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Hormone Therapy vs Orchiectomy?

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Just as I am no fan of surgery for the treatment of PCa, I am no fan of hormone therapy and have already decided that, if there is any need to reduce testosterone production in order to prevent PCa recurrence or growth, I would opt for an orchiectomy instead of HT.

I just happened to see the following article, which confirms the choice I've made, that I thought others should read in order to come to their own decision regarding this matter, if they haven't already done so.

Of special note is this quote from the article:

"The current standard of care is long-term use of GnRH agonist products such as goserelin (Zoladex, AstraZeneca) and leuprolide (Lupron, AbbVie).

However, there is mounting evidence that androgen-deprivation therapy is linked to significant adverse effects, such as cardiovascular events, diabetes, acute kidney injury, and bone loss, the authors write. The US Food and Drug Administration requires that GnRH agonist product labeling include a warning about the increased risk for diabetes and cardiovascular disease."

See: http://www.medscape.com/viewarticle/856574

So, if you haven't considered it previously, perhaps you should conisder choosing orchiectomy instead of HT when and if the need arises.

 

hopeful and opt...
Posts: 2226
Joined: Apr 2009

"Many times,  hormone therapy is temporary, not permanent like orchiectomy. From a cosmetic viewpoint, I would be bothered, and additionally cutting  my " BIG BALLS"  off, would put me off  balance; I would not be able to stand straight.  (LOL)

VascodaGama's picture
VascodaGama
Posts: 3029
Joined: Nov 2010

Swing,

I wonder what made a “Casanova” be so assertive and strong-willed towards orchiectomy. Was there an accidental “brush-off” from someone?
Are you giving up with those lovely nights?

(Casanova means: http://www.yourdictionary.com/casanova#4jQEPZlMw7JdHkuC.97)

 Why having the balls cut off for the purposes of accomplishing hypogonadism if one can reach that status with a pill that allows reversing to normalcy later?

After reading the article of your link I saw it addressing only one side of the glass half full. It does not mention on the benefits of having the glass half empty. In fact most of the risks attributed to the hormonal drugs takes also part in orchiectomy. The biggest problem in regards to the risks is that of hypogonadism. The testosterone is important (maybe essential) for our body functions, “except” for prostate cancer.

I believe that orchiectomy should be used at extreme cases, such as; financial problems (cheaper way to treat none-castration resistant PCa patient), pituitary disorders (found to be not properly in function), related illnesses involving/needing the pituitary (mal functioning of thyroid or other endocrine glands), aging of the patient (older patients or when in advanced PCa status).

Orchiectomy causes permanent hypogonadism and that leads to decreased libido, erectile dysfunction, decreased vitality, decreased muscle mass, increased obesity, depressed mood and osteoporosis. It also causes increased risk of death due to cardiovascular and respiratory problems/diseases. Here is another article in the Pubmed about a study demonstrating associations of low testosterone (hypogonadism) to mortality with clinical outcomes;

http://www.ncbi.nlm.nih.gov/pubmed/17911176

Men that had orchiectomy do not only “give up” with his sex life. He is risking muscle loss in all tiny tendons that move our inner organs (heart, blood vessels, lungs, stomach, bladder, intestines, etc). In the “outside” we see weakness, fatigue, gynecomastia and sore bone joints. Many guys require later TRT (testosterone replacement therapy) to return to a more normal-like life.
The idea in having orchiectomy or hormonal manipulations to treat prostate cancer is solo to submit the bandit to ones control. Surely many indolent cancerous cells will die of starvation but those more aggressive will survive and free itself from the “grip” of hypogonadism.

I hope you never reach that status (recurrence) in need of ADT. I would invite that "someone" for a romantic dancing dinner instead of thinking in the uselessness of the balls.

Best wishes,

VGama

A Note on Hypogonadism:
Low testosterone is considered when T is lower than <240 ng/dL (normal levels are between 260 to 880 ng/dL)
Very low testosterone is considered when T is lower than <50 ng/dL (orchiectomy and LHRH agonists levels)

 

Will Doran
Posts: 207
Joined: Sep 2015

Swing Shift Worker,

I had read those articles you suggested.

