The term 'Castration' resistant/sensitive is offensive
The term 'Castration' resistant or sensitive has bothered me since I was told I had stage 4 metastatic castration sensitive PCa. Why isn't it called 'ADT' resistant/sensitive? It's bad enough with all the side effects we go through being on ADT, but then to be labeled with the term 'Castration' when I still have my testes and generate T when not on ADT, it's offensive to me.
Just something to think about...
I think the term is a holdover from when surgical castration was the norm. But for "castration sensitive" to disappear as a term, probably the term "castrate level of T" would have to first disappear.
When one first begins ADT, one's T is not necessarily at a "castrate level." Same for a small number of men well into ADT. So perhaps it wouldn't makes sense to refer to an "ADT level of T" as the same as castrate.
What might make more sense is to use the actual threshold numbers that we are shooting for, T<50 or (preferably) T<20. Then we could be even more specific than saying "castrate resistant," and refer to men as either "T20 resistant" or "T50 resistant" depending on where their actual T levels have been during ADT.
I agree there is no good reason, other than convenience, to use the term "castrate" to refer to anything other than literal physical castration. If you still have your testicles, you have not been castrated.
well it’s all semantics. We are “ chemically “ castrated “ ( or not ) anyway…. So the term is actually technically accurate. Speaking of myself of course… I sometimes experience the “ castration rage “ , mostly impacting my relationships with my wife, manhood , etc. . as I continue to run shorter and shorter on time, I’m trying to turn that ….and refocus that energy on QOL with family and for a better personal benefit in my remaining time. Get the “ crap “ set aside for nicer things …. Optimize “ things “ to a nicer place with and for my family. Yes it’s easier said than done , but that’s the gist of things for me. Just one perspective …. Hang in there brother . ( bad pun yayahahahaya )
❤️ ❤️❤️
What’s offensive about it? Does it make you feel like your manliness is being questioned?
“Castration sensitive” and “castration resistant” are medical descriptions of YOUR CANCER, not of your masculinity.
yea … you said it brother … We’re not gonna let little things like zero T , a shriveled missing penis and man boobs rain on our parade. Right ??? …….. right ? ……. Nosiree!
😂😂😂
We’re gonna have all that no matter what label they put on the cancer… How would calling it ADT resistant cancer change any of the side effects?
I suspect many of us had low T and a hint of man boobs before ADT anyways, just look at the typical crowd in a mall. 😂
yayahahaha you’re right of course , at 73 when diagnosed , you are spot on. Of course , in my head … I’m prolly late 40s - ish , long as I don’t look in a mirror. Yayahahaha
It’s just fun to try a humorous spin sometimes to offset the dismal Debbie downer aspects. I’m pretty sure I can say , with some confidence, that none of us ADT saturated croakers are happy about being in this boat. We are , tho, all here in the same boat … all with one oar … misery loves company, it’s good to be among compadres , if this has to be.
Love ya brother
❤️❤️❤️
Just because the term is used in a medical definition does not mean the historical connotations of the word are eliminated or neutralized (or "neutered" if you'll pardon the pun). Because historically, that's exactly what castration is: the removal of the reproductive ability and potency that has always associated with "manhood."
Now theoretically, we enlightened modern men have moved beyond that association. But from an evolutionary point of view, having the ability to reproduce (whether you use that ability of not) is pretty important to sexually mature males of many species. Humans may have the cognitive ability to re-define "manhood" in whatever terms they desire, but does that make the historical baggage of the notion of "being castrated" just disappear? Not for everyone.
Through the ages, castration was used as a punishment for crimes or a way to dehumanize. In war, it was used to torture or demoralize enemies, or to extinguish opposing male lineages. Castration is sometimes used to refer to emasculation, where BOTH the testicles and the penis are removed. In male horses, an animal that has not been castrated can be referred to as "entire" or "intact," implying that the castrated animal is NOT complete. And of course, there's the pejorative (that I myself use) of saying "he has no balls" to imply another is being weak or cowardly. So most connotations of the word are pretty negative.
Of course, we do not need to think of that history when we use the term medically. But nor can we pretend the historical context of the word never existed!
I know all about the history of the word and the practice.
