Any Cons to Orchiectomy?: Currently on... - Advanced Prostate...

Advanced Prostate Cancer

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Any Cons to Orchiectomy?

33Ford profile image

Currently on Eligard & Zytiga and strongly considering an Orchiectomy. Is there any benefit to Eligard over surgery and testicle removal? I understand all of the psychological aspects, I'm interested in any treatment advantage between long term LHRH agonists vs testicle removal. My Gleason scores were 5+4 & 5+5 and metastasized into the Lymph glands outside the pelvic area. No detected bone involvement yet. I am also Diabetic and have Heart issues, so some of the concern between the two.

60 Replies

If you decide for an intermittend ADT therapy you will not be able to do that after Orchiectomy. Also, when the results of the Embark trial are published, you may not need ADT with Xtandi any more. One of our forum members currently takes Nubeqa without ADT. Saves a lot of side effects.

In my humble opinion, each case is different and treatment has to be tailored to the stage and aggressiveness of the disease. In my case, in the span of 4 years since diagnosis I have done a Radical Prostectomy, Radiation, ADT, Erleada, Taxotere, Provenge, Xtandi, and at that point my PSA was doubling every 3 weeks and my Oncologist said I'll never be off the ADT. So I made the decision last November to get an Orchiectomy and it was a breeze...no real problems at all. Now I'm on my 10th dose of Jevtana and fortunately I'm responding well.

33Ford profile image
33Ford in reply to CRK2

Sorta the path I'm on. I'm not a fan of the injections and for some reason my testicles are very sensitive, not painful really, just uncomfortable. I live a very happy existence and enjoy my life, the cancer is what it is and I try and make the best of it. But, it is not going to get better. Like someone posted the other day, your on a river headed for the waterfall. I think I define QOL very differently than what other do, and not taking the Eligard injections would increase my QOL as would the removal of my uncomfortable testicles! Can not see being off of ADT in my future. And, one of the biggest drivers in my life is my great granddaughter. We take care of her a great deal of the time, she is currently 9. Me passing a way would be a crushing blow to her, and she doesn't deserve that at a young age. So my goal is 10 year, that would get her out of high school. 10 years might not be realistic, but it is my goal and I am doing everything in my power to achieve it! Diet, exercise, mental state, etc. So want to be sure an Orchiectomy supports that goal!

Lulu700 profile image
Lulu700 in reply to 33Ford

I did 18 months of Lupron .I did the orch sept 1 2017. Mine were shrunken to nothing and a bit painful . I dropped the Lupron . You will still have the side effects of no t . I’ve had 3 t now for over six years. It’s depleting. I’m thinking of trying e-2 myself soon if possible? TMI , but I have night wood like a teen every night . Although my penis shrank in half . You can get wood without nuts. Not that it translates into sex . For me it doesn’t. . My sexy wife has no attraction for my broken form. 3 T means no libido meaning you won’t even ever think about sex again . That’s a distant good memory only. At least , this has been my experience . An orch is a realistic affirmation of your will to live . For me it is just that . No more. I’m still here after most thought I wouldn’t be . Take care .

33Ford profile image
33Ford in reply to Lulu700

Hear yeah!

ronronHU profile image
ronronHU in reply to Lulu700

Scott,

I still have mine; however, they might as well not be there since I consider them just 'useless weight on the dragstrip'!

Lulu700 profile image
Lulu700 in reply to ronronHU

That’s was me too RonRon . Mine were painful and shrunken. From adt already . Now I’m svelt like gazelle .😳

ronronHU profile image
ronronHU in reply to Lulu700

The gel hasn't had any effect on my nuts other than to make them useless!

Lulu700 profile image
Lulu700 in reply to ronronHU

Helping the other SD’s is worth it though

Is there any benefit to Eligard over surgery and testicle removal? If anything, it's probably the opposite, in terms both of cost/convenience and health impacts. But as mentioned, the surgery is permanent and means "ADT for life." (Even so, one could always add back some T or E2 by injection or patch/gel.)

33Ford profile image
33Ford in reply to noahware

That's about sums up my current thinking.