After having a Robotic assisted radical prostatectomy , 8 weeks of radiation, and being on ADT (Lupron) for two years, I am now off the Lupron and have been for two months.  One month from now, I will go in for blood work to measure Testosterone, PSA and numerous other things.  If my PSA is coming back up, I will have to make the decision as to whether to go back on Lupron or have an Orchectomy.  With the pure hell I went through on Lupron, I made the decision over a year ago, and my doctors agreed, to have the Orchectomy rather than go back on the Lupron.  We have talked about intermitant Lupron treatments, and that is still on the table at this time.  However, at my last appointment, My doctors said they would recommend having the surgery.  I know there are many of the same side effects.  However the pure hell I went through with the muscle weakness and bone and joint pain, I don't want to go back to that.  While on Lupron, I actually gained bone mass except in my Femers.  I lost 12%, in my femurs, from the radiation.  I am now on Chemo to try and correct that damage.  The side effects from the Prolia are muscle weakness and bone pain in the legs.  I am dealing with some of that as I am on the Prolia.  I don't want that added pain and weakness added from the Lupron. I have read over and over and been advised that the muscle and joint aches & pains are much less with the Orchiectomy. I have actually been able to keep my weight at bay, with tons of exercise and diet. I've actually gained muscle mass, and actually lost a little weight while on the Lupron.  That has been puzzling to my doctors.  They said if I reacted to the Lupron that way, that I would be just about the same after the Orchectomy.  As far as the sexual side effects, it would be no different that what I'm already having from the Lupron. The hope is that my PSA stays at <0.010 where it has been for over two years.  If so, then we will stay as is and not go back on any form of ADT until it is called for.  My doctors said point blank that they really don't care what my Testosterone level is as long as the PSA stays at"0", or below 4.  I've actually read that .2 is the number suggested for PSA in my situation. MY testosterone can go back up to normal as far as they are concerned.  However they said the likelihood of that is about "0" becasue of how long I was on the Lupron.  At my last check up, My urologist said that many times the testosterone never comes back up, after long periods on the Lupron.   As I have learned from study, and been told by my doctors, they want the Testosterone level at 20 or below to keep the cancer "at bay". The last test I had mine was at 18 while on the Lupron. That is extremely low.  My GP questioned that number, but as he has learned along with me, that is the new number they want the "T" levels to be at, for control of the cancer, if there is any left in my system. So, if the PSA rises, then we have to knock it back down to below 20.   

So, fingers are crossed and hopes are that I can continue to have a PSA listed as undetectable, and not need to do further surgery.    But we will need to do what we need to do to fight this beast. 

Best Wishes to all

Peace and God Bless

Will

Rakendra's picture
Rakendra
Posts: 198
Joined: Apr 2013

My experience is that you can suffer plenty from orchiectomy as well.  I chose that route and the first year was a horror.  I was also taking casodex, which I will never take again - I hope- My doc in singapore said that I would not have needed the casodex with the orchiectomy.  I stopped the casodex on my own and the side effects were very much diminished.  One problem is that any case can be different from all the others when it comes to cancer, so you can never really know what to expect.  That is one reason why I advocate celebrating your life and making the time you have left the most valuable time of your life.  If you chose to make cancer a spiritual event as well as a medical event, you will have understood why it came your way in the first place.  Everything is about spiritual growth, but, of course, there are very few who see it that way.  What a pity.  l

ove, swami rakendra

 

 

 

 

 

 

 

Old Salt
Posts: 720
Joined: Aug 2014

As several others have pointed out by now, I would recommend ADT (hormone therapy), unless a strong case can be made for orchiectomy. Will Doran certainly made a strong case for his particular situation, but I am glad that I had the opportunity to go the other way. Yes, hormone therapy (for me it was 18 months on Lupron) was no walk in the park with the well-known side effects, but by now (a year later) the obvious side effects are gone and my testosterone has recovered to a reasonable level (for my age). Still need to measure my bone density; will take action based on the data.

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Glad my post started a healthy discussion of the topic. 

FWIW, I am not wedded to my balls and I am perfectly willing to give them up PROVIDED THAT it is "absolutely necessary" in order to insure my survival. The older get (I'm 65 now), the easier the choice will be because, although I'm still sexually active, my survival would be more important to me than my libido and ability to "get it up" as I age further.

