Removal of testicles

[Paulo1968]

Is the removal of testicle helping more to beat prostate cancer? Anyone had this experience?

[Dionysos]

Paulo, so sad to hear this. Hormone treatment can also delay progression. The removal of the testicles also, but is irreversible, and the impact is hughe. Saudade.

[Paulo1968 in reply to Dionysos]

Hi, I am not having that in my plans (yet). I am just asking how reliable that treatment is In fact hormone treatment is doing good. PSA dropped to 0.01.

[Leeaussie5]

Hi Paulo. Here is a story of someone who have the surgery. people.eng.unimelb.edu.au/l...

Best of luck my friend

[Tall_Allen]

The medicines are a little better at suppressing non-testicular androgens, but orchiectomy+Zytiga should be very complete.

[Paulo1968 in reply to Tall_Allen]

Hi, Why would we need to have Zytinga?

[Tall_Allen in reply to Paulo1968]

Because of non-testicular (mainly produced by the adrenal glands) androgens.

[spencoid2]

For reducing testicular androgens there is nothing more complete than orchiectomy. I had mine removed for a variety of reasons. Still taking "Zytiga" for adrenal androgens.

Orchiectomy has less cardiac and other (forget which) side effects than drugs. Also I live far from MO and it takes basically a day to get a shot. If I ever get LU 177 and am "cured" I could restore testosterone with injections that I can do myself. My husband does them and I do Vit B myself so no problem with an injection if appropriate.

[Paulo1968 in reply to spencoid2]

That is what I had expected. I am anemic now and they can't revert it ... Why are you sing Zytiga?

[Miccoman]

Hi Paulo1968. I finally had a bi-lateral orchiectomy last year and am very happy with no more Lupron. I had been on Lupron since 2014 so everything had atrophied completely and as I'm in my 70s there was no chance of recovering their use (I still have my prostate, BTW).

My only regret was not discussing prosthetics with the surgeon. I would really like to have something down there aside from a big flap of skin.

Bottom line (excuse the pun) I'm happy I did it.

Plus it is always an option in the future if you decide side effects from the chemical is no longer tolerable.

Here in the US there is a definite cost savings as well as Lupron is around $5,000US every 90 days (so about $1,000US with a 20% insurance co-pay for someone your age, unless you are poor enough to be on Federal Aid).

[Paulo1968 in reply to Miccoman]

Do you take any other drug? As I am anemic as a result of Hormone therapy, this came into my mind again!

[Miccoman in reply to Paulo1968]

At this point, since Xtandi stopped working and Docetaxel proved too toxic, I am not taking any cancer meds. I feel Great!!! PSA is rising, so my only chance appears to be being among the ones that Pluvicto works for. Otherwise I don't really have an option, except to just keep on keeping on.

It is my understanding that you can have the orchiectomy at any time and just continue with whatever other drugs you are on, except Lupron/Eligard as they are no longer needed to keep the testosterone levels down.

You don't say what drugs you are on presently but all of the other drugs are also antiandrogen hormone drugs, I think. So if Lupron is not causing your anemia then an orchiectomy won't help that problem. Something to discuss with your MO or urologist I would think.

Also, how severe is your anemia? My red blood cell count runs just under the lower limit and has for years. I do hope you get the actual results from your tests and keep them organized so you can review them and see trends yourself.

I don't know about Portugal but in the US the doctors are so busy making money by seeing as many patients as humanly possible that they have a tenuous, at best, knowledge of their patients' history and complaints. I take a summary of all my medical records to every appointment so I can tell the doctors dates and places where tests, scans and procedures were done. And I also have a written list of everything I want to talk to that doctor about.

[Paulo1968 in reply to Miccoman]

I started with Goserelin, sold under the brand name Zoladex, so I was told. I am with this since February 2021. Next February I will have a doctor appointment and another shoot. She said I needed to have this as long as I can take it. I don't know what she meant exactly with that!

Usually, she is very responsive, and we talk over emails, where she explains the next steps. So, I find it quite reassuring, because not always we have to wait for an appointment to get any feedback from the doctor.

My anemia is 10.4. It is a light one, but it has been decreasing ... I took iron, but it didn't help.

If I may ask, how old are you?

[Miccoman in reply to Paulo1968]

I'm 73, diagnosed at age 65 with Stage 4 PC metastasized to the bone.

Your 10.4 gm/dl is just below the 13.5 gm/dl lower limit. My hemoglobin has ranged from 12.3 gm/dl to 13.4 gm/dl. None of my many doctors has even mentioned my low red blood cell count, ever. My previous MO was taken aback when I mentioned it, as he didn't think it was a problem.

From a quick Google search on Goserelin/Zoladex it is similar in function to Lupron in that it stops production of Testosterone as an LHRH agonist.

from: chemocare.com/chemotherapy/...

"LHRH agonists work by telling the pituitary gland located in the brain to stop producing luteinizing hormone, which (in men) stimulates the testicles to release testosterone and (in women) stimulates the ovaries to release estrogen. The drug does not have a direct effect on the cancer, only on the testicles or ovaries. The resulting lack of testosterone (in men) and estrogen (in women) interferes with stimulating cell growth in testosterone or estrogen dependent cancer cells."

So, in that case, an orchiectomy would eliminate the need for Zoladex. I am surprised that you are not on an additional drug such as Casodex or Xtandi or Zytega + prednisone. In the US they are combined with Lupron (another LHRH agonist).

From the same site, above, on Lupron:

" In treatment of prostate cancer LHRH agonists are often used together with anti-androgen medications. Anti-androgens are substances that block the effects of testosterone. Cancer of the prostate depends on the male hormone testosterone for its growth. If the amount of testosterone is reduced it is possible to slow down or shrink the cancer.

Examples of anti-androgens are: bicalutamide, flutamide, nilutamide."

In my quick research, anemia was not listed as a side effect of LHRH drugs, except that low testosterone can lower production of red blood cells.

Zytega and Xtandi are used only after bicalutamide/Casodex stops working, in the US. It appears, from my reading on this site, that early use of docetaxel/Taxatere chemotherapy early on, along side LHRH + anti-androgen, is becoming the new Standard Of Care (SOC). The path I followed put chemo at the end.