Surgical vs. chemical..,

[billy1950]

Wondering about the difference between surgical castration and chemical? Primarily if you get surgical castration do you need to go on hormone therapy...and what are the side effects of surgical castration? Thanks

[Tall_Allen]

I think surgical castration is a great idea IF you have no intention of being on INTERMITTENT hormone therapy. You can avoid taking a GnRH agonist (like Lupron) or antagonist (like Firmagon). But it does not substitute for SECOND-LINE hormonal medicines like Zytiga, Xtandi or Erleada.

[billy1950 in reply to Tall_Allen]

Tall_Allen ; I am not sure what it means to have second-line. Are they needed if the surgical castration is no longer working?

[Tall_Allen in reply to billy1950]

Yes. When PSA rises in spite of chemical or surgical castration (called "castration resistance"), second-line hormonals (Zytiga or Xtandi) are added to the mix. Zytiga is also approved for use in newly diagnosed men. Erleada is approved for men who are castration resistant but not yet detectably metastatic.

[billy1950 in reply to Tall_Allen]

Many thanks!

[Hidden in reply to billy1950]

I guess the main difference between the two, irrespective of their effectiveness, is that orchiectomy (surgery) gets rid of the main source of testosterone. The consequences of that is the effects of a lack of testosterone. I'm not aware of all the consequences but I do know that this will reduce your libido and possibly make you less aggressive. I believe that libido in adulthood is at least partly a matter of habit rather than wholly phsyiological so might not entirely disappear. Aggressiveness is also partly a matter of habit and personality. You will have patterns of behaviour which are more or less aggressive, I doubt if they will change significantly. A certain amount of aggressiveness is healthy, but again it certainly will not disappear.

There may be physical effects in that testosterone is andronergic and anabolic. Anabolic means it promotes and maintains muscle mass. Andronergic means it promotes secondary sexual characteristics, e.g. hair growth etc and fertility. So with orchiectomy these might decline.

There may be other consequences which can be summed up as "feminising" you.

"Chemical castration" (Androgen Deprivation Therapy ADT), I admit I know little about. There are various types but they all aim either to reduce testosterone levels or inhibit the action of testosterone. Either way, they will have the same consequences of orchiectomy BUT, depending on which type, may have more marked or additional consequences.

Other than that, orchiectomy is a "one off" thing, you have it done, that's it. (It can't be reversed!) With ADT it's an ongoing thing.

If primary treatment fails (orchiectomy or ADT) I believe there is a back up plan of different ADT drugs.

I've no idea of the relative effectiveness of the two treatments, sorry.

When it comes down to it, I guess it's a matter of personal choice. I get the feeling that orchiectomy is a less favoured choice because of the physical emasculation you have to undergo and the way you perceive it.

There seems to be so many ADT drugs and new ones keep appearing. It might be best to seek the advice of your physician and then try to talk to men who've experienced ADT to see how they've felt about it.

You might find this website helpful

cancer.org/cancer/prostate-...

I hope you find an answer