Of course, the more prudent approach would be to give HT drugs a "try" 1st to see what kind of effect they have before taking that irrevocable step and I may well do that BUT, like chemo, I do not want to indure any horriffic pharmaceutical side effects of the drugs merely to "survive."

The cost of the drugs, the medical risks of the drugs -- particularly cardiovascular events which are common in my family -- and one's QUALITY OF LIFE are other considerations of equal or greater importance to me than retaining my balls. 

The effects of hypogonadism are common to both HT drugs and orchiectomy and nothing can really be done about it IF the ultimate goal is to eliminate testosterone production. 

While you can stop taking HT drugs temporarily to moderate the pharmecuetical effects of the drugs and of hypogonadism, one can also receive controlled doses of testosterone to moderate the effects of hypogonadism caused by an orchiectomy. 

In either case, doing so may increase the risk of recurrence or growth of ones PCa.   However, in the case of an orchiectomy, one does not have to suffer the risk of any pharmeceutical side effects if they never take any HT drugs.

Why indure the negative effects of such drugs (temporary and/or permanent), when it isn't necessary?  

The same reasoning guided my thinking when I chose to avoid surgery for the treatment of my PCa.   Why suffer the awful risks of surgery when equally effective means of treatment by radiation are available w/o such risks?

An orchiectomy is an alternative to HT drugs that to me is a perfectly reasonable choice, especially since its hypogodanstic effects can be moderated, if necessary.

Fortunately, I don't have to make that choice yet and hopefully I never will be forced to do so but, if the time comes, I'm pretty certain what course I'll choose.

 

VascodaGama's picture
VascodaGama
Posts: 3029
Joined: Nov 2010

Swing,

I may not be the right person to comment on ADT because my experience is short (18 month on Leuprolide Eligard) and the symptoms though numerous were mild or unnoticed. Although, at some occasions, I could identify some effects related solo to the drug or those related to the hypogonadism. Those effects/symptoms combined prejudice the quality living of many and some experience lasting periods with nasty symptoms very uncomfortable.

I recall my wife commenting about my constant irritability (mood change common in hypogonadism) but during a period of two weeks such mood went to the worse turning me aggressive towards the people. I was not pushing anybody but I would shout to people at shops if I wasn’t pleased by something (pituitary effects over expressive due to the agonist). I also experienced in fewer occasions blurred vision at night when driving (agonist’s effect). However, the most annoying symptoms were fatigue, low libido and the loss of interest in doing things, a cause due to hypogonadism.
Hot flashes, spongy-balls, crying without a reason, and the many other symptoms along the 18 + 3 months existed too but did not border me.

I wonder about the “later” side effects from agonists. I did not find any reading materials on this matter but I guess it does exist. An example is the urinary urgency or frequency that most ADT patient experience while on treatment and thereafter. Another is the level of the testosterone that after recuperating do not reach those levels sufficient to feel energetic (levels within the normal bracket but low). Some experience late head ages due to vision problems. There are also those whose pituitary does not recuperate to normalcy causing permanent hypogonadism. In any case, the majority seem to return to their way of living, symptomless, once the period of effectiveness of the drug vanishes.

Living with low levels of testosterone is not something one may recommend to the others. Apart from being uncomfortable in the daily life is not healthy. I recall Rakendra’s reports on the trouble he has gone in terms of vitality. Were not for his love of bodybuilding, he may have become a “couch potato”. His friendship with steroids (TRT) saved his interest in living. He is not young and I wonder what would be the case if the patient were someone younger than 70. Other orchiectomy patients have reported about their experiences, all not very satisfactory.

I think I agree with you but for the moment I may try the intermittent approach with the agonists. When these become not “sufficient” or unbearable, I will incorporate antiandrogens in the “cocktail”. I want to live longer but prefer quality living than a handicap life style. Travelling and engaging in agriculture has given me the enjoyment and sense of well being.

Best,

VG

Will Doran
Posts: 207
Joined: Sep 2015

To All,

It's great to have all of you to discuss our situations with. 

