Orchiectomy or ADT

[old64horn]

I'm 80 years old with ED since my prostatectomy. Both surgery an radiation have failed to cure my PC so, I find myself at a fork in the road. Do I have an Orchiectomy or use ADT medications. from what I have read, Orchiectomy has shown to have better result than ADT in terms of long term survival plus it is a lot cheaper than paying indefinitely for ADT drugs and may have less health issues.

[Tall_Allen]

It may have fewer cardiac side effects than Lupron.

[Hidden in reply to Tall_Allen]

God bless you old64horn! At 80 do what ever you think is best . I was told shots for life ! But after 18 months of Lupron I chopped the boys at age 57 four years ago . It was the Best t thing that I’ve done yet to be proactive for apc . I Have friends that have told d me they’d rather die than do so . It’s all ego . Mine was shot before I ever chop chopped! Good luck Sir! U do u . 💪👍

[old64horn in reply to Hidden]

Thanks for the thumbs up.

[Hidden in reply to old64horn]

Anything to feel better is my thinking Sir! Who’d of thunk that we’d end up like this? We strive to survive this! 😎🎯

[daguro in reply to Hidden]

I'm trying to get an idea of the difference in side effects between Lupron and orchiectomy. I was on Lupron for 2 years after my radiation and had hot flashes just about every hour, even while sleeping. I found that my verbal skills went down (there were times when I couldn't find a technical word, but could describe it), abstract reasoning was impacted (puzzle solving times went way up), and I had to push myself to get stuff done because of a lack of energy.

What was the difference in hot flashes? Have they decreased over time?

What is your energy level like being on Lupron and now after the orchiectomy?

Thanks.

[Joecarver]

How major of a surgery is it . How long is recovery period, I was 78 and wasn't given a choice.

[old64horn in reply to Joecarver]

My understanding is that it is a day surgery. Google it and you can see that it is not very serious.

[Vangogh1961 in reply to old64horn]

Outpatient procedure. Can be done under local, my Dr prefers Propofol, but still 30 minutes and done. I'm scheduled in a few weeks.

[Murph256]

My question is, what if one of these immunotherapies that are currently in trail end up working? Doesn’t that tip the scale in favor of a more temporary treatment like ADT? I know it’s a long shot, but hope springs eternal.

[old64horn in reply to Murph256]

Murph, if I was younger and had any sexual ability I wouldn't consider this at all however, as things are now loss of sex is not something I worry about.

[katartizo61 in reply to old64horn]

I am strongly considering surgical castration at 70! Up side no more lupron shots, down side the body does not become castration resistant, the cancer does. IF!!! this happens doesn't matter chemical or surgical castration your resistant and on the road to different treatments. IDK however I understand this procedure is similar risk of a vasectomy.

[Miccoman in reply to Murph256]

Hi Murph, if you've been on ADT for a while everything atrophies and there's no coming back, at least for us old folks. Dad had a couple of years of ADT in his late 80s and never recovered from the side effects in the 10 years he survived past stopping. I had mine removed last year and am very happy with the results, for the most part.

[winkoliu]

At your age, surgery may be risky, I don't think it is worth to do Orchiectomy.

[CAMPSOUPS in reply to winkoliu]

What are the surgical risks with Orchiectomy specifically? Thanks.

[old64horn in reply to CAMPSOUPS]

Every surgery has some risks, even a colonoscopy has risks. Recovery is about two weeks with no lifting and no exertion

[CAMPSOUPS in reply to old64horn]

I don't equate Orchiectomy with a colonoscopy but I also don't equate it with a lung transplant. I just wondered what specifically winkoliu found to be risky with Orchiectomy.Yes always small risk of infection with any surgery etc. Anyway.

[old64horn]

It certainly is a concern and a risk. Other than PC I'm in good health and exercise regularly. I will discuss it with my Dr. before I do anything.

[Don_1213]

At 80, given your conditions, if it was me, I'd also be considering removing the source of testosterone if medically possible. If several miracles happen and they discover a cure for advanced PCa, AND something that reverses aging - you could always take T supplements to recover from the loss of your naturally produced stuff. Or ask for some new ones grown from stem-cells since the other two miracles are just as likely to happen.

IMHO - I think you're being pragmatic and practical.

[Shorter]

My thoughts are to try a 6 month Lupron shot and see how it affects you. That way you will know what you are getting ready to possibly make permanent.

