ORCHIECTOMY OR ADT??

[steinmother]

Having side effects from ADT. Hot flashes, no libido, penile shortening. Testicles now shrunk to size of a grape. I understand orchiectomy is simple and prosthetic silicone balls can be inserted for a good cosmetic ( and Manly) look. I have no hang up about castration since they have already done that with ADT. I do wonder if after surgery there is any improvement in the ADT symptoms. Is osteopenia a bigger concern long term if surgery is the method of castration? l

[MelbourneDavid]

Sadly I think the symptoms you are experiencing are from the low testosterone, not the drug, so they would be no better with orchiectomy.

The ADT drugs do have their own side effects but the ones you listed are just.low testosterone.

I don't know about the osteopenia.

[steinmother in reply to MelbourneDavid]

Obviously the symptoms are from low testosterone, that's what ADT does. Orchiectomy does the same but is permanent. I'd like to know if there is some benefit to one or the other.

[MelbourneDavid in reply to steinmother]

There can be other side effects from Lupron etc. One benefit of orchiectomy is you don't have to worry about drug interactions between the ADT drug and other medications.

[ng27868168]

Steinmother, I am 77. Was diagnosed with PC at age 52. Had surgery and 2 years later, had an orchiectomy to stop the PSA rise instead of ADT which was very expensive and not covered by my insurance. No further sign of PC and PSA rise was stopped. Orchiectomy surgery was minor, but hot flashes was the result, some very severe and hourly for 18 years. Miserable. Tried different drugs with no effect and after 18 years of being cancer free, New Urologist recommended monthly injections of testosterone to help hot flashes. Getting testosterone injections following PC is controversial but Dr. thought being cancer free for so long was worth the risk. Hot flashes are gone, energy level up, no noticeable side effects and doing well. PSA checked every 90 days. Good luck.

[WVtwinsmama in reply to ng27868168]

When you were originally diagnosed, had the cancer spread beyond the prostate? My husband was diagnosed 3 weeks ago at age 50, cancer spread to the bones (hips, spine, etc.) which is how we discovered. He opted for the orchiectomy immediately. Your success is inspiring, so curious.

[steinmother]

Thanks for sharing. Sounds like those hot flashes were pretty bad. Some guys get those from ADT. I do but not as bad as you had. I've read that some guys have worse hot flashes than others even with ADT. Happy to hear you are well and getting better! Hearing your story made me feel better. Thanks.

[ng27868168]

Sorry for the delay in answering, was out of town. According to my urologist the scans following surgery did NOT show anything outside the prostate, but my PSA began to rise slowly to the point he suggested hormonal treatment At that time my insurance would only a small portion of the hormonal injections so I opted for the orchiectomy which stopped the spread of PCa. I had a elderly friend whose cancer had spread outside like yours apparently has, and he finally decided to have an orchiectomy and it added several years to his life. he has since passed away, and he said before his death, he wished he had opted for the orchiectomy sooner. Removing the testosterone does help slow the disease even though it may not stop it. Good Luck!

[rust]

Wondering if a PSA of 10 is too late for orchiectomy? PSADT of 2 months over the last year and 6 years past surgery and salvage RT. Applied for EMBARK trial at Emory this week. Waiting for scan results as no mets are required for entrance.

[MelbourneDavid in reply to rust]

If they think Androgen Deprivation Therapy is useful, orchiectomy will be useful too. Adding Casodex or Zytiga may be recommended too.

[WVtwinsmama in reply to rust]

My husbands PSA was 900+ at dx, he chose orchiectomy because it was the only sure way to kill the testosterone and hopefully extend his life, he’s only 50. 3 1/2 months later after 3 rounds of chemo and now on Zytiga, and PSA is 4.28. So I’d say it’s not too late! Best wishes!