Surgical Castration vs Hormone therapy

[6big]

I am a 68yr old guy who had a Rarp in August 23 for a Grade 5 T3a prostate cancer Jan this year my PSA started to rise setting of alarm bells with my Urologist further test and a PSMA PET scan confirmed Metastatic recurrence on lymph nodes and a rib I was put back on to monthly Degarelix Hormone therapy having not tolerated Zoladex well whilst waiting for Surgery

I am about to be put on to Enzalutamide as a secondary form of attack on my cancer

My Urologist has suggested that I have a subcapsular orchiectomy to do away with the need for the Degarelix/Zoladex injections

My question is has anyone had this procedure and happy with the outcome as a alternative to the monthly/Tri monthly injections

[Derf4223]

Your adrenal glands make T precursors, and ADT is indicated whenever metastatic lesions occur. Orchiectomy would not obviate either issue. Your onco team's objective is to control your cancer _full stop_. You can take matters into your own hands (so to speak) and go with orchiectomy & no further ADT -- refusing care is always an option. Your onco team uses PSA to guide deeper diagnostics/scans, but in the end neither T nor PSA levels are their end objective.

[GP24]

After orchiectomy you will not be able to choose intermittent ADT.

[NotDFL]

Unfortunately, it is my understanding that your cancer can become independent of exogenous T. Therefore, orchiectomy is not a 'forever' solution.

[Nusch]

I’m 69 and decided for full orchiectomy. I’m satisfied with my decision, no injection every three months and according to some studies and also my own anecdotal experience less side effects, too.

[anothercyclist]

I went the orchiectomy route in March or 2021. So far I am pleased with the result. Hot flashes are the only real side effect in my case--annoying but not a major problem. My PSA is rising--up to 13 now--so I expect to be put on abiraterone soon. Otherwise I have had no further treatment or medications.

[HikerWife]

Just curious - several times, you mention a urologist directing your treatment - do you not have a medical oncologist? With metastases, it seems you would be better served with a MO.

[6big in reply to HikerWife]

I do indeed have a oncologist who has put me on the secondary form of hormone treatment he to has put forward the surgery as an alternative for the injections Just looking for some feedback from people that have taken this route

[DesertDaisy]

My husband had an orchiectomy 14 months ago. The procedure and recovery were easy. He had very little pain from it and wasn't down for long. He was golfing within a week, even though the surgeon said to wait a couple of weeks.

He no longer takes Eligard, but does take abiraterone and prednisone.

He is glad he did it. His only side effects are less energy than he used to have and osteopenia from not having any testosterone. But, he's here with us and doing all the things he enjoys.

He doesn't regret having the orchiectomy at all.

[MGBman]

In Jan 2015 I had a full prostatectomy including seminal vesicles. My PSA began to rise shortly thereafter. I started Zoladex as well as radiation. The latter of which landed me in the hospital due to internal burns. I stayed on Zoladex for two yrs (8 injections) and it drove my PSA down to the nadir of .01 in Oct 2017. I stayed off Zoladex until my PSA reached 7.0 which was Jan 2022. I was put on degarelix for eight months but shortly thereafter I returned to Zoladex and I am still on Zoladex. Zoladex has been holding my PSA at around 0.56. My assessment of Zoladex is that appears to have worked quite well for me. However, I do know that there will be a day when I will have to switch to some other treatment and I'm under no illusions that my 'enemy' will get me. The obvious downside of Zoladex is that it removes most of your testosterone and I have to have quarterly injections in my stomach. But hey....I'm alive and active...bonus!

[Miccoman]

After 7 years of ADT I had the orchiectomy and have been sooo glad I did. The emotional swings had been growing for years and now they are all gone. I get a few hot flashes a day, less than when on ADT, and feel that my overall QOL is much better -- also aided, I believe, by having had Provenge immunotherapy after Xtandi stopped working.

I just saw a urologist who ridiculed my decision, but it seems like both your MO and urologist are familiar with the benefits of not going the drug route for the rest of your life. My (now former) urologist is an idiot and, worst of all, teaches at the local medical school. SMH

And you can always consider, if your doctors agree, testosterone injections to simulate intermittent ADT, if you come to think that would help improve your QOL.

I am past everything, except Xofigo or (hopefully) another round of Pluvicto and my QOL amazes my doctors. I am happy with my treatment choices and content with my life.

Oh, and one thing that is stressed at my prostate cancer group: once you make a treatment decision, do not second guess yourself! You made the best decision for you, own it and move on with living.

[fast_eddie in reply to Miccoman]

"... once you make a treatment decision, do not second guess yourself! You made the best decision for you, own it and move on with living. "

Very true and it can be annoying and even infuriating when someone on this forum criticizes and even outright condemns your treatment choice despite having no personal experience with that treatment.

[j-o-h-n]

That's why I got rid of my ex-wife.....she was always a pain in my balls...

Good Luck, Good Health and Good Humor.

j-o-h-n