply to Hidden]

I figure if I just had one cajon, my T would be in the normal range (1/2 x 1200) = 600. The question would be— right or left? Probably the one that hangs lower? But maybe should just wait to see if T recovers after ADT.

[Hidden in reply to timotur]

Do both or none at all , is my suggestion . What good is one ball? Are You trying to have kids? Wait , maybe your t recovers and all is good . I don’t even dream of t returning . Ain’t going to happen . Be well and follow your own needs. Peace ✌️

[bitittle in reply to timotur]

Three days after my RP still in hotel pain was so bad in right testicle I could not stand. Paramedics wheeled me into emergency room. Emergency room Dr did ultrasound and determined no blood flow to right testicle. An artery feeding the testicle was inadvertently cut during RP. The testicle had to be removed. At 55 with only left testicle my T is around 300. I have no idea what T was before I lost one of the boys. I have always been very active, running, biking, weightlifting etc.

[noahware]

To see this study as objectively scientific, one would have to view the the EROTC QLQC-30 as objectively scientific. I have my doubts about the ability to objectively measure and compare subjective valuations. One would actually have to control for the variation of mindsets (optimistic men? pessimistic men?) in how men judge quality of life. This is of course impossible with a small sample of dozens. I would think you would need THOUSANDS of men for these variations to average out.

Even if such were possible, a perfectly reasonable explanation for a statistically significant favoring of physical castration would be the simple fact of its ability to bring a feeling of a less ambiguous future. One no longer has the option of getting cold feet, of changing doses or abandoning the treatment. The die is cast: you now have no balls, and never will. One less thing to worry about.

I also wonder, where and when was bilateral orchidectomy ever really ruled out as a potentially valuable and effective treatment option for ADT? It just happens to be a treatment option that many reject on the grounds of : 1) its complete irreversibility, and 2) its psychological impact to manhood status.

[addicted2cycling in reply to noahware]

My "manhood status" WAS ALWAYS AND STILL IS located between my ears, not my thighs.

[Hidden in reply to addicted2cycling]

What has happened to the heart and soul of a man ? This makes a man !

[Hidden in reply to addicted2cycling]

I was taught a lesson about who is in charge of this world by this disease And , It ain’t me ? I’m here by the grace of God . I am no more important than a grain of sand to this world . Love those close to us and love life itself . Or there is not point in it all. Each day not in brutal

Misery should be spent in appreciation . May God have mercy to our families in suffering . For us on cruise control . Make the most of our limited time here on earth . There aren’t any retakes . Live it up boys and girls while you can ! 🏄🏼‍♀️🚣‍♀️🚴‍♀️ Just to it !

[Hidden in reply to addicted2cycling]

I went from the macho to the effeminate... had to shed the past and it’s baggage . For me, That included Dem balls , Now I’m like Dorris Day “ Que Sera Sera! Macho is the young mans field . Mine is survival

[addicted2cycling in reply to Hidden]

After castration I became very aware of what my wife had been experiencing all of her matured years and wound up apologizing for any wrong doings I might have unknowingly done. I ALSO seem to have some PINK DAYS of my own and take them in stride.

[Hidden in reply to addicted2cycling]

Is it too late to say I’m sorry ? 😂 I was a mean bitch when I thought myself dead . Turned into my crazy mother screaming and yelling for no reason at all . I owe my wife my life . Everything in her name now. I don’t even have a bank account . No need . She’s in charge . With my advice she won’t be in poverty any time soon . We’re limping along on a tiny income . But no debt. I’m more concerned about being spiritually ok . Don’t want go out in anger .

[addicted2cycling in reply to Hidden]

We're married 47 years this June. Both of us had jobs when we married and I told her --- "Any money you make is yours and any money I make IS YOURS." NEVER had arguments about $$$$ like soooo many married couples.

[Hidden in reply to addicted2cycling]

Sounds like a solid pact . 😂

[Hidden in reply to addicted2cycling]

My wife and I are in menopause at the same time. She’s coming out of it now. Hurray ! I’m a lifer ! Whoohoo! The joy! I’m born again . This time female . 🤣

[monte1111 in reply to Hidden]

Dem balls? Lets not get political. And half of them don't have balls to begin with.

[Hidden in reply to monte1111]

😂

[noahware in reply to addicted2cycling]

Yeah, but not all men feel/think this way. And unfortunately, not all women do, either.

The literature contains references to men killing themselves (and threatening to kill doctors) due not to despair or physical pain from disease, but due to the impact on the psyche of castration. It's a real thing.

[Hidden in reply to noahware]

Threatening doctors? Why didn’t I think of that . ? I praise them working on me . My Hope is to never need their hands again . Reality is , we are stuck in the machine. I was castrated chemically before surgically .

[noahware in reply to Hidden]

Ha, "stuck in the machine" is a perfect phrase. From the moment I was even PRE-diagnosed (via DRE and PSA) it was evident that the inertia of the insurance-medical-industrial-complex would try to direct my path of treatment.

After removing his finger from me, the second thing my urologist said to me (after, "yup, that's a tumor") was, "well, you don't OFFICIALLY have prostate cancer until we first do a biopsy."

