Anyone considered bilateral orchiectomy: Why or why not?

Posted by rxharleydude @rxharleydude, Sep 21 11:23am

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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@rxharleydude, I think fellow members @landc @BuckyFestoon @kujhawk1978 may have some thoughts to add to this question.

Harleydude, what is the need or desire to get off Lupron? Are the side effects of surgery similar to or less than ADT therapy?


The "Cut them off" option by and large does the same thing as the ADT, stops the testicles from producing the testosterone. For me, faced with the decision to have to start ADT , orchiectomy was not an option since I did see it as a lifetime of being on it, rather than 18-24 months my treatment plan called for. The Lupron was my choice since it was for a limited and defined time. There was also the manhood psychological issue and "cutting them off."

There may be some "cost savings" depending on the frequency associated with the cost of Lupron, consult with your urologist and any charges for administering the shot, your insurance and frequency, one, three or six months.

The side affects are more or less the same whether you are on Lupron or you went the orchiectomy, either way your T is castrate with all the side affects, hot flashes, genitalia shrinkage, loss of libido, metabolic and cardiovascular, bone…

The differences may be:

Time and money in less visits to see your urologist and have the Lupron shot administered .

It's a final decision, can't put them back on. Still, there are prosthetic testicles so from an appearance standpoint, no issue there.

You can stop the Lupron and your T May recover, a lot depends on age and time on ADT. You may be able to use testosterone replacement therapy.

At your age, the psychological issues associated with orchiectomy may not be in play.

Certainly if the administration of the ADT shots are "painful" around the injection site then "orchiectomy" may solve that.

If you are going to say on ADT for life, then orchiectomy may make sense.



@rxharleydude, I think fellow members @landc @BuckyFestoon @kujhawk1978 may have some thoughts to add to this question.

Harleydude, what is the need or desire to get off Lupron? Are the side effects of surgery similar to or less than ADT therapy?

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I have been on Lupron for over nine years. I am a patient at Mayo Clinic. In recent months, they were having supply issues with Lupron. Consequently, Mayo Clinic has converted over to Eligard. Eligard injection is administered SubQ & is extremely painful and the pain lingers for up to two hours post injection. I will dread getting this injection every three months for the rest of my life. A subcapsular orchiectomy is a simple procedure that can be done in the office then I wouldn’t have to get any more injections going forward. Just considering it at this point.


I was on monthly injections of Lupron and casodex for 3+ years. I started treatment in 2011 and stopped in 2014. I was 59 when I started and 62 when I stopped. I had had all of the kids I was going to have. I had a number of discussions with my wife regarding "to have or not have a bilateral orchiectomy". Truth be told our sex life stopped after the first Lupron shot in 2011. The seriousness of my cancer in 2011 with a PSA of over 25,000 (yep you read that right), 20 or so cancerous lymph nodes ranging in size from a football to a golf ball, jaundiced (on the verge of kidney and liver failure) and chronic itching from head to toe due to extremely toxic blood and a REMARKABLE response to ADT (My PSA dropped from over 25,000 to 103 in 8 weeks as a result of ADT therapy) meant I either needed the orchiectomy or I would need to be on ADT for the rest of my life. I had no way of knowing the long term effects of but I preferred not to be a guinea pig and was tired of butt shots so after the talk to my wife I opted for the orchiectomy in 2013. BTW I have been cancer free since and my PSA has remained undetectable for over 9 years. I feel (actually WE (my wife and I)) that we made the right decision. Once you learn how to overcome motivation for things like everything like exercise by just getting up and doing it!!! the tough work is done. I think I'd opt for the orchiectomy 10 out of 10 times rather than deal with the unknown side effects of long-term ADT therapy!!! BTW RXHARLEYDUDE where are you from and who is your Mayo urologist? All my best and prayers. Feel free to reach out to me at any time. Bucky

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