Considering Orchiectomy: New here... - Advanced Prostate...

Advanced Prostate Cancer

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Considering Orchiectomy

RockinSidney profile image

New here (except I am 79). Very little knowledge of where I am or where I am going. Began PC journey with PSA 139, Gleeson 9 on 8 of the samples and 8 or 7 on the other 4. Metastisized to 4 locations in bones. Began Firmagon and Erleada. 3 months later PSA .14, Testosterone 4.7. Considering orchiectomy. From what little I have read it seems to offer a little more in terms of length and quality of life and may be a little less expensive. Would like thoughts from you all.

30 Replies

IMO...You do not need Orchiectomy. Why ? Because your T is going down to super low level which is good sign. So meds are achieving what needs to be achieved as for T level.Once you get testicles removed, you loose any chance of doing Intermittent ADT in the future. Medically, I do not see any advantage of Orchiectomy . The surgery has its own potential risks. The only advantage is that you might save some money.

An orchiectomy would not be indicated. You might consider Xofigo for your bone mets.

I had an orchiectomy and it will be three years this coming April. I had a few shots of Lupron before that and those shots hurt, and I could feel the lump of paste in my butt cheek. I don’t regret getting it done. It’s saved me several days of the time spent getting the shots. It’s been cheaper. But, the extreme low testosterone is no joke, as now I am back on abiraterone, so even my microbiome is prevented from making androgens.

There’s been a ton of discussion about the topic….

healthunlocked.com/search/p...

Orchiectomy is a very reasonable choice. The only downside is that if you wanted a "castration vacation" you would have to do it with testosterone replacement. Here are the other pros and cons:

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/labs/pmc/a...

spencoid2 profile image
spencoid2 in reply to Tall_Allen

I read all the advantages and disadvantages and many opinions of members and decided to have them whacked. Absolutely no regrets. No way to really know but I feel fewer side effects. Have them from other drugs and of course having virtually no T there are those effects but that is the goal. In case you ever want testosterone again for a vacation or your PC is cured there is now an (expensive but my insurance would cover it) oral testosterone supplement. If not that, injections are no big deal. I give myself B12 which is similar although the testosterone is more viscous and a bit harder to inject (husband takes them)

For me, driving 10 hours plus the typical time to get the injection of an additional hour is now history. Also the (minor) risk of exposure to covid.

Firmagon is very expensive but my insurance covered it with a very small copay. For those who have to pay for it there would be major cost savings. An additional cost savings is not having to buy a special bicycle seat with a space for your balls. I can use the stock seat that came with my bike. Too old to fiddle with my balls to attract attention. I could wear girly underwear if I were so inclined.

But seriously it was the statistics that convinced me. I am still taking aberaterone to deal with the testosterone from other sources.

• any fractures (-23%)

• peripheral arterial disease (-35%), and

• cardiac-related complications (-26%) .

I agree and don't regret it. My PSA over last 8 months has declined very slowly to .27 since the surgery. MO has no explanation.

marc_andersun referenced the pain associated with his Lupron shots and being able to feel the pellet or substance at the site of his injection. It is for this reason that my Medical Oncologist recommended I take the Eligard shot instead of Lupron. The Eligard shot didn't hurt, FYI. Here's more detail:

Understanding that the actual medicine is the same (Lupron and Eligard both contain the same ADT drug - leuprolide, it made sense to me to try the version my MO said might be less painful. He described the Lupron shot as a pellet being inserted and the Eligard being more of a thick liquid substance. In any case, I received the Eligard shot, and it was not painful. It felt similar to the pain associated with having a needle put into a vein when blood is drawn. The Eligard shot was given to me in my lower left "underbelly". I have tolerated the Eligard well, I guess, but it's only been 3 weeks! The hot flashes have arrived.

Also, not knowing that the shot would be reasonably uneventful, I was prepared for some pain, so here's a link to a post about one of the things I did to lessen the pain of the shot :)

healthunlocked.com/advanced....

I switched to eligard a year ago, much less pain and a piece of cake, it sounds painful due to putting it in the belly region but it is not That bad compared to a sore hip for 2 days.

Foldem profile image
Foldem in reply to Skipper238

I’ve had both and prefer the butt injection to the belly injection. I thought the belly was more painful. Obviously ymmv.

Is Voladex the same as Lupron?

Hi CountryJoe,

I think you might mean Zolodex.

I looked it up online and saw that Zolodex and Lupron are similar but different drugs. Lupron (and Eligard) are the drug Leuprolide. Zolodex is the drug Goserelin. Apparently, they both block production of certain hormones, including estrogen and testosterone.

Below is a link that will provide more detail.

drugs.com/compare/lupron-de...

Thanks so much for this, Skipper238. It is very helpful.

CAMPSOUPS profile image
CAMPSOUPS in reply to CountryJoe

Both of them Zoladex and Lupron are:"LHRH agonist hormone treatments.

