Chemical vs surgical ADT.....

[Jashelby]

I read so much on here about ADT with Lupron, Casodex or whatever. I had an Orchedectomy shortly after diagnosis, so when my PSA starts to climb would adding an ADT regimen help me??? There's some topics on here about casturation but mostly just chemicle casturation. My PSA started to climb a year after my surgery and I've undergone radiation, just finished actually, so waiting to get a PSA in a month or so. My pain is unbearable at times, feels like someone is taking a sharp pencil and stabbing me in various places and my fatigue is so bad getting up out of my chair and going to the bathroom sometimes seems like an impossible task. I'm just curious why so many men DON'T do surgical casturation vs the chemicle meds? Is it because it's such a permanent fix?? Can't help but wonder if I did the right or wrong thing in having it done?

[Jeff54]

You have to do what you think is right for you in your heart! I have wondered about doing the same thing often myself. Every year they change my insurance where I work so I have to go through an approval process! And the cost of the two drugs that I take is ridiculous! Eligard and Xgeva. I take these shots every 4 months now! It used to be every 3 months.My out of pocket limit is almost to its limit! This means that when I pay another 387 dollars I dont pay for anything until my insurance runs out in November!

[Hidden in reply to Jeff54]

I had blue cross and somehow a payment was late and I was due for my tri-monthly lupron.$6700 ..We straightened it out and they paid.I first started firmagon10k monthly..So like all C. Treatments ,they are outrageously priced..I did the surg and I have to say I'm glad I did. It sure wasn't a life long dream of mine,but of the choices available I feel it was best.. Good luck!

[eggraj8]

The Orchedectomy was never even suggested to me by my oncologist. i would have considered it if he had.

[Jashelby in reply to eggraj8]

I'm not sure why urologist or oncologist don't suggest this. Most insurance companies pay 80% and no need to take the meds. Of course hot/cold flashes and fatigue still prevail!

[Hidden in reply to Jashelby]

You still have the same side effects from no testosterone...But no more shots.

[Hidden in reply to eggraj8]

My ono is from India and made me wait for a year to make sure that's what I wanted..The norm is chemical castration. No more shots for me..

[Hidden in reply to eggraj8]

Urologist's suggest castration.

[Jashelby in reply to Hidden]

Unfortunately not all of them do. I guess it really depends just how far your cancer as spread as to how fast they suggest this option.

[Hunt4Fun]

Thank you for raising this question! I think this is topic not much discussed and should be!

I have been on lupon for 7 years I am age 62. Orchiectomy was never offered or mentioned as an option. I ran across orchiectomy as option in an article and did research. My conclusion was basically get same results in testosterone control as Lupron but great reduction of some of bad side effects such as bone fractures, arterial problems, cardiac problems, and risk of venous thromboembolism.

Make sure to do your own detailed and objective due diligence! Lots of info out there.

I asked my oncologist and he said that is what they used to do before new drugs. He validated my research and stated that since without question I would be on ADT for rest of life being T3b and cancer is wandering in blood stream and incurable.

Because of work pressure to take early retirement and with loss of insurance after COBRA, I have terrible dilemma... instability in insurance market because of political environment, no insurance companies in ACA for my county (Blue Cross pulling out) all leaves me with no affordable insurance options.

My lupron cost for 6 month shot is $19,350.00. No way can pay that!!!!... so I have opted for orchiectomy and have surgery scheduled for May 12th.

Personally looking back to when my PSA immediately began to climb after RP and 36 blasts of radiation, if I knew what I know now, in all likelihood I would have opted for orchiectomy. Again that is just me.

Regarding why never informed about this as option, my personal opinion is the money is in administering the drugs!!! Insures continuous high margin profit revenue stream.

Again...Make sure to do your own detailed and objective due diligence!

Best a luck to you!!!

Happy trails and peace out!!

[Jashelby in reply to Hunt4Fun]

I totally agree with you, big Pharma seems to brainwash pysicians as being the best alternative when getting rid of the source with surgery is more cost efficient and has less side effects (putting these chemicles into your body can't be good). I realize the stigma attached to casturation.....but it was an immediate cessation of testosterone production, hence stopping the fuel for PCa growth.

