Orchiectomy vs ADT

[Wynnsts]

Orchiectomy, pro’s or cons? 6 years in 39 rad treatments to prostate bed 2 yrs ago, 5 big rads to 2 nymph’s and iliac bone combined with Eligard. Not fond of side effects but manageable. 74 years pretty good health other than this little PC issue! Thanks in advance for feedback!

[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...

[6357axbz in reply to Tall_Allen]

Great summary. Thanks TA

[Wynnsts in reply to Tall_Allen]

Thanks TA, great info. Would you have any recommendations for MO’s in the Suncoast region of Florida, or Florida as a whole. Always look forward to reading your replies!

[Tall_Allen in reply to Wynnsts]

No one comes to mind. I'm sure Moffit has several good ones.

[Wynnsts in reply to Tall_Allen]

Thank You!

[Wynnsts in reply to Tall_Allen]

I did forget to include the dates for the five doses of radiation, they were 3 months ago and at the time PSA was 5.1 up from 1.74 6 months prior. Follow up is mid October with more extensive blood work at that time.

[Hidden in reply to Tall_Allen]

Do you know if there is any data on how much T suppression occurs with an orchiectomy plus either abiraterone or enzalutamide?Seems like a CYP17 inhibitor might do a better job with an orchiectomy than an AR antagonist. Just a guess though.

[Tall_Allen in reply to Hidden]

Abiraterone suppresses T and other androgens from the adrenals and the tumors.

[Hidden in reply to Tall_Allen]

Assuming that I have an orchiectomy, do you think that this would provide more coverage than Xtandi (AR antagonist)?

[Tall_Allen in reply to Hidden]

You mean Xtandi as a monotherapy? It looked good in an early test but it hasn't been tested in a randomized comparison vs castration:

thelancet.com/journals/lano...

auajournals.org/doi/10.1016...

SOC is to give it with castration for mHSPC or non-mCRPC or mCRPC

[Hidden in reply to Tall_Allen]

My MO wanted me to take Zytiga instead of Xtandi. But that was when she thought that the estrogen-ADT that I was starting wouldn't make me castrate.

I need to ask her what her thoughts are about combining or not combining drugs if I am castrate.

[Shooter1]

Orchiectomy was right for me... no more Lupron for life... working on year 5.

[Wynnsts in reply to Shooter1]

How long ago did you have the orchiectomy? I like the “No” ADT for life!!!

[Shooter1 in reply to Wynnsts]

3 3/4 years ago. Snip/snip instead of 3rd Lupron shot. The first 2 had shrunk me up to where I had 2 jelly beans in my sack. At 67 I didn't need to saddle myself with Dr appt for life if I could get out of them.... 71 now and glad to have missed the last dozen shots.Life is Good with fewer Dr. appts.

[ctflatlander]

I had it done 6 months ago, age 77 3/4. I think +it has given me more energy and my PSA has creeped down from 1.1 to .7Went for my 3 month checkup yesterday and my MO doesn't have an explanation. Nothing else changed except stopping the Lupron. I should have had it done 4 yrs ago.

[Wynnsts in reply to ctflatlander]

Glad to hear it’s working well for you! I keep looking for the negative reply and I haven’t seen it and I’m happy for that and all that it has worked for!!

[addicted2cycling in reply to Wynnsts]

What's NEGATIVE to having an ORCHIECTOMY????

For myself it was the FIRST treatment procedure some 6 years ago WITH NO THOUGHTS given to ADT BECAUSE >>>

1st -- it resulted in the fastest 10 pound weight loss IN MY LIFE!!!!

2nd -- increased the enjoyment of 100+ mile bicycle rides tremendously

3rd -- have not had a problem hitting those HIGH NOTES when I sing

[Hidden in reply to addicted2cycling]

And bra shopping!

[6357axbz in reply to ctflatlander]

Does it keep your T levels as low as lupron did?

[ctflatlander in reply to 6357axbz]

My T has not waivered in 4 1/2 years, <7 then and now

[CSHobie]

I had the Orchie about a year ago, and not regretting it. Glad not to have the extra effects of Eligard shots, I do feel better now.

[jbskiatook]

I had Orchiectomy last December 2020 since my cancer went castrate resistant and I would have have to take the Lupron shot, which I have hated for the last 10 years, plus Extandi. I wish I had done it 5 or 6 years earlier as my life has been so much better to date. Yes I have a little weight problem (30 BMI) but working on that. After the Orchiectomy I had a Penile Prosthesis Implant which solve several other problems. Penile atrophy (shrinkage), impotence (not dependable) and a lowering of self-esteem over a period of time. Intimacy with my wife also suffered due to dependable problem. I did not realize how far this had affected me until after the PPI and now I have such a happier life and no shots. I thank God and my doctor for this!!!!

[Wynnsts in reply to jbskiatook]

Great to hear, I too have had the penile implant along with the AUS since my prostate removal 6 years ago. I have a follow up in October and this is heavy on my mind! Thanks for the reply!

[jbskiatook in reply to Wynnsts]

Actually it looks like to me you're done pretty darn good.. I'm 79 and Wish you the best.

[Wynnsts in reply to jbskiatook]

Thank you!

[jbskiatook]

I need to add that I had what is the best available implant which was the Boston Scientific AMS 700 LGX which several men in my prostate support group have also used.

[Spyder54 in reply to jbskiatook]

JBS,Thanks. This ADT induced shrinkage of genitallia is getting to me. I ask for privacy to shower. My wife is not used to this new found extreme modesty. Where did you have the PPI surgery? How tough was the recovery? Any urinary complcations?

Mike

[Frigataflyer in reply to Spyder54]

My penile shrinkage while on Lupron was quite extreme. So much so that it looked as if I were never circumcised. Now a year after orchiectomy, My penis longer, but not stronger.

[Wynnsts in reply to Spyder54]

Mike, I had the PPI at Tampa General and the urologist name is Justin Parker, he did a great job, this was February of this year. Recovery was more awkward than tough as the only pain medication I used was Tynol. Surgery is same day, in and out. I have no regrets. Many urologist discourage the surgery because they have no experience with it. I strongly suggest you find someone who has preformed many PPI procedures as you don’t need an apprentice down there. I’ve had no urinary problems with the implant!

[6357axbz in reply to Wynnsts]

What is PPI?

[Wynnsts in reply to 6357axbz]

Penile Prosthesis Implant, more commonly referred to as a Penile Implant. Technically the implant is considered a prosthesis just as an artificial leg or arm.

[Spyder54 in reply to Wynnsts]

Thanks. Im in St Pete. That works. I know another PCa guy that had his at U of Michigan. He said it all works very well.

Mike

[Wynnsts in reply to Spyder54]

Mike, I highly recommend Justin Parker and his office. He has literally done 100’s of the implants, he is really good! His partner, Lucas Wiegand did my AUS and both were recommendations from Moffitt. It does work quite well! I’m in Venice so it works well for me as well. Everyone in Venice are SOC docs. Best of luck in your journey!

[Frigataflyer]

My transition from Lupron to orchiectomy was seamless. I could have saved myself mucho dinero if I had had it from the start.

[j-o-h-n]

What has 16 balls and sings?.....Answer: A quartet.........

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 09/22/2021 5:30 PM DST

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

Thanks John, I always enjoy your humor!

[Shooter1 in reply to j-o-h-n]

Only if they don't have aPca and don't want to join the Vienna Boys Choir..

[j-o-h-n in reply to Shooter1]

close but no cigar...........

Think my man..... Think.......

(and it's not think or thwim)

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 09/24/2091 3:00 PM DST