For anyone who had the bilateral orchidectomy, I would like some advice for my husband. When was it done? Before or after BCR occurred? What are the side effects? Do you take any other ADT meds after? How is your QOL and is there anything you'd do differently.
He had RP in Dec 2021. No other treatment since. PSA has been 0.02, but slowly rising now. Any advice is always appreciated. Thank you.
Why wouldn't he be cured with SRT?
Would it be unreasonable to get the surgery done after SRT? Would he then avoid the ADT short or long term side effects? I also read testosterone levels get lower with surgery.
Very unreasonable! Don't do it!
You want to get him permanently castrated but you don't want him to risk the short term side effects?
Can you shed some light on Xtandi, that was recently approved for non metastic hormone sensitive PC? So much to consider.
I don't understand you. Why is there "so much to consider"? It is either SRT or wait - what am I missing?
Thanks, for me waiting is the worst part. Hopefully when the time comes for SRT will yield good results for a long time.
Your question caught my attention because of the reference to orchiectomy. I'm way beyond that with my so far successful treatment of metastatic prostate cancer. But along the way I looked into the whole question and it's very interesting. Because surgical castration used to be much more popular. And it's not popular for obvious reasons. But there is some debate that perhaps this is an unfortunate development. There is some evidence that surgical castration may be appropriate and have better sequelae then the deluge of medications and radiation.
There are references included reply here (and other replies in the same thread):
healthunlocked.com/advanced...
Otherwise though I can't comment on your specific situation - metastatic prostate cancer is so complex.
Hi John, thanks, I'll look at the link. He's not metastatic yet. PSA just starting to rise from 0.02 to 0.04. I'm looking at all the options until he needs to ADT/SRT
It sounds like you are jumping the gun. ADT or orchiectomy is warranted when there is a need to reduce testosterone to slow down castrate sensitive PC. I elected oriciectomy because although the effects of low testosterone are the same with both, other side effects such as cardiac disease and diabetes are significantly lower with orchiectomy than with ADT. Consider orchiectomy when it gets to the point of needing to reduce testosterone. There is no benefit until that point is reached.
Hi spencoid2, thanks for taking the time. Can you clarify needing to reduce testosterone? Isn't that why he would be going on ADT once PSA hits 0.1- 0.2. I was under the impression that he could choose surgery to avoid the ADT meds.
Different doctors have different ideas as to what rise in PSA signifies progression that needs to be checked. If your doctor does think you need to control the PC you have to decide which of several options to take, surgery radiation, ADT. ADT is the only easily eversible option. Some people have major side effects others less. When I was on temporary ADT together with radiation I less concerned with the side effects knowing that it would be over. Getting on full time ADT was more disturbing knowing that this was the way it would be for the rest of my life.
I did not get the full details of your history nor am I qualified to suggest the best method of treatment. Just saying what I have learned over 10 years or so of PC.
I had one testicle removed aged 4, and an orchiectomy back in 1982 due to cancer.
I was on testosterone replacement right up until Pca forced me to stop the testosterone in 2020.
Quite quickly, my PSA fell to undetectable. It’s very convenient, no injections, etc.
If the prostate cancer ever allows me to go back onto testosterone supplementation, it’s simply a matter of getting a prescription for the daily gel, which you apply to the lower abdomen.
All this of course presupposes you’ve had all the kids you want. 😊
I’ve only experienced the usual side effects of ADT, fatigue and impotence.
Let me know if I can answer any other questions. Cheers, Anthony
My husband had an orchiectomy in August 2023. He had an RP in April 2021 and one 6 month Eligard shot after that. He has been under the care of a MO who did not think any further Eligard was needed. We also met with a RO at that time who did not think radiation was needed (even though one cancerous lymph node was found) and he discouraged it. He had undetectable PSA's until May 2023. He was then given Eligard again and started on abiraterone and prednisone.
He had hot flashes with Eligard and lost muscle mass. He decided he preferred an orchiectomy rather than continuing with Eligard. He still has to take abiraterone and prednisone.
The orchiectomy was a simple procedure for him with very little pain involved. He feels good. His worse side effect, which occurred earlier with Eligard is the loss of muscle. He does not regret the orchiectomy. From my point of view the only thing that should have been done differently was that radiation should have been done once he healed from the RP.
From comments above, it would seem he’s not metastatic. If that’s the case, no need for the surgical versus chemical castration question. When and if that time comes, I would (and did) choose surgical with estradiol patches or injections to manage the side effects of said castration.
Hi FourString, thanks. how did you find the side effects and what were the ones you had?
Side effects from the orchiectomy? 20% more mental time. Some thoughts and impulses just don’t come when you have no hormones. What body hair I had disappeared. No body odor. Also felt a hard-to-identify lack of identity. Over time that receded. When I started with transdermal estradiol, I swerved right back into my lane psychologically. I felt much more functionally human. It’s much better to have hormones than not. Doesn’t seem to matter that they’re female hormones.
Hi Fourstring. How long ago was your surgery completed please. Are you pleased with the outcome? Thank you for your time.
I had my orchiectomy December 28, 2016. A bit over seven years ago. I’m very pleased with the outcome. Fewer side effects and lower maintenance than chemical castration.
Thank you for your answer and time really appreciate it 😁
I am metastatic and had the orchiectomy after 3 years of ADT because I will be on ADT for life and it is an easier way to go. BUT your husband will not need ADT for the rest of his life so don’t do it. It is a life sentence of no testosterone.
Lucrin after orchidectomy
ADT or no ADT
Living on Firmagon (ADT)
Estradiol vs ADT?
18 vs 24 mos ADT 