I like Tall_Allen’s suggestion below, but there are just too many other things to worry about calling a cancer castration-whatever for us to get angry about.
I can see not saying “I’m castrated, or on testosterone reducing drugs, or even androgen deprivation therapy,” largely to avoid the jokes ignorant people might make, but to stew in anger over the name of the cancer just doesn’t seem healthy.
To each his own I suppose
Cheers.
Oh, I agree... I am too busy being angry about my fatigue and lack of energy to expend anger on the name of the therapy! Personally, if I think of it in terms of "I've been castrated!" it actually makes it easier to think, well, no wonder I feel shi#. But as you say, to each his own.
Now that we have 2nd line hormonal therapies that work even after conventional castration resistance (chemical or physical), I think we need new nomenclature. I propose the following:
H0= hormone sensitive
H1= resistant to first-line ADT (i.e., GnRH agonists and antagonists, estrogens, and orchiectomy)
H2= resistant to second-line ADT (i.e., abiraterone, enzalutamide, apalutamide, and darolutamide)
I doubt it will change.
intriguing and practical . Kewl …
As alway consice and simple to understand....i hereby proclaim the TA apc/ adt assay acryonyms....to be acceptable substititutions for those enuics afflicted with stg 4 pc who are heretofor offended by the word "castrate"...to those of us who carry our apc as a badge of courage and think it takes a real man to walk around with a empty nut sack.....we shall be members of the society of the nutless apc warriors...ill let kaliber design coat of arms...gee i miss the humor that use to be around.....bw
Hi TA,
I've done some work on the UCSF website, and on the Advanced PCa section I pushed toward eliminating the use of the term 'castrate' from patient facing materials. The oncologist I was working with suggested "ADT resistant" as a substitute term, and we ended up using it throughout the section. I personally liked 'hormone resistant,' but it fails a criterion that you point out - it doesn't distinguish between resistance to first-line therapy from resistance to later lines.
I don't think the medical community will ever go along with your H0-H1-H2 suggestion since it's a completely new set of names, but I'm pretty sure that "ADT resistant" is something that they could accept since it's a rigorous term, and its only real shortcoming is that it uses yet another acronym that patients need to learn.
So, do you think you could go along with "ADT resistant?"
Bruce
I can go along with it if the medical community does. And would you change the abbreviation for hormone-sensitive (usually abbreviated as HSPC) to ASPC? So you would use the abbreviations ASPC and ARPC? I think they would be too easily confused. I've seen CSPC (equivalent to HSPC) used in some publications, but I think it is too easily confused with CRPC.
But the challenge isn't me, it's changing the terminology used by the entire medical community. You run into the same problem as my H0-H1-H2 schema. You would have to convince all peer-reviewed publications and the major professional organizations to change the nomenclature they use. I think HSPC and CRPC terminology is locked in in the US. I think changing it now would not be accepted by journals, orgs, and doctors. I think if you could get Elsevier to accept it, that would be a big step.
yea …….. I dunno TA …. that ASPC and ARPC , tho great acronyms , starts crossing into other territory that could cause serious issues with us old guys that are already AARP and ASPCA friendly …… mix in that Lupron fog and natural geriatric MCI and PDQ and you’ve got a OMG situation. Just say’in.
Why aren't we people with Prostate cancer that is metastatic, given a orchiectomy first thing? If you are going to kill of the testosterone capabilities by pharmaceuticals anyway, why not just cut off the source and shorten the amount of time needed to have treatments?
Definitely, it is an option, and many men have opted for it.
If say in the beginning of the discovery of Prostate Cancer that has spread to the bones, if you were summarily castrated would that have dropped the PSA down to near zero within weeks? Why go on a few years of Casodex with Lupron shots, when instead cut nutz and wait to use drugs when it begins rising? I asked my MO and he would never give me a clear answer. Since the body becomes resistant to the drug treatment after time, if castration is done first would it add time before drugs are needed, therefore extending life itself?
While I agree that physical castration is an appropriate alternative to chemical castration, it is incorrect that "castration is done first would it add time before drugs are needed, therefore extending life itself." Castration (physical or chemical) prevents testes-generated testosterone from forming. The androgen receptor of the cancer cell is always sensitive to testosterone. The term "castration resistant" means that the AR has found a way to self-activate even without testosterone - but it is still activated by testosterone.
