I am 58 and was diagnosed three years ago. I am currently still castrate sensitive and doing well. I have been on ADT injections (Zoladex) for 3 years with bicalutamide added for the last 6 months (PSA was rising very slowly and was approaching 1.0 in January). Current PSA is 0.08. Testosterone is <0.2 nmol/L. Latest bone scan says that my few bone mets are no longer visible.
I've been considering getting an orchiectomy. I don't like the side effects of ADT but I have become used to them and they don't bother me any more. I do not want an ADT holiday as I do not want to give the cancer any chance to grow. I have accepted that I will be on ADT for life. I think the chance of a complete cure that doesn't involve ADT is extremely unlikely in my lifetime; hopefully there will be great long term management like HIV.
Should I have an orchiectomy? I can't think of a good reason to keep the testicles. It would be nice not to have the injections any more. I have read, however, that a small amount of testosterone is produced in the adrenal glands. If I have an orchiectomy and stop the ADT injections, will there still be enough testosterone to help the cancer cells grow?
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MarkBC
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Your are doing quite well although the fact that you no longer can see bone mets doesn’t mean they aren’t still lurking around albeit smaller.
I am praying for an immunotherapy or mRNA based treatment that will really set this beast of a disease back for many years. So I am keeping my testicles.
You might do the same, or not.
The adrenal glands are a source of testosterone BTW so second line hormonals may be right for you.
Also if you aren’t controlling the hot flushes and sweats try venlafaxine.
Are the Zoladex and the bicalutamide that I am currently on stopping the production of testosterone in the adrenal glands? If not, then my current testosterone level of <0.2 nmol/L would indicate that there is very little testosterone coming from my adrenal glands. Is that correct?
Testosterone is not the only androgen produced by the adrenals. Zoladex does nothing to stop them.
In many parts of the world, orchiectomy is still the standard for ADT. Yes it's permanent, but so is the need for ADT for many of us.
Hormone suppression is still the best treatment for almost all advanced prostate cancer and it is also the oldest. Nothing has replaced it since 1941 so I think you are right that it's unlikely to happen. Wishing the best for you in your decision.
Yes, it's depressing. When I realized what was happening to me and that I was about to be treated with (then) a barbaric 75 year old technology that would make me feel this s*** every second of every day, I was infuriated.
I've been thinking of having the same done instead of the ADT Eligard in my case. I'm 62, been on Eligard for 17 months, and doing very well on it but I also believe I'll be on it for life. I think the SE's like hot flushes and fatigue will still go on after the orchiectomy but maybe the potential heart problems won't (I hope). I had 70% blockage in an artery and had a heart stent put in a little over a year ago. Like others have said the testosterone from the adrenal is a separate thing that our current ADT has nothing to do with. Good luck in making your decision, I'm a little scared to pull the trigger and make that decision.
Your BRAIN needs some 'T' to function - you can't stop all activity - but the remaining 'T' isn't going to feed the PCa significantly ....
I’m 57 and had the procedure done Dec. 2020. I too accepted that ADT will be for life, and if a cure came along in my lifetime, I could easily get testosterone injections or the roll on etc.
I donated my balls to the trash bin shortly after my advanced diagnosis (at age 57) vs the ADT shots for as long as it lasts. It's given me what I think is a great bar statement "The day I made executive I lost my balls!" It makes me chuckle at least.
I'm glad I did as it enabled insurance to cover my Provenge Immunotherapy which ain't cheap.
Regrets, none, though I do notice my penis misses the pillows it used to rest on while driving (in otherwords, I need to adjust his placement more often than ever).
you have the perfect excuse for playing with your little dick (or at least i assume yours is teensy now like mine) but i lost all interest in anything related to my dick other than peeing.
Hello, From a fellow Canuck. I am assuming BC refers to British Columbia. I too am on Zoladex. I have been for over eight years. Like others who have written before me, I see no significant advantage to having an orchiectomy. If your side effects are tolerable, stay the course. Your next move, should your PSA start climbing rapidly, would be to add a second tier drug like Xtandi (enzalutamide) or Zytiga (abiraterone). If you do live in BC feel free to contact me. I might be able to help you navigate through the protocols of the BC Cancer Agency. Hope that helps.
RyderLake2 wrote --- " ...Like others who have written before me, I see no significant advantage to having an orchiectomy... "
UNLIKE most others, I am an endurance bicyclist and am very pleased to be minus both of my ⚾ ⚾. Fastest 10 pounds of weight loss in my life!!! 🙂
Hey Mark! I’m 60 now and I did the orch four years ago and after 18 months of Lupron . I’m still on a pill form test drug adt( Tak-700) that stops adrenal production . For me it was stated shots for life . The side effects are the same . But I think that the cardio issues are lessened with the orch . Some guys would rather die . For me it was like trimming dead wood from a sick tree .
Mark, Have you considered using transdermal estradiol gel? Only SE is little boobies? I have been using it as mono-therapy for 39 months now with great results. Some of our comrades have been using it for 20 years and are still hormone sensitive.
I'm still trying to make the same decision. In my case I'm 74, so a little easier. I have already had a quad by-pass, the cardio is the major concern with me.
MarkBC, I can't tell you how many discussions of "whether or not to remove" I've been in and/or read! It's clear that there isn't a consensus--either among men with cancer, or among MOs--about one being a better choice than another. At 76, with a 99% likelihood that I'll be on Lupron for the rest of my life, I've already made an appointment to discuss the operation. I don't really mind the Lupron shots, and they don't cost me anything (thank you, Medicare!), but post-orchiectomy can't be any worse than the bother and SEs of 3-month shots, and based on anecdotal reports, it just might be better. Plus it avoids some of the SEs such as those mentioned here. My only reluctance if I were in YOUR shoes, is that your 20 years younger than I. Which means there is a much greater likelihood that some new treatment might emerge during your active years.
Thanks for your always informative post. I really sat up when I read your comment about spatial recognition. OMG! I have always been a fairly aggressive--and I think competent and safe--driver. But things have really gone woozie since I started Zytiga + prednisone 5 weeks ago! In the middle of the day, my visual perception has turned bizarre. If I look away from traffic to my instrument panel and then back, it's like my eyes/brain can't handle the adjustment. Feels like I'm stoned [I wish]. I even made an appt with my optometrist to see if anything weird is going on. Your comment makes me wonder if it might be the prednisone, though. I've been on Lupron for 3 1/2 years, so the only change 5 weeks ago was to eliminate the T from the adrenal, which isn't that much in comparison. Anyway, your message gives me much food for thought. Thanks again.
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