Knowledge and Attitudes Regarding Surgical Castration for those on ADT for metastatic PCa

This seems to be a topic not often discussed, even among those on permanent ADT. I have rarely seen this discussed on this forum.

As far as I know, there are only a couple of us here who elected this option. I haven't said much about it, but I had this done over two years ago now, and I'm quite pleased with the results. It is a valid alternative to a possibly very long series of ADT injections.

The article speculates that it may be a lack of education. Urologists quit talking about this option when drugs like Lupron became available, since so many many simply reject the idea of surgery. It is quite a thing to wrap one's mind around, I will say.

Knowledge and Attitudes Regarding Surgical Castration in Men Receiving Androgen Deprivation Therapy for Metastatic Prostate Cancer and Their Relationship to Health-Related Quality of Life.

Thank you, Redwing, for bringing up this interesting subject and telling us about your personal choice and experience. There was at least one other I know of years back who chose orchiectomy, and was happy with his choice, but I can't recall who that was.

The article doesn't tell us much about the pros and cons of the two choices, other than the rather obvious aspect of one and done with the surgery. Also, I suppose, no hope of ever coming back from the surgery, but that would probably be moot if there was little hope of ever not needing the drugs.

But one thing I have wondered about a few times: are there any negative side effects of the drugs not caused simply by the absence of testosterone? IOW, SE with the drugs that would not exist or perhaps simply be less severe with the surgery? At least assuming an uneventful surgery and recovery thereof?

From posts by men who had the surgery, studies I have read and discussion with my urologist, their side effects were basically the same as those of men on GnRH drugs. The side effects come primarily from the low T, not the actual drug used.

Regarding the drug vs. surgery side effects, my impression was the same, that most of the side effects are due to lack of testosterone. At the same time, all drugs have their own side effect profile, so in general I like to take as little of anything as possible. They interact too, and everyone seems to be a little different. But generally, the drugs have proven hugely successful in their primary goal, and there are different ones for people who may find one is not working well enough for whatever reason.

The definitive benefit of surgery is knowing that T production is gone with the elimination of the little factories! Unlike ADT shots, there isn't any chance of "breakthrough" T production that can happen before the next shot is due.

Surgery is, well, a surgery so there are the inherent risks of that (albeit typically quite minor). My recovery wasn't bad, which seems to be the case for most.

It is quite permanent of course. Now, with an understanding urologist, one could take a "holiday" by adding a T supplement (gel, patch, injection). It depends entirely on one's specifics. For my G9, 5+4, stage cT3a case, all the studies I could find about this holiday idea said, "Maybe ok, but not recommended for the very high risk G9 cases". Those are smoldering embers that we do NOT want to receive anymore "oxygen".

I take estradiol by patches to offset the no-T side effects, and feel just great.

[Edit to add: BillyBob@388, I recall that discussion too. I think the member was "Shaba.Doug". He also chose replacement implants, but I didn't. Another personal preference. For reference, here's a link to his thread starting shortly after his surgery in Dec 2014: Post Orchiectomy, now at 12 months. He's the only other one I recall ever discussing this.]

Post Edited (Redwing57) : 5/28/2021 1:16:50 PM (GMT-6)