For some people it is torture losing their testosterone. For some it is not. I actually thrived without it and got rid of the boys about a year ago at age 66. I had another issue caused by prostate surgery that made sex impossible. My outie turned into a painful innie.

[old64horn in reply to Shorter]

That is definitely an option

[Starstation]

I was on the fence between surgical and chemical castration....in part cuz I wanted to avoid the side effects of chemical castration...as I figured it would be Lupron shots, Zytiga and Prednisone....but my MO at Emory gave me a briefing on Orgovyx...one pill each day to lower T and PSA...then use it intermittently....so I went that route knowing that surgical option is still available....FWIW

[maley2711 in reply to Starstation]

what was your out-of-pocket for Orgovyx?

[Starstation in reply to maley2711]

Initially it was $621/mo (once deductible was reached)...but Emory is working with me to get it down to nothing.you have to fill out a form with all your insurance info and then attach year end Soc Security Statement--Just received notice that my application for support from Orgovyx has been approved. I have previously posted that side effects are minimal and effectiveness is incredible .....after 28 days on it, my PSA went from 12.89 to 0.39 and T went from 616 to 30.

[old64horn in reply to Starstation]

Are you on Medicare insurance. I have AARP Medicare Advantage

[Starstation in reply to old64horn]

I have Medicare A&B plus Plan F and Plan D thru Blue Cross/Blue Shield....go on orgovyx website and there's a tab for patient support....if you make under $73K a year you are eligible for support from them.

[old64horn in reply to Starstation]

According to my Medicare Advantage plan the cost of Orgovyx is $640/month

[jazj in reply to Starstation]

Based on all my reading, my plan should I need ADT is Intermittent Orovyx based on everything I've read. It seems like the best ratio for minimizing hit to QOL while still getting good therapeutic benefit, aka, a good balancing act. It's so new there's only a very small percentage of people in the PCa forums that have a history using it. Many people got to castration resistant before it was created, tested and approved. Your report is very encouraging.

[Starstation in reply to jazj]

So far so good...I am on day 70...a bit of hot flushes--mostly nocturnal--and some minor GI issues....but therapeutic benefit is worth it. I go back to Emory at end of June for more labs and to see my MO...will be curious if he suggests ADT vacation then.With Emory running interference, Orgovyx has enrolled me in their financial assistance program...where I am getting it for nothing.

Best of luck to you.

[old64horn in reply to jazj]

Thanks for your input. Once I get the PSMA pet I’ll have a tough decision to make

[Horse12888]

IMO, this decision is 99% based on the mental state of the patient. Younger people, even those with advanced PCa who will be on ADT for life, have a very tough time even thinking about surgery. Older people who have no further prospects for sexual activity of any kind have an easier time.

I'm 66, and my MO says absolutely no to surgery, because she knows the psychological trauma that I would face.

[Vangogh1961 in reply to Horse12888]

My MO was a younger female and was not recommending it. My PCP is an older female who said ADT for life, it makes sense. My urologist also said it makes sense. I don't see the "psychological trauma". The shots have made them little shrunken shells. ADT for life and a chemical injected to prevent what a 45 minute procedure resolved?

As of today, Me One, Testicles Zero.

[Miccoman]

In my personal experience, I am so much happier not to be taking Lupron. That procedure was no biggie but I would encourage you to talk to your surgeon about prosthesis so you look and feel more normal afterwards. That is my only regret, that I didn't have the chance to get prosthesis because: surgeons.

[Atlpapa]

I just had my orchiectomy last Tuesday so it's been one week. I had general anesthetia and I think that is the only risk which is true for any surgery. I felt (and was) black and blue down there, couldn't sit for long. Today is first day I feel much better. I'm going to be ADT for life so what was the point of taking drugs when this will do the job. You will still have the SE of no testosterone but not any other possible SE from the drug.

[old64horn in reply to Atlpapa]

Thank you I’m leaning that way

[j-o-h-n]

Take one off at a time and see how it works.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/26/2022 10:01 PM DST

[ctflatlander]

I had it done a year ago at 77. No brainer

[Grumpyswife]

My advice is make sure you’re getting a highly experienced surgeon. My husband had considerable problems with the quack we had do his orchiectomy. I am not sure if one can do BAT after an orchiectomy.

It is great not to have to plan your life around Lupron injections.

Now we have to plan around Pluvicto injections.