CRK2 wrote -- " In my humble opinion, each case is different and treatment has to be tailored to the stage and aggressiveness of the disease ... "

Orchi in 2015 immediately upon diagnosis. NEVER considered anything other than life forever without *T* so continued to exercise and eat healthy. Side effects as to be expected with most noticeable the loss of muscle mass/strength/endurance. Treating Dr. had other thoughts and said when treatment completed that he would get me on *T* injections. At the time I was only GL10 with no mets. seen on scans.

noahware wrote --- " (Even so, one could always add back some T or E2 by injection or patch/gel.) "

Almost 1 year after orchi. AND treatment had been completed my Dr. got me on biweekly Cypionate injections(Jan. 2016) and have continued with latest one last Tuesday and next one next Tuesday. Muscle mass/strength/allowed endurance has continued but slowed. NO *T* BOOST noticed after injection even thought numbers rise to 1,600ng/dL.

QoL IS PARAMOUNT to me and wife of 48 years is totally on board even though death could very well be hastened.

Quotes by Dr. George Sheehan -- Cardiologist, World Record holder in running, dx with prostate cancer in 1986 already spread to his bones and died four days short of his 75th birthday on November 1, 1993 due to it ---

​“We are each an experiment of one.

A unique, never-to-be repeated event.”

“Don't be concerned if running or exercise will add years to your life, be concerned with adding life to your years.”

^^^ from --- georgesheehan.com/bio

Here here ! 👏🏼👏🏼👏🏼👏🏼👍

If the lymph nodes are distant, you will have to be on lifelong ADT anyway, so there is some advantages of chemical castration, but mostly orchiectomy has more advantages.

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...

33Ford profile image
33Ford in reply to Tall_Allen

The lymph nodes are just below the rib cage area. But, these are just the ones that are currently delectable, I'm sure there are more involved that are below the current MRI / CAT detection level. So far bone scans look good. Would love to get a PSMA scan in the future, however my current PSA levels are too low on the Zitiga.

One con is if you stop adt your T won’t come back without injections.

33Ford profile image
33Ford in reply to Lulu700

Don't see stopping ADT in my future, other than a holiday, which I'm not a fan of anyway

Lulu700 profile image
Lulu700 in reply to 33Ford

I was told shots for life myself . I hated the shots. I’m still on a pill form adt halting adrenal production still.

33Ford profile image
33Ford in reply to Lulu700

Yep, Zytiga for me, so far.

Lulu700 profile image
Lulu700 in reply to 33Ford

I believe that it had a similar function of halting adrenal production of t . Same as the the drug i take? Good luck brother .

33Ford profile image
33Ford in reply to Lulu700

Yeah, don't expect much improvement there, but exercise does seem to help, a LOT! Too bad I'm not a fan, but I can do what I have to do.

Lulu700 profile image
Lulu700 in reply to 33Ford

Do you have a 33 Ford?

33Ford profile image
33Ford in reply to Lulu700

Working on a 50s style Hot Rod for my son, 5w coupe with a flathead and QC rear axle. I have a lot of cars, LOL. One I am wanting to get finished up is my 38 2dr std. I also have a 65 Comet Cyclone I am working on for my son (he has the money!). 460 in it. I also have two 5.0 Focus conversions I am working on. So much work, so little time! 😊

Gearhead profile image
Gearhead in reply to 33Ford

Great choice re flathead rather than now-in-everything LS, and original torque tube drive train with QC banjo! '39 or similar Ford transmission?

Seebs9 profile image
Seebs9 in reply to 33Ford

My nephew has a 38 standard 'Buslteback'. I am the chief consultant, it is fun.

33Ford profile image
33Ford in reply to Seebs9

Love that body style!

If you have serious side effects with Lupron or other LHRH then the orchiectomy would be an option.

33Ford profile image
33Ford in reply to Magnus1964

My main side effect is major fatigue and not sure the surgery will solve that.

Lulu700 profile image
Lulu700 in reply to 33Ford

This is a side effect of no t .. it’s the fuel we feed on normally .

Magnus1964 profile image
Magnus1964 in reply to 33Ford

It might. If your not taking Lupron the fatigue should not be a problem.