"Old Salts" post has given me a more hope, that maybe these side effects from the Lupron will subside.  I had been off the Lupron for one month and I was starting to see some changers for the better.  However then the Bone Density comcern came about and I was put on Chemo (Prolia) for that.  Within a week, all the gain I had made from being off the Lupron was wiped out.  I was back to the leg muscle and bone and joint aches and pains I had while on the full sterngth of the Lupron. Prolia has many of the same side effects as Lupron when it comes to Muscle and Bone side effects.   My main concern is that if I have to go back on Lupron, on top of the Prolia, that I will be unable to walk and get around.  It's a struggle right now, and I'm back to relying on my cane again.  After going through Physical Therapy I had stopped needing my cane, and as the Lupron treatment was coming to an end, I could see that I was feeling stronger in the legs.  I continue to do my PT exercises daily, plus free weights, Ab Crunches, and up to 100 minutes on a Spinner Bike daily, with some treadmill work added.  I also work out at the gym two afternoons per week.  I guess at the age of 69, I remain pretty active.  But things that used to be easy for me are now a struggle.   As "Swami" has said in earlier posts, he is doing a good bit of exercise and is/was competing in a body building competition.  Good for him.  Others have talked about their staying active and exercisisng.  That is , in my opinion, the only way to fight this .  My doctors have and still are encouraging me to keep all of my physical activity at full "blast".  I am doing that.  And, yes "Swami" the spiritual side of this is very important.  Being out in nature is a big help.  Wild life, the smell of new cut grass, the flowers and trees coming out at spring time, which I've lived to see again, this year, and so forth.  Drives in the country with my wife on Sunny days, and such are a big help.  Yesterday I spent the afternoon out mowing the lawn on my tractor, and then my wife and I trimmed dead limbs out of the spruce trees.  That made me feel good.  But by the end of the afternoon I could barely walk.  I had done 80 minute of Trainer Bike in the morning plus my PT and Free Weights.  Three years ago, that would have been a "walk in the park".  At that point, I was out riding a road racing bicycle with some of the Penn State Student Cycling Team.  I'd ride that bike like my pants were on fire.  That part of my life, I've lost.  My concern about doubling the side effects with Lupron and the Prolia (which I think I'll be on for a good while) combined, just plain scares the hell out of me.  I have voiced that concern to all my doctors,  Even though I had already agreed to the possability of having an Orchiectomy over a year and a half back, I can't imagine being on both of these drugs at the same time.  My doctors have agreed with my concern.  

As "VG" said about the mood swings, and the crying, more frequent urination, etc.  Yes, I had and still have that after being off the Lupron for two and a half months.  Plus the Prolia even makes the more frequent urination worse.   My doctors have told me that the side effects from Lupron can hang on up to a full year after going off of it.  At this point, the hot flashes are as bad or worse, since I've been off the Lupron.  So, At this point I assume My "T" is still at a very low level. Thus, my PSA should stay down for now.  I'll have all the blood work done two weeks from now before I go for my next check up and we will decided where to go from here. 

As is always the case, all of our cases are different.  We all react to these treatments in different ways.  I just seem to have stronger side effects to these drugs at times. 

Thanks to "Swing Shift" for starting this discussion, and Thanks to all for all the input to this discussion

Peace and God Bless

Will

Swingshiftworker
Posts: 1013
Joined: Mar 2010

I have been a fan of various veterinary shows aired on cable TV recently in the US -- The Incredible Dr. Pol , Dr. Oakley Yukon Vet and Vet School (Cornell U) -- all of which like to show in great detail how various animals -- particularly bulls, horses, pigs, dogs, cats etc -- that are commonly castrated in order to "settle" them down and resolve problem behavior. 

I particularly love the scenes of bulls testicles being thrown on the ground by the vet and then picked up for a snack by the farm's dogs.  LOL!!!

Anyway, I was wondering: Do castrated male animals suffer the kind of "problems" -- like hot flashes, mood changes and urinary frequency -- that human males apparently do when castrated?   If so, why not?  Seems to me if men suffer such problems, castrated animals should too.

Don't really expect an answer but if anyone "knows" anything about this,  I (and I assume others) would be very interested in hearing the answer. 

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