"If say in the beginning of the discovery of Prostate Cancer that has spread to the bones, if you were summarily castrated would that have dropped the PSA down to near zero within weeks? Why go on a few years of Casodex with Lupron shots, when instead cut nutz and wait to use drugs when it begins rising? I asked my MO and he would never give me a clear answer. "
This is incorrect too. Castration along with a second-generation hormonal agent (Casodex is too weak and is no longer used for this purpose) extends the time until castration-resistance sets in and extends survival. This has been proven many times.
Chemical castration is preferable to orchiectomy if it is for limited duration, or if intermittent ADT is desired.
At this point 5 years in, the sac which is supposed to hold testes, has two small almond shaped things instead. They do nothing, I am unable to have sex, so why keep them?
When having metastatic PC the name of the phases of the cancer is something we should not worry about. There are more important things to think about.
I have been on some form of ADT for 9 years, now I'm also on Xtandi.
My balls have all but disappeared. So not only am I chemically castrated, I'm essentially physically.
Do I mind the term castrated? Not really, I just hate that I am.
ADTs job is to chemically castrate us, it does nothing, absolutely nothing directly to PCa.
Well said....
Could you please fill out your profile?
I agree, It made me feel like a sex offender when told I had been chemically castrated & recently had to tell a female that, which did not go down well with her. Maybe she had other plans but ADT takes all that away from my perspective.
Was going to refrence that...but didnt have the balls🤣
I suppose we could just refer to ourselves as eunuchs. 😀😀😀
Yep, I agree, with not using those terms, I always wince when I hear it. We have some, however complicated, possibility or at least imagination of cure and return to function. I'm glad you said so. Encouragement is good for the immune system
I have to say that I do not stay awake worrying over the name given to my husband's condition but I did not like it when his urologist first mentioned the treatment in the cruellest tone possible as 'I am going to chemically castrate you'. Seemed rude, insensitive and unnecessary when speaking to a well educated kind man who was just given news of an aggressive cancer diagnosis. We had to drop the incompetent urologist as soon as we could, because he had delayed the biopsy unnecessarily.
I never cared about the terms castrate resistant, castrate sensitive, levels etc.
However I did at first wonder when I went on ADT why they said they were ‘giving me hormones’. They were taking them away, not giving them! Now that was a curious turn of phrase.
But no matter, here’s the only directive that can’t be safely used on me:
‘Grow a pair’
Every man has his limits, chemically castrated or not 😀
that’s not explicitly correct …. right ?? ….. we do “ grow a pair “ with treatment “ …… but we need a manzier to hold them up. Just say’in 😂😂😂
The terms don't particularly bother me but it's not very nice to know you're getting the same treatment as a sex offender for sure. Try not to worry about the words, but concentrate on doing the best things to fight this scourge while having as much fun as you can along the way is my advice.
For goodness sake - “man up” 😃!
My wife asked if we were now lesbians. 😏
I recall being really upset when they prescribed Firmagon that first month. I said to the oncologist that I couldn’t believe they named the drug that. This cruel name hadn’t occurred to him previously.
Right...should call it "Firma-Gone"
the first time I heard the name " Firmagon " I immediately thought: what kind a sadist named this?
Exactly. Combined, that comprises what they should have told a lot of us about ‘giving hormones’.
‘Here you go, we’re giving you hormones, they’re called Firmagones. Your testosterone will be at castrate level. Some call it chemical castration, but don’t worry it’s not the real thing... although between us that’s probably a better choice. Have a great day’
I still remember my urologist telling me that 50% of guys that get RP have permanent ED, and 50% of the other 50% also. The other 50% of the 50% have ED too but it resolves- sometimes. He actually said this. I felt like I was buying a used car from Steve Buscemi.
All this is of course before being eventually given the gift of ‘hormones’.
Oh the fargo reference....that image of the foot in the chipper......
I was thinking more Tommy in Trees Lounge but it all works with him.
