Anyone considered bilateral orchiectomy: Why or why not?

@jeffmarc
Thank you Jeff, that's helpful. I was also trying to find a post where you had commented, that adding ARSI or APRI at the initial treatment (ADT + RT), helps in better control or probably in OS. I could be wrong...

@sbd
Adding an ARSI (ARPI is the same thing) when you are on ADT has been shown to greatly extend the amount of time it takes to become castrate resistant.

Median survival after becoming castrate resistant is two years. Happened to me six years ago.

My first cancer (2001) took my left testicle. Now it's aggressive early prostate cancer. Given the side effects of suggested medication, I am considering having the other testicle removed. I read that the survival rate is about the same, but I think my quality of life might be better this way.
Anyone with comments about the down side of orchiectomy? Some places I read of simple removal by a cut in the scrotum, which seems a lot simpler than the radical orchiectomy I had in 2001. That entailed cutting through the abdomen, and took some time to heal.

We are in dillema. My father 76 years old with high blood, glucose and chollesteral, just diagnose with Prostate cancer at one side of prostate, Gleason score 8, localised no spread out. We had seen Oncology, and Urologly. The Oncology suggest to do Radiology 20 times (MRIT) and follow by hormon. Urology suggest Surgery. Both doctors give contradicting opinion. These group of doctor from both side, i am not sure are they really independant ?

Urologist mentioned if do radio now, if cancer coming back we cant do surgery anymore.
While Oncology mention, with his age, high blood and glucose, it is challenging to do surgery.
They claim radio had radio both side and upper part of prostate. Should not come back to this area again. Seek doctor member opinion

@dale1618
Well, it does sound like a good answer. There are issues with doing that. Removing both testicles will eliminate testosterone for life. Many prostate cancer patients only need to eliminate their testosterone for a year or two, They can then get it back and restore their energy and any other side effects they’ve had from low testosterone. Are you sure that you never need to have your testosterone back that your cancer is so aggressive that you will be on ADT for life? That did happen in my case because I have a genetic problem, but most people can get off ADT and get their testosterone back.

When you have no testosterone, it doesn’t matter whether you are on ADT or have no testicles, You will have the side effects that people have with very low testosterone. Those include

Hot flashes
Fatigue
Muscle deterioration
Bone weakening
Brain fog
Depression
Weight gain
Joint pain
Difficulty in breathing

Not all of these side effects occur to everyone on the drugs. Most of them are just things you have to be aware of and circumvent. I run on the track twice a day, 1 mile at least, to help prevent bone weakening, fatigue and muscle deterioration. I also go to the gym three days a week (usually) and spend an hour with all different types of weight exercises. One thing that happens is people get a beer belly from the muscle deterioration, I do a lot of sit-ups to try andoffset that.

In my experience, they do not cut the scrotum to remove a testicle they go into the stomach next to the penis and remove it that way. I suppose they could remove it directly through the scrotum, but for some reason that isn’t the technique I’ve seen done.

@kingsiang
I got prostate cancer at 62 and had surgery, That was followed by radiation 3 1/2 years later. I have a genetic problem that causes my cancer to keep coming back, so that was probably the best choice.

My brother got prostate cancer at 77, He was on active surveillance for six years before. He had a Gleason 4+3 and had 5 sessions of SBRT radiation. Three years later, his PSA has stayed stable. There is Usually no need at that age to do IMRT radiation. SBRT is just as effective and actually kills the cancer cells more aggressively. They usually don’t like to do surgery on somebody that’s 76, The long-term results are just as good with radiation.

You may need to find another center of excellence so that you can Have the option of SBRT radiation. You should talk to your radiation oncologist about this.

Yes, they do usually want you on hormone therapy (ADT) after radiation, for a Gleason eight they recommend 18 months. In some cases that may not work well. It can affect your blood sugar And cholesterol. The drugs I have taken for prostate cancer gave me high blood pressure, but I take three pills twice a day and they keep my blood pressure quite under control. You can control these problems by eating carefully, Watching how much sugar and cholesterol are in food you eat. I have very low cholesterol and a very normal blood sugar But I’m very careful about what I eat.

I am 78 and run 1 mile twice a day every day. I also go to the gym three days a week to do weight training. If you go on hormone therapy, you really need to exercise and do weight training or your muscles will deteriorate and you will frequently have fatigue. I’ve been on hormone therapy for eight years because my cancer keeps coming back due to genetic issues. While it seems counter productive to do exercises when you are fatigued by the hormone therapy. It actually works just the opposite and gives you more energy.

Just some things to think about and talk to your doctor about.

@jeffmarc thank you for sharing. Did any of your urology doctor advised to do Surgery to remove the prostate ? From your story, you just doing hormone therapy, without doing any radio ?

@kingsiang
It was quite specific in the message I wrote. I had a prostatectomy 16 years ago and 3 1/2 years later my PSA started rising so I had salvage radiation. 2..5 years after that, my PSA started rising again, and I went on Casodex for a little over a year and then Lupron for six years.

That was in the first sentence I wrote above.

I was given the choice of surgery or radiation. My father died of prostate cancer and he had radiation so I decided to have surgery Because if it came back, I could have radiation.

I had a prostatectomy in 2018. Went on radiation 35 treatments and testosterone blocker for one year. PSA low until this year when it rose to 5.1 from 2.9 over 7months. Now back on eligart for 6months. If this does not work is orchi the best answer. I am 79 and very physically active - core exercises, resistance training and sprinting.