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Orchiectomy or ADT drugs

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Posted 4/25/2022 7:56 PM (GMT 0)
I'm 80 years old with ED since my prostatectomy. Both surgery and radiation have failed to cure my PC so, I find myself at a fork in the road. Do I have an Orchiectomy or use ADT medications. from what I have read, Orchiectomy has shown to have better results than ADT in terms of long term survival plus it is a lot cheaper than paying indefinitely for ADT drugs, and may have less health issues.
Posted 4/25/2022 8:35 PM (GMT 0)
ed -- i would not rush into either if i were you. but if/when it becomes necessary i'd choose ADT
Posted 4/25/2022 10:38 PM (GMT 0)
ADT can be reversed; some new oncological strategists even suggest to alternate it with testosterone adds. Moreover, consider that testosterone is also produced by other organs. Newer third line ADT drugs address to this problem. In any case, an early deprivation of testosterone may induce a faster castration resistance. Therefore, I also agree, do not rush and choose ADT if you really need it.
Posted 4/25/2022 10:59 PM (GMT 0)
Ed - it probably makes sense to wait for your PSA to rise a bit more and try to get one of the newer PSMA scans before making a decision. At least that way, you have a chance of knowing what you are dealing with for treatment. Might allow more radiation to help.
Posted 4/26/2022 2:04 AM (GMT 0)
I would be a long way from either choice at your age and PSA having just succumbed to SRT. Let it work for six to nine months before getting too excited. Do your math and determine when things get dicey with life altering Mets. Don’t be in a hurry to treat. Go fishing, play golf, get with the grandkids, but don’t commiserate over PCa.
Posted 4/26/2022 2:06 AM (GMT 0)
I would be a long way from either choice at your age and PSA having just succumbed to SRT. Let it work for six to nine months before getting too excited. Do your math and determine when things get dicey with life altering Mets. Don’t be in a hurry to treat. Go fishing, play golf, get with the grandkids, but don’t commiserate over PCa.
Posted 4/26/2022 1:06 PM (GMT 0)
I have to agree with everyone that responded.
The rate of increase of your PSA combined with your age, personally I would wait for any treatment.
Posted 4/28/2022 1:01 AM (GMT 0)
To answer your specific question, if one is definitely being placed on lifelong ADT, orchiectomy is a valid option. The main side effects are due to loss of testosterone, same for ADT. Though ADT may have additional side effects due to the drugs used, themselves. The urologists don't like orchiectomy, and almost never offer it. Many guys won't consider it (for vain reasons in many cases). The urologists make a LOT of money from the ongoing series of ADT injections. One surgery that eliminates the entire future income stream from all those expensive injections? It's a bit cynical, but the financial motivations are certainly there.

Orchiectomy is a valid option, a minor surgery, and eliminates the expense of ongoing injections. For what it's worth, I'm not a big fan of "ADT vacations" for recurrent PCa anyway. Full disclosure, that approach has some strong feelings on both sides.

At advanced age, I'm not sure what choice I'd make. I might prefer to ride it out with minimal further treatment if faced with your choice. You're the only one that can really make such a choice.

All the best!
Posted 4/28/2022 11:06 AM (GMT 0)
...of course, if you go with the 'ADT' (leuprolide chemotherapy) you may well get both options anyways - I did. Leuprolide pretty much killed off both my boys. I am just glad it didn't kill my pituitary gland as well.

These are known/published 'side effects'.
Posted 4/28/2022 