Any opinion on orchiectomy?

First post; I am a new member, age 70. I have just been diagnosed with aggressive prostatic cancer, contained, bone scan shows no metastasis. 3 of my 12 cores show aggressive cancer. My psa is 4.4 and my gleasons confused me as he said 7+8+9+9, so I am assuming it's a 10? I see my urologist in 2 weeks again after he recommended maybe a year of hormonal injections and a proper series of radiation treatments and he said he feels confident that would stop the growth. I on the other hand am very nervous about the side effects of chemical castration and am considering asking him to do a surgical castration (orchiectomy) for several reasons: Cost (I hope it's covered by medicare or medigap), The side effects and lifestyle changes are supposed to be far less than from hormone therapy, And at my age and being divorced have no macho qualms about testicles being replaced by prosthetics. Minimal number of injections keep from reminding me of the shadow hanging over me. I wonder if any members have advice from experience with the procedure.

Welcome to our corner of the world. Sorry you need to be here but it's a great place to get answers and support.

I am not sure you got the Gleason scores right - normally we'd expect two numbers below 5 to make up the number between 6 and 10. i.e. a 9 would either be a 4+5 or a 5+4 for a total of 9. You go by the highest number of the most aggressive core sample, if the numbers you have are the total Gleason you'd be a 9.

In your case a 9 would indicate an aggressive PC justifying an aggressive treatment. Our HT folks will weigh in soon about the side effects of the meds. You should do a bit more thinking about the orchiectomy and have a good talk with your doctor. You have a low PSA which suggest that even though it's aggressive, it might be contained and full treatable by radiation.

At this point you're still dealing with the news and it takes awhile to get over that emotional shock. Consider your options carefully. In addition to seeing your Uro, you should also see a good radiation oncologist and possible an oncologist that specializes in PC.

You're insurance is a concern, of course, but there are plenty of options for treatment even with medicare. Don't know where you live but where I am we have plenty of good doctors that deal with PC and take medicare.

Hang in there,
Andrew

I've also been told that the side effects are basically the same.

If you do a few months of Lupron (or another similar drug), and it is not tolerable, you can stop, and things will slowly return to normal, leaving the opportunity to try something different.

Cutting is permanent.

 

You have all been very helpful; I appreciate this very much. Thank You.

I agree with Southern Comfort...First, talk with a couple of Radiation Oncologists and hear what they have to say..Your numbers are not that bad and a CURE is possible...Dropping your testosterone to zero for a year or two greatly improves the effectiveness of the radiation treatment. But if the radiation succeeds in producing a cure, you can stop taking the Lupron (or whatever) and get your life back..

Before Lupron and it's clones were invented, castration was a common treatment for prostate cancer. It still is in many (poor) countries..Here is a rough price list:

6 month hormone shot, $2500
Surgical Castration.......$900
Radiation Treatment, 40 visits, $100,000

Except for the doctor co-pays, Medicare pays for it all....

The side-effects of "Hormone Treatment" are considerable no matter how it's accomplished...

I was hoping to hear from men on both sides of the medical/surgical testosterone suppresion issue, and now I have. A bonus was hearing one member break down the approximate costs, and of course to hear "cure is possible with a contained cancer" such as yours, are the encouraging words I can use in darker moments of doubt. You gents are remarkable.

your plan sounds nice and simple but all the treatment options are usually not black and white choices. I think prostate cancer, and presumably other cancers, treatments aren't so cut and dried. So take some time to carefully weigh the issues. Certainly,I would want to talk to a few people who actually had the orchiectomy to see what the side effects they had. I understand you feeling that you don't need them any more but I am guessing it is not that simple.
I hope you can get some plan you are comfortable with and it will work. Hopefully your age ( not being 40 something) relatively low psa and only three cores positive will give you several options to make a choose from. Like the other responses said, it may not be as bad as you are thinking.
good luck Ron