[Hidden in reply to Jashelby]

The hardest part is making the decision..

[Hidden in reply to Hunt4Fun]

Insurance is a scary mess .Thank you for telling me of your finding of those decreased serious side affects..That sounds good to me

[RonL]

Secondary hormone treatments like Zytiga work by interrupting androgen at 3 sources—the testes, the adrenal glands, and the tumor itself so I would think these treatments would be effective post orchedectomy. Most people on these treatment also continue with first line ADT like Lupron. It's something you should bring up with your oncologist. I wouldn't say your decision to have surgery over chemical casturation in any way adversely effected your treatment outcome so you shouldn't beat yourself up over that.

Good luck

Ron

[Jashelby in reply to RonL]

Thanks Ron, I was on Casodex for a couple of weeks prior to surgery but that's it. My cancer doesn't give me real elevated PSA's so that's not real helpful in following my progress, but a climb is a climb.

[Hidden]

I did orchiectomy 9-1-17,after a yr. of; firmagon,eleguard,lupron and I'm on the test drug Tak-700 until it fails.It was a no brainer instead of getting those shots for life. Was already castrated chemically,and truthfully the boys were done..I had my fun with them.Now ,what balls?? I did go into a dark place after the fact..Feeling of worthlessness and suicidal thoughts in the 2 months afterwards.I lost the family jewels....But it's all ego...Something we must let go of.. It is permanent.. For me however ,it's a fight for life.It was the right decision for you and I..After time there is no difference except not using those costly chemicals, and I don't have to worry about getting kicked in the balls ever again..We all know that feeling.....Good luck in your journey.. Many men I'm sure would not do it ..It's not an easy call by any means. I'm sorry for your suffering.I can relate to those pains..Follow your will to cure yourself and find relief in any form possible..Thanks!

[Jashelby in reply to Hidden]

Thanks Lulu700, this is a difficult road to go down, and you're correct, the decision to have the orchidectomy was a no brainer to me! I have a loving and supportive wife (who's a nurse too) . Life became more important to me than ego......as I think it does to all men diagnosed with PCa. Good luck with your jorney too!

[Hidden]

My wife also is with me and incredible.We are both so fortunate to have such unconditional love.Good luck in proceeding...

[MelbourneDavid]

Androgen receptor blockers such as casodex and Xtandi can still be useful in castrated men because the prostate cancer sometimes switches to making its own testosterone or to activating the Androgen receptor without testosterone. There can alsobe some androgen produced in the adrenal glands. So it may be worth having a blood testosterone level test and considering trying one of these medications, although I know Xtandi xan have some pretty painful side effects.

[Jashelby in reply to MelbourneDavid]

We're told that Xtandi was best tolerated......I'm so weak now from radiation treatments that I feel like I'm dying some days. See the Dr tomorrow and get my education on Xtandi, then I guess I'll be starting the drug. I'll certainly ask for a testosteron test too! Thanks.

[MelbourneDavid in reply to Jashelby]

I'm told that exercise helps you cope with radiation fatigue. It is counterintuitive but has been well established.

Another drug sometimes used for castrate resistant prostate cancer is Zytiga which inhibits production of testosterone by the cancer and by the adrenal glands.

Unfortunately low PSA prostate cancer is a bit different from the usual kind and I don't know much about it.

[Hidden]

Sorry to hear from you all about castration, whether chemical or surgical. I haven't had the experience (yet). I dread getting to the stage where I would have to consider it. I'm not sure what I'd do, cling on to life by taking whatever and all treatments available at the cost of losing my manhood or decide that the reduction in quality of life would be so great it wasn't worth fighting. You also have to consider the financial limitations as well. It just points to the fact that the "battle" is as much psycholgical as a matter of medical treatments. I hope you are getting help in that realm as well and have a faith, support from partners, family and friends. I have found "mindfulness" practice extremely helpful, cancer or no cancer. Keeping your awareness in the present and in the place you're in. The moment you're in is actually the only time you have. If you're not in it, you're missing it. Don' waste the time you have.

[Hidden]

Insightful ,thank you!