orchiectomy Yes or No?

[Nirman]

My fasther is on 12 weekly triptorelin injections on last 4 years now abiraterone stopped working already started steroid switch few days ago, now doctor suggested for orchiectomy if somebody with knowledge shares goods and bads of orchiectomy or if continue with injection treatments?

[Tall_Allen]

In a retrospective study, compared with those treated with GnRH agonist (like Lupron), patients who received an orchiectomy had significantly lower risks of experiencing:

• any fractures (-23%)

• peripheral arterial disease (-35%), and

• cardiac-related complications (-26%) .

• no statistically significant difference for diabetes and cognitive disorders.

jamanetwork.com/journals/ja...

However, in a randomized clinical trial, fat accumulation was higher for orchiectomy :

bjui-journals.onlinelibrary...

Chemical castration may get testosterone levels lower:

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

[Proflac in reply to Tall_Allen]

Thanks. My husband has been considering orchy, since he will be on lifelong ADT and has no psychological or cosmetic objection. (Also currently on Zytiga). He is not concerned about the injections but has had MI possibly ADT related in the past and there seems to be some level of evidence of other potential negative effects of ADT other than the effects of low T per se. I've looked at the literature suggested in this and your other helpful contributions and it looks like a difficult call. There seem to be some advantages to orchy, but the last paper in the list (RCT) showing a less effective reduction in testosterone gives pause for thought? Do you think this is significant? There seem to be few RCTs in this area - I guess because orchy is less popular tx. these days. But is it crucial to keep testosterone as low as technically possible, or is there a 'low level' which is adequate to do the job. I think currently his T is 5.

[Tall_Allen in reply to Proflac]

Zytiga can be used to get testosterone levels lower if needed.

[CSHobie]

How old is your father?

I had the surgery, and I happy with my decision.

[Nirman in reply to CSHobie]

Well he’s 71 it’s been 4 years he’s diagnosed that time Gleason 8 stage 4 metastatic with several bone mets so we started 12 weekly triptorelin injections immediately and after two months added abiraterone with prednisone which worked very well like 3 and half years now psa is rising so we are exploring treatment options perhaps would go for lu177 Psma as it works well while being chemo naive so few days ago while meeting MO he suggested to get orchiectomy that’s why I posted here because I found this support group knows treatment and so knowledgeable people here I found MO is not that much updated he just doing good old gold standard protocols but he always welcome our suggestions

[Nirman in reply to CSHobie]

My Dad hasitent because he perhaps read somewhere few months back some disadvantages or side effects on hearth or some organs and he also asked me that undone chemical therapy in future but you can’t undone orchiectomy.

[CSHobie in reply to Nirman]

I am not an expert, but I doubt Orchiectomy will do anything more, than the injections already did.