I don't like the term nor do I like having resistant cancer. As others have highlighted, I focus on family and fun. When I talk to friends and family, I don't see the need to use the term castrate resistant. In most cases people don't understand the situation and terminology anyway. I think phasing out its use is good. It isn't making the unfortunate medical situation any better.
I agree, I never use that term if I’m explaining my situation to someone who is unfamiliar with advanced prostate cancer. I just say “treatment resistant”.
Ed
Austin, I totally agree. It's bad enough that we have cancer and referring to us as castrated makes me feel like a neutered farm animal or a spayed pet.
Why not "androgen suppressed" or "Low-T"?
It's better than eunuch resistant/sensitive. 😜
i like using castration better. It informs people what we are really going through.
Number 1,256,734 on my list of things to be concerned about😀.
I still twitch at the term " castration " and Alan Turing immediacy comes to mind. A number of times I have told people that I have been castrated chemically and the usual response is a gasp !
When I first heard the term castration sensitive/resistant I had the same reaction. After more research it was obvious it is just an historical hold over. I did hate the results though on ADT. Same as we all know. These items upset me a lot more than the term. And then I found out I can't tolerate ADT (from low T). This is a mixed blessing of course. I say mixed because now I can't go through the SOC that most of us have to do. But - I was happy that, as my T came up, the nasty side effects went down. I am totally glad I did not get chopped.
Here's what my online dictionary says:
"noun
the removal of the testes.
the removal of the ovaries.
the rendering or condition of impotency, literally or metaphorically, as a result of psychological means, especially the willful threat to a person's masculinity or femininity.
the deprivation of strength, power, or efficiency"
Notice that it does not mention chemical "castration" although that would fit right in.
i had a recent consult with a medical oncologist who stated the only treatment “ for you is castration”. May well be true, but whether chemical or surgical its brutal when you hear it Sometimes the truth really hursts
I have to say I never thought this post would get this amount of replies, but I am pleased it has. I am grateful to everyone that replied, regardless if I agree or not because I respect all opinions here, especially on a topic that is more about dignity of care vs SOC. Some replies made me laugh out loud, but mostly they made me think. Yes, I agree we have more to worry about than what the medical community calls our disease, but I still think it's important to question the medical community when, rightly or wrongly, one feels undignified or offended by their terminology. Cheers to all my fellow sensitive and resistant survivors!
I heard a lot of terms when I was diagnosed and staged that worried me a whole lot more than castration. Advanced. Stage 4. Very high risk. Metastatic. I quickly learned to ask my doctors what those terms mean in medical treatment terms, at which point I calmed down. If all you have to worry about is castration you are one lucky ba$tard. I am one too.
If you ever get radiation therapy just look around the waiting room and realize that many many other people have insanely more than castration to worry about. Cancer surgery is very often brutal when it comes to other forms of cancer.
I prefer "Manliness impoverished".
I completely agree. Having this MF of a disease for 17 years is bad enough. I find the term insulting and emasculating. ADT is emasculating enough as it is. I agree, the term hormone sensitive/resistant is much more palatable.
"T deprivation", whatd' ya think?
It's a harsh term but I have noticed that the medical establishment is harsh in how it treats patients. When I first got my diagnosis I feel into a deep depression. I confided with my urologist told him my world was falling apart I was worried about losing my life, my girlfriend and ending up in financial ruin.
When I mentioned losing my employer insurance and not being able to pay for ADT the guy didn't miss a beat and offered to cut my balls off. I was like really I'm suicidal my world is falling apart and you want to cut my balls off...I sneered at him flipped him off and said I'm through with you and walked out...
sorry R&me, I trusted my urologist to monitor my PCa and not let it get outside the prostate and he failed me miserably. I had a little spike in my PSA reading in fall 2016 (from 1.9 to 2.3) and he said it was nothing and we should wait to the spring and then do a MRI....so I listened to him and come spring it was 7.4 and into my lymph nodes! I seriously do not trust doctors anymore and never do what they say unless i'm 100% sure it's the right thing to do.