Have an appt with a surgical oncologist on the 7th (the appt is related to a pancreatic issue), I'll see what his input is on the subject. My oncologist is somewhat neutral, but seems to lean in favor of ADT. But then he makes more money on ADT, so not sure how bias he is, LOL.

Blueslover profile image
Blueslover in reply to 33Ford

Have wondered from time to time if the Dr's income is a factor. Certainly hope not!

I also have some concern about memory lapses - is it mental grogginess due to Lupron and Daralutamide, or due to the fact that I'm 77!! Exercise as much as possible, but feel great most of the time.

Like this discussion as my situation is very similar. My oncologist advised against castration. Following....

Hugh

33Ford profile image
33Ford in reply to Blueslover

Not sure it is deliberate bias, but a surgeon leans toward surgery, that's what they know best. Likewise a radiologist would lean toward radiation therapy & an oncologist toward meds. It is their training and knowledge area. If there is an obvious advantage of one treatment over another I would think any professional would go in that direction, but when it becomes a little less distinct I would think they would fall back on their field of expertise. I like my oncologist (or I would switch), but still believe his first instinct is his standard protocol. But, if I discuss/bring up other options, he lessons and often agrees on that approach. Think we need to go into our appointments with questions and data to back them up. Then you can have a discussion with them. I find my providers seem to like me taking an active approach, as long as it's not something totally off the wal, LOL.

He would be the one to ask . Who cares what they . They’re helping to save you . Do what is best for you . There is Not a more personal decision to be made ..

33Ford profile image
33Ford in reply to Lulu700

Oh for sure, I think I had already made up my mind before I posted. Just curious if I was over looking anything important.

Lulu700 profile image
Lulu700 in reply to 33Ford

I was 56 when i did it . I went trough some self loathing im no good thinking for a few months afterwards .. all in all I’m glad I did it .

33Ford profile image
33Ford in reply to Lulu700

73, so a little farther along, LOL.

Lulu700 profile image
Lulu700 in reply to 33Ford

I’m Not speaking selfishly but it should be easier at your age . I was a macho fuck so I suffered some “ I’m not worthy as a man to walk the earth anymore” but after 3 months the dark clouds lifted . You be a bit hit for a month or so . Then no more worries about dem balls . They are an afterthought to me now . I have friends that told me they’d rather du3 than chop the boys . Mine were do so already . Like trimming dead wood or mistletoe from a tree .. good luck sir ,you didn’t hear any of this from me ? I plead the fifth ! 😎✌️😳

5 window coupe ? Awesome ..I love old cars ..

I had an appointment with my urologist last month to ask his advice on having an orchiectomy. He advised me not to. I am responding well to ADT injections and am still castrate sensitive after 3 years. He said that I shouldn't make a permanent decision like that because we can't predict what future treatment may look like. He also said that there is always a potential risk of complications when doing surgery. If I don't mind the injections, I should just continue with them.

33Ford profile image
33Ford in reply to MarkBC

I get the same type of response, but don't seem to get a straight answer (at least in my mind) which approach has the best long term outcome. One of my major concerns is longterm SE of ADT meds on my heart, etc.

MarkBC profile image
MarkBC in reply to 33Ford

I asked my urologist about that. He said that the science was not definitive about whether surgery or injections are better. He also said that the new ADT pills may be an option once they are approved here in Canada. He said orchiectomies are more commonly done in other countries or for remote patients who have difficulty getting the injections. He hadn't recommended an orchiectomy for three years. He said that, if I don't mind the injections, I should just keep with them.

Lulu700 profile image
Lulu700 in reply to MarkBC

Follow you confidence is a knowing Dr. My uro almost killed me by letting me fall into k failure awaiting a biopsy . When he chopped the boys 2 yrs later he bragged to his surgeon cohorts pre op . “ This guy, does not want to come see me for shots for the rest of his life . “! They all nodded in accordance . That’s the last time I saw a uro . Thank God! 4 yrs ago..😳For me at 55 ,I wanted to live and not with shots for life . We are all a project of one . What works for me might kill the next guy . Good that your doing well . Keep rolling . 👏👏✌️Best wishes to BC !