He didn't bother to tell me about any risks involved in that procedure, but only that insurance can't cover treatment of that which obviously exists until a very expensive procedure FIRST confirms the obvious.

[Hidden in reply to noahware]

I went into k failure waiting for a biopsy . The uro put his finger in and said” you’ve got a GIANT! Prostate!”i said ” I don’t have insurance” he said “ better get some” so I did prior to k failure. Blue cross spent $800 k on me the first two years . Thanks Bcbs ! I didn’t need to ,be told , nor did he tell me that I had pc . It was obvious . Welcome to the club. As the pretty young tech told me as she inserted my first foley” welcome to the golden years”! My girlfriend and I cry Ed for two werks. Then I asked her to

Marry me . She said yes . Tubes and all. I owe her everything .Only her love pulled me through the hell . Take care .

[TJGuy in reply to addicted2cycling]

addicted2cycing

How do you adapt to the loss of testosterone and the resulting loss of muscular power and stamina necessary for cycling, especially at the distances you ride?

I would àssume this would affect your ability to ride as fast and strongly as before, yet you ride long distances?

Do you use any testosterone injections to provide just enough testosterone or something else to enable your performance?

[addicted2cycling in reply to TJGuy]

TJGuy, performance decline was predictable following the orchi. and I accepted it while doing my best to continue as if nothing changed. Upon completion of initial treatments my doc prescribed bi-weekly Cypionate injections allowing recovery from exercise. Decline continues but at a much slower rate.

[Hidden in reply to noahware]

Impact is the same as extended adt use . Castration either way .

[noahware in reply to Hidden]

Yeah, except for the reversability... no going back and "un-castrating" in the real deal.

[Hidden in reply to noahware]

True..I don’t have that dream

..

[Zetabow]

I went for Subcapsular orchiectomy in Nov, there is no chance for me to every have an ADT holiday as It's too aggressive. I had brutal hot flashes (20 a day) I'm down to about 8 on average, with a couple where I might have to change clothes.

MO said for my current progression he felt Subcapsular orchiectomy would give me a better chance of survival and maybe reduce the hot flushes, I trust his judgement and went for it.

[Hidden in reply to Zetabow]

Right on . Heal yourself ! It took 53 years for my chemistry to get screwed up . I figure I had to make changes now. . Be well Zetabow ! Keep rockin! ✌️

[TFBUNDY]

Oh bloody hell. La la la la la la la..... Don't tell me any more..... La la la la la la la....

[monte1111 in reply to TFBUNDY]

Funny funny funny funny funny funny funny....

[Kaliber in reply to TFBUNDY]

I hear that brother ....la la la la la la ....hummmmmde dummm, .... la la la ... oh bloody he’ll isn’t all .... OMG put those damn scissors down . Yayahahahaya yay owwwwwww...nooooooooooooo

😱😱😱😱😱😱

[GeorgesCalvez]

Given the role of FSH in promoting prostate cancer you can have your nuts snipped off and still have to go back on the Degarelix!

Have a look at this poor soul;

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

[Hidden in reply to GeorgesCalvez]

Whatever! Doesn’t help anyone that’s had an orchiectomy already . Se la ve .

[MateoBeach]

Well what is of most interest here is the enthusiasm for those in this forum who have had (chosen) orchidectomy. Are there none who have regretted it? Though that may be a difficult place to go as one must live with it. Anyone?

That also shows the weakness of this "study". Of course it is necessarily self-selected and/or biased by the advising and operating surgeon. And surely there must be differences in personality and life-view between those choosing the permanent vs. medical reversible route. So those rather small differences in the chart showing their QOL scales do not impress me. And why do they not report the range and mean levels of the PSA and T levels between the groups and their statistical significance (or lack thereof)? This study does not cut muster as presented.

But the range of reactions to it here is indeed very interesting.

[MateoBeach]

And note that "cutting mustard" is not the same as "cutting orchids". There is a vas deferens.

[pjoshea13 in reply to MateoBeach]

LOL

-Patrick

[monte1111 in reply to MateoBeach]

Tou che.

[Kaliber in reply to MateoBeach]

No one is gonna cut my wilted flowers .... yayahahahaya ewwwwwwwww

[Hidden]

I’m happily cut ... no signs of PC thank God!🕊

[Kaliber in reply to Hidden]

😱😱😱😱😱😱😱😱😱😱😱

[Cheerr]

Thanks for the info.

Dad has to be on permanent ADT and has been given the option to do a orchidectomy. When I asked what’s better?, the doctor said both were equally effective and it was totally a personal choice.

Is it wise for us to consider orchidectomy then?

One wouldn’t want to miss out on better long term results

[pjoshea13 in reply to Cheerr]

Dr. Myers once said that one aim of a durable remission is the restoration of normal testosterone [T] levels. Unfortunately, for most advanced PCa cases, a durable remission never occurs. Most of us have lower expectations - long-term management.

Orchidectomy has advantages & if a durable remission occurs, T can be restored. In any case, for men on long-term ADT, T rarely recovers to normal-high, & supplemental T might be required.

-Patrick