Surgical Castration

I would like (if I may) receive input from those who had surgery, then used
surgical castration. How well ( and how long) has this been working out for them.

My last PSA was 0.08 and early in the process of if/when to pull the trigger on a second
treatment choice. Desire to stay ahead of the curve.

Thanks

Clearly a personal choice, but unless I'm missing something your initial pathology wasn't so bad so this seems (to me) like an extreme step to take. And Allen raises a very practical point about who would perform the procedure.

Looks like you and I are in the same boat, Sag.

I'll have my next quarterly PSA test done next month and if it continues to show that slow and steady climb, I think I'm gonna push my uro to refer me to a radiation oncologist.

What are your concerns about HT and RT?

Most men want to exhaust their curative options before they take on PC as a lifelong manageable disease )with permanent ADT or castration).

If you want to pursue a curative option, first you have to see what your PSA is doing. If it's increasing steadily and at a speed ≥0.05ng/ml/yr, that may be a good trigger point for salvage radiation. Earlier is better. Whether you have short term (6 months) adjuvant HT with your radiation is controversial for a GS 3+4 - there are no clear answers.

I agree that radiation is nothing to be taken lightly. But again with your pathology, my non-medical mind tells me that it would have a good chance of curing you.

As someone that went through HT, I can tell you it ain't very fun. But it does end (for most guys), as opposed to castration. Good luck to you!

Sagittarian

Happy New Year! WOW, unless you are in some remote isolated country and you have been charged with being the guardian of the King's personal harem of temple virgin's, I can't imagine why castration would be a topic of discussion. Wait, are you wanting to become an operatic castrati tenor? Those jobs are really very scarce since the 17th century. Not making fun of your question by any means. Just trying to focus in on those in history who have "chosen" this route for non-medical reasons.

Like the others have stated, seems way too early for this drastic measure. I have had surgery and SRT follow up. No side effects with SRT. Current PSA is <.006. Glad you are back, asking questions.

Gemlin,

Thanks for the link ... very interesting.

Seems a QOL argument can be made in favor of Orchiectomy.

Sagittarian,
Typically orchiectomy today is best when the disease is manifesting fast and all primary and secondary approaches are not controlling the rise in PSA. For many the procedure decision is a financial decision as it is quite inexpensive when compared to years on HT. But if it is necessary to remain on HT then orchiectomy becomes reasonable as there are side effects that come along with medicated castration.

I would tend to side with Allen on the fact that you could get good results with salvage radiation. And as Allen states, the technology today as compared to even 5 years ago has improved results and better toxicity control.

But if radiation is simply something you do not want to do, cryotherapy and HIFU are salvage options as well though they seem to not perform as well as radiation in a salvage or primary treatment setting. But they could be a better option than orchiectomy.

As far as early use of chemo (docetaxel based) the available data does neither confirm or deny better disease control prior to metastatic disease being detected. While it probably will help it is far more toxic than radiation.

As someone who will be 70 next year and has higher quality of life with Testosterone Replacement Therapy, there is more than one or two reasons to keep testosterone levels at a good point than just sexual and PSA reasons.

I feel better, sleep better, and my brain is more clear on TRT.

Glenn,

You may want to make that next meeting with a radiation oncologist rather than a urologist. Uros just aren't as knowledgeable about all this compared to ROs (although that may not keep them from expressing a strong opinion).

- Allen

Always good to get recommendations. What's your nearest big city?

Allen:
I am aprox 90 min from Atlantic City, New York City, Newark, Philadelphia.
My zip code is 08759 if that will help. If cost and travel wasn't an issue, is there
a preferred place ? I know some travel great distances for that special surgeon, is there
such a place for salvage radiation ? I am aware that the medical physicist also plays an important part. I prefer someone/team who is really good at what they do, in lieu of talking sweet and having good bedside manners.

Ok guys/gals, surgical castration is out for second treatment. But, will be back on radar if/when a 3rd treatment choice is needed. A realist looks ahead with honest eyes, as ugly as it may be, and accepts it as it is.


Thanks
Glenn

Michael Zelefsky at MSKCC in NYC is excellent, but I think Philly is a lot closer to you. If salvage radiation is in the cards, you want someplace close because it can be up to 7 weeks of daily treatments.

At Fox Chase - Eric Horwitz

At Thomas Jefferson U - Adam Dicker (who was involved with Decipher development, and would be a great person to discuss that with)

U of Pennsylvania probably also has some good people - but a name doesn't come to mind.