Considering Orchiectomy as a Treatment Option for BCR at Age 50

I think that is a great choice, and with the prosthetics they now give you, you can have the balls of an 18-year old.

The upside is, as you say, that you can avoid some of the side effects of chemical castration.

The downside is if you want to go on intermittent androgen deprivation therapy, you can have vacations from the chemical castration. But with the physical castration, there are no vacations. Perhaps bipolar androgen therapy (BAT) will one day resolve that problem, but it is still in early clinical trials. For this reason, some guys choose orchiectomy only after castration-resistance sets in and intermittent ADT is no longer an option, or when the vacation periods no longer last long enough for testosterone levels to return to a level where one feels better.

A 2.5 month doubling time is very, very short. That's a concerning situation.

Last year mine was rising quickly, but it seems now that was a proportional early response to coming off of 3 years of ADT. During that time I did a lot of searching for intermittent vs. permanent strategies.

It's really a mixed bag. While many have good success with intermittent therapy, a doubling time of less than 3 months was seen as a serious risk factor. I decided then if mine continued on that trend, with a treated G9 like mine, then early and permanent ADT was my best option. With 3 years on ADT I knew I could handle it even though it's not fun. The surgical option made a lot of sense, and will still likely be my choice if it's ever necessary.

As others pointed out, after surgery there's no chance for intermittent ADT, so you just want to be darn sure you won't ever want to pursue that.

Tough choices. This is a really perverse disease. How does a regular guy find himself in a position where being castrated actually seems like a good idea?! Yet here we are....

Break60 said...
Interesting. What SEs do you avoid with this procedure vs. ADT?
Bob

Bob, I would assume that there would be a burden on the liver and kidneys and other unknown metabolic changes when using a drug therapy. It also makes sense to me that the earlier after BCR that you get an orchiectomy the better chance of halting disease progression. I read on one web site that tumor progression is stopped in 90% of patients. I suppose that might be "maybe for a time" for those with hormone resistant disease. My father lived another 12 years after being diagnosed with Stage IV in 2004 on ADT and the bone infusions he had after metastasis. His quality of life was very poor though in years 9 through 12. He was as tough as nails and managed to age alone at home though until 6 weeks before his death at age 83. I wish I had had a biopsy at age 37 when he was diagnosed and although my PSA was in the 3.5 range I heard that PCa was slowly growing and most people don't die from it. What an idiot I was. The 10% population of those with prostate cancer representing younger men who get it are considered aggressive in type and are now classed as a separate phenotype. in other words, I may have had further DNA changes form my father hence earlier disease or maybe a combination of DNA and other factors I was exposed to such as tobacco, alcohol, petro-chemical exposure early in my career in the environmental services industry, unprotected sex, marijuana use. I wonder if my recent increase in testosterone of 50% to 260 with a recent 5-month intensive exercise program has caused a PSA doubling time spike as a result of "hormone flare" so wondering what the next PSA reading in 4 months will be. Maybe the doubling time will increase past 3 months.

Traveller58,
just wondering if you take any estrogen medication or wear estrogen patches to offfset any breast enlargement due to Casodex? I have heard that can occur. I may need to go on some sort of ADT next year and would prefer to stay away from Lupron. In the 6 months I was on it, I believe I developed osteopenia (as confirmed by dexascan)

Thanks for any insights

Teddy9,
Yes I do take ER antagonists to prevent gynecomastia. I started with tamoxifen 10 mg daily, it worked for preventing breast tenderness and swelling but it also caused o continuous decrease in testosterone level. So we decided to use another ER antagonist, Raloxifene, when T level drops below a certain level, say 200 -250. Raloxifene helps to prevent gynecomastia but does not have any impact on testosterone. I will switch to tamoxifen when T level approaches to 400.