CountryJoe profile image
CountryJoe in reply to CAMPSOUPS

Thank you my friend.

CountryJoe profile image
CountryJoe in reply to CAMPSOUPS

Thank you my friend.

4 yrs so far of no Lupron shots has been worth it for me. Good luck Rockin!

BIGGEST PRO ---

ORCHIECTOMY = COMFORT (i.e. - today I am 71 years and 6 months OLD. This morning at 3:06AM while most of the USA's residents were sleeping I was out under a star studded sky COMFORTABLY riding my bicycle 42.24 miles.) How sweet it is!!!! 🚴‍♂️👍👍

no more sweaty balls. my orchiectomy was maybe 4 months ago and my sac has shrunken. my husband has almost no balls but we have new balls in the family and we are keeping them. Our (very large) Red Standard Poodle has the cutest fuzzy balls and they are huge. and yes, he can and does.

spencoid2 wrote --- " no more sweaty balls ... "

BIGGEST and BEST Balls around 👍👍 >>>

youtube.com/watch?v=bPpcfH_...

I think it’s hard to get a straight answer on your question simply because no one (including doctors) wants to think about having their testicles removed, much less do it.

That said, my numbers and mets were/are remarkably like yours and I got an orchiectomy as soon as it could be scheduled. SEs were not that bad until I became castration-resistant 18mo later and had to take Zytiga/Prednisone.

After struggling for a couple years with Zytiga-induce fatigue, etc., I started Estrogen patches (100 mcg), and things turned right around for me. Now have reasonable energy, bones, skin, and even weight. It’s hard to live without any androgens of any kind for very long.

VHRguy profile image
VHRguy in reply to FourString

Thank you for mentioning estrogen (actually estradiol, or E2, the active part of what is called in aggregate "estrogen"). I had the boys evicted almost 3 years ago now, and have been on estradiol patches for about 2 years. I feel great!

In primary treatment I was on Lupron for 3 years with no other supplementation but Megace for hot flashes. I lost bone density fast, and did go on Prolia injections for a couple of years until my T returned post-Lupron.

When my PSA looked to be drifting slowly higher than I liked, and considering my G9, cT3a diagnosis, with primary Type 5 (G9 5+4), I decided to go back on permanent ADT. And that was going to include compensating for the lack of T by supplementing with E2. I fully expected some physical side effects, but the gyno is just cosmetic. Apart from that, life is terrific. Lots of energy, good bones, no hot flashes, great mood, and on, and on. Even better, my PSA remains undetectable.

I'm pleased every day with my choice 3 years ago now.

I got my orchiectomy a few years ago when I was newly diagnosed at the age of 57. To me, it simply made sense to do a physical castration rather than a chemical one. No regrets. My wife and I still are very close, we cuddle etc., though I do not have the physical drive we still make due.

I had my Orchi, done a few weeks ago, so far so good, I'm on Medicare with no cost for the shots, but someone was paying, and someone was making $$ at my inconvenience, best of luck with your choice, your age and health may play a part in it

spencoid2 profile image
spencoid2 in reply to Hotcars74

Yes I am saving the government thousands of dollars a year which they can spend on useless dementia drugs. Big Pharma will get it one way or the other.

If you ditch em, remember you won't be able to comply with the army command "Sound out like you got pair!!!"

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/11/2022 7:24 PM EST

Greetings RS,

Please tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/11/2022 7:26 PM EST

I had an orchiectomy a few weeks back (age 74). So far think it was the best cancer related decision I have made to date, just wish I had done it sooner!

RockinSidney profile image
RockinSidney in reply to 33Ford

Thanks. I just scheduled the event. I will keep the group informed re my responses. By the way, one of my most vivid and unpleasant memories is that as a youngster in Tennessee when I had to help my grandfather and uncles castrate the pigs. From the time my grandfather started sharpening his Case pocket knife until I slopped on some black concoction with a hand mop that served to prevent infection and the squealing, squirming pigs were released, it was pretty horrifying to a young boy. Now I believe that all those pigs are smugly thinking 'See, what goes around really does come around'.

I was 70 with a PSA of 3500 no decimal points. Prostate cancer widespread mets to the bone. I choose orchiectomy, 5 target radiations and abiraterone and predisone. Two years later PSA is .1 for six months now. No side effects with medication or radiation. I also needed spinal surgery to mend a break that posed a risk for the cancer to spread into spine and that would be lights out. I have not had an erection since the two surgeries, we suspect the spinal surgery caused that. I have no interest in sex now and that may be a result of the orchiectomy. So mostly good results and I feel fine these days.

AdT is best. Ask for chemo with ADT. See Stampede trial. Also Zytiga. You should then, have undetectable PSA. Everyone is unique. That was my experience. Always be guided by a competent MO.

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