I've been thinking about getting an orchiectomy as well. I had several mets on the pelvis bone and one lymph node, so I think I will be on ADT for life. When I ask my urologist his thoughts on an orchiectomy he responded similar to what MarkBC posted '.. I am responding well to ADT injections and I shouldn't make a permanent decision like that because we can't predict what future treatment may look like'. But deep down I know it going to be for life. I had a heart stent put in last year because of a 70% blockage in an artery; it was right around the same time I got diagnosed so the heart problem was not because of ADT. But because I know ADT (I'm on Eligard) can accelerate heart issues I think about the orchiectomy. I just don't know if I have the balls to go through with it. 🙃. Good luck in your decision.

33Ford profile image
33Ford in reply to Atlpapa

I'm diabetic and had a quad bypass several years back. 98% blockage in one artery. I like to be positive, but! Don't think things are going to get better. Like I posted earlier, I have a 10 year goal and working hard to get there!!! My A1c was in the low 7s, got it gown to 6.4 and last test was 5.3! Same with LDL, down to 46. So working on it. I've been talking to my MO about this from day one. Bring it up every visit. Like the guy, but think he is just geared towards the injections. Never get an answer as to which provides the best long term outcome.

I'm 77 1/2, gleason 4+4. mets to the bone. I was on lupron for 4 1/2 yrs before I had it done in April 2021. No regrets. Still on Zytiga and stay busy biking, sawmill, gardening, skiing, gym 2 times a week and tinker on old ford tractors. My 37 Ford in the pic is all original, deluxe model, won many awards. Still have the 85hp flathead in it. I went through the trans many years ago and should have put 39 gears in it at the time. Still would like to pull it again for 39 gears and face the flywheel while I'm at it. Good luck on your decision. Bob in northern VT.

33Ford profile image
33Ford in reply to ctflatlander

Love the old Fords! I have an 8N as well.

ctflatlander profile image
ctflatlander in reply to 33Ford

I have 2 working Ford N's. A 1944 2N with aarps tracks that I use in the winter for hauling maple sap, great in the snow. A 1952 8N with a Wagner loader and a Sherman backhoe. Both run great but not show pieces.

Not that I have found. Had PPI surgery also so my relationship with my wife improved. I found memories of past and romancy did the trick. I do not miss the shots.

33Ford profile image
33Ford in reply to jbskiatook

LOL, good approach!

Had an implant years ago too. Unfortunately wife not interested as she was in pain. She now has had a very successful hip replacement.Who knows what might happen next?

I went straight for the Orchiectomy. No second thoughts. I didn’t want the side effects and possible interaction problems of chemical castration should I need Zytiga/Prednisone later (which I did).

33Ford profile image
33Ford in reply to FourString

Thanks for the input. That was my first approach, but kept getting talked out of it! Sure moving more in that direction.

FourString profile image
FourString in reply to 33Ford

I don’t know about anywhere else, but here in the U.S., the doctors with whom I discuss my procedure (bilateral orchiectomy) tend to take it personally. I’m using the estradiol patches so I don’t become a jellyfish.

33Ford profile image
33Ford in reply to FourString

It does seem that way, LOL.

One consideration I would have is the possibility of some radical new treatment that obviates the need for ADT. Both my MOs say that such a development is extremely unlikely in the foreseeable future, but I'm not completely convinced. The future always looks like the past until it looks like something entirely different.

My main MO recommends against orchiectomy for me personally, because she knows how depressed and angry I was on ADT, and she's afraid surgery would put me over the edge. I guess everyone has is own psychological reaction to the concept.

When I need to get back on ADT, I'll be using high-dose transdermal estradiol (tE2), as it reportedly carries a far more tolerable array of SEs.

33Ford profile image
33Ford in reply to Horse12888

I'm happy and mellow on the ADT, so no issue there. More concerned about the long-term.

You can always use your balls as hood ornaments....(as is or chrome plated).

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 09/03/2021 7:28 PM DST

MINE are hanging down from the REESE Tow Hitch and I had to install a "LIFT KIT with AIR SHOCKS" so the back bumper didn't drag on the ground.

I bet there was many a time when you loved to hear the sound of your balls bouncing and dragging against her back bumper....(and that was without hearing aids)....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 09/04/2021 12:17 AM DST

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