Anyone considered bilateral orchiectomy: Why or why not?

Posted by rxharleydude @rxharleydude, Sep 21, 2022

Been treated for metastatic prostate cancer for the past 11 years. 82 yo & had a total prostatectomy. Have been successfully treated with Lupron for the past 10 yrs and Zytiga added about a year ago. Considering a bilateral orchiectomy to be able to hopefully get off the Lupron/Ellegard (very painful option compared to Lupron)
Has anyone considered this option & if not, why?

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Profile picture for seeker001 @seeker001

@john1951 I suggest you think very carefully about bilateral orchiectomy. I had my orchies removed 4 months ago, and it was the worst mistake I have ever made. Testosterone and estrogen levels in my blood both went to zero, which introduced a profound and continuous fatigue. For 2 months, I could do little more than lie in bed and stare at a wall. I now wear estrodiol patches which, over several weeks, restored some capability, but I am nowhere near as capable as I was before the surgery. I did research the procedure (on this forum and others) before proceeding, and ALL postings said no biggie, go right ahead. I was not so lucky.

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@seeker001 Thank you for your reply.
Does not the same thing happen on ADT? Testosterone levels drop to castrate levels very quickly. I don't know what happens to estrogen, but I believe you can take estrogen without causing the cancer to grow? I am thinking once the cancer is controlled I could go on HRT just like I would stop ADT. I might still have to do the radiation treatment to control the cancer, my urologist is saying that is likely even with an orchiectomy. I am thankful for this site as I am getting many comments which I will take into account before I make the final decision.

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Profile picture for jeff Marchi @jeffmarc

@john1951
ADT is not a lifetime sentence. When you stop it, your testosterone comes back. Have the surgery and that won’t ever happen.

The radiation treatments are really not that bad for salvage radiation. I had it many years ago and had no side effects at all. I can give you a significant number of years before you need to do anything. I am 78 and I’ve been on ADT for eight years because I have a genetic problem. While I got a lot of hot flashes in the beginning They’re no longer much of a problem. There are many side effects from ADT, which will be identical if you have the surgery.

I live a normal life besides the fact that I go to the gym three days a week because the loss of testosterone really does deteriorate your muscle muscles.

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@jeffmarc Thank you for your reply.
I am thinking that if the cancer gets under control and I could effectively stop ADT I could go on HRT to restore my testosterone levels to normal. It is just that I hear than many men have problems with the ADT similar to orchiectomy, but there can be more pain from the drugs, greater risk of diabetes, and cardiovascular risks. The other factor is that I live far out in the country where it would be difficult to make regular trip to the doctor for the injections and blood tests. I do thank you for your reply and I will take into consideration your reply.

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Profile picture for john1951 @john1951

@jeffmarc Thank you for your reply.
I am thinking that if the cancer gets under control and I could effectively stop ADT I could go on HRT to restore my testosterone levels to normal. It is just that I hear than many men have problems with the ADT similar to orchiectomy, but there can be more pain from the drugs, greater risk of diabetes, and cardiovascular risks. The other factor is that I live far out in the country where it would be difficult to make regular trip to the doctor for the injections and blood tests. I do thank you for your reply and I will take into consideration your reply.

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@john1951
Not many doctors will let you go on hormone therapy after having prostate cancer. That can really aggravate the cancer and get it growing and spreading quickly.

They do Hormone therapy alternating High dose testosterone with ADT drugs In advanced cases where People become castrate resistant to the ARPI. I can really screw up the Cancer because he doesn’t know which way to go when it all of a sudden gets testosterone and then gets ADT. That’s A style of BAT.

They can also do BAT, if you become castrate resistant to ARPI drug. In that case, they just give you testosterone for a while, And some people then can have the ARPI drugs work for them again.

Just some alternate treatments, you may not have heard of.

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Profile picture for john1951 @john1951

@seeker001 Thank you for your reply.
Does not the same thing happen on ADT? Testosterone levels drop to castrate levels very quickly. I don't know what happens to estrogen, but I believe you can take estrogen without causing the cancer to grow? I am thinking once the cancer is controlled I could go on HRT just like I would stop ADT. I might still have to do the radiation treatment to control the cancer, my urologist is saying that is likely even with an orchiectomy. I am thankful for this site as I am getting many comments which I will take into account before I make the final decision.

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@john1951
You can take estrogen while on ADT. It will reduce the hot flashes, Help with bone strengthening and Make sex interesting again.

At the ancan.org Weekly advanced prostate cancer meeting a few weeks ago. One guy was talking about how he was trying different estrogen strength patches to get the best results. You don’t put on multiple patches like you do with Estradiol replacement for ADT you only need a single one of a much lower strength. You can experiment around to see what gets the best results.

As long as you don’t have genetic issues that can work very well.

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Profile picture for jeff Marchi @jeffmarc

@john1951
Not many doctors will let you go on hormone therapy after having prostate cancer. That can really aggravate the cancer and get it growing and spreading quickly.

They do Hormone therapy alternating High dose testosterone with ADT drugs In advanced cases where People become castrate resistant to the ARPI. I can really screw up the Cancer because he doesn’t know which way to go when it all of a sudden gets testosterone and then gets ADT. That’s A style of BAT.

They can also do BAT, if you become castrate resistant to ARPI drug. In that case, they just give you testosterone for a while, And some people then can have the ARPI drugs work for them again.

Just some alternate treatments, you may not have heard of.

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@jeffmarc Thanks for your two replies. Obviously I need to speak more with my urologist and possibly another too. Thank you again for your feedback. I have a lot to investigate before I go down any path now.

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