Let me share my story. Many years ago my PSA went from 4 to spike at 6 and my doctor said "no problems, if it doubles in 2yrs, then we do something about it". Years later PSA spiked to 8.6, same story from my doctor. Thankfully he retired and my wife urged me to see the new doctor. Best thing I ever did. He immediately sent me to a Urologist (my recommendation because he had removed a kidney from my wife due to cancer). He then did the DRE, followed up with MRI then biopsy. The result - Gleason 9, high grade PC. Straight on ADT because of cancer close to bowel to shrink prostate way from the bowel wall. Then heart issues prevented Brachytherapy for 6mths. Had Brachy, 17 rods in the perineum into the prostate and 3 doses of HDR followed by 23 sessions of EBRT. Still on ADT (Zolodex) for 2yrs, 2 more implants to go when the 2yrs is up. Apart from the side effects of Zolodex which we all experience, things look good from a 'cancer viewpoint'. Currently my PSA is .008 and T 0.5<. The message here is always do something when there is a spike in your PSA. And, finally, all posts on this site is something I read daily. Never give up, stay positive, live life as though we don't have PC and maintain a sense of humour as indicated by the many posts. Cheers. The secret to getting old - just keep breathing!
Dear Austinsurvivor et al.,
The language of cancer and how men with PCa respond to it, I believe, is influenced by their knowledge of both history and pyschoneuroendocrinology. Both topics interest me.
It is nice to see that others share this interest as evidenced by the extensive discussion here and the diversity of opinion. That diversity in and of itself shows why this language caught my attention as an academic nerd, who happens to have been on ADT almost continuously now for over 20 years.
If anyone is interested in a deep look into how we respond to this language, here are two papers that my colleagues published some time ago:
Cushman, M.A., Phillips, J.L., & Wassersug, R.J. (2010). The Language of Emasculation: Implications for Cancer Patients. International Journal of Men’s Health, 9(1), 3-25.
Aucoin, M. W., & Wassersug, R. J. (2006). The sexuality and social performance of androgen-deprived (castrated) men throughout history: implications for modern day cancer patients. Social science & medicine (1982), 63(12), 3162–3173. doi.org/10.1016/j.socscimed...
Richard Wassersug, PhD (not an MD)
oh dear …. This sounds great and all ….but ….. I got to about the “ endoc “ part of psychoneuroendocrinology word and my Lupron fog ( small vessel white matter atrophy ) and geriatric MCI kicked in and I started thinking about that ice cream in the fridge. Sorry …. Just say’in. Dang …..
Just kidding of course … great post
I’m just glad for you that it’s sensitive.
why is it that when you become resistant to ADT you continue to take it ?
? WTF sometimes I think life would have been better if I just didn't know I had PC
Love it....right on.....
All coat of arms need an inscription"nuces dedi mihi
sic ego ut vivam"........i gave up my nuts
So i may live....
a true sacrifice for the better good … we all deserve medals …or free penis pump implants yayahahahaya.
😂😂😂
Dear austinsurvivor? At 53 I was dxed. At 55 I chopped the boys in order to save myself from lupron shots and pc . All inhibitions left me the at that time .. .I chose to castrate myself . Iwas already chemically castrated by double adt . I’ve lived 7 yrs free of pc . That doesn’t mean that I have no complications however . No t for a man is brutal . Many a man here dreams of returning to the old self . I’m past that dream, I’m just grateful for each day above ground in any form . I don’t buy into labels .
As someone on ADT+Abi, I sympathize with women who go through the far more invasive mastectomy route. Or if you prefer hysterectomy. Or to anyone with a colostomy. Chemical castration is trivial. Suck it up my fellow Buttercups!
It's a hell of a greeting to use upon entering an elevator.
I have man boobs, a shriveled penis that resembles a cocktail weenie, I go through 4 maximum absorption pads daily, erectile dysfunction, low testosterone and the stress of PSA blood tests every 90 days. I have no wokeness sensitivity to the nomenclature of my condition. Sorry but I have much bigger issues to worry about than words!!
we live in land of the offended
Just evaluated as castration resistant
Is my PCa becoming castrate resistant?
Nadir - variation prior to castration resistance 
Duration of ADT until castration resistence
The term “hormone sensitive” or “hormone resistant” is coming into favor over “castration”.
Hormone Resistant or Sensitive is appropriate. The stigma of the word castration is obvious. Come on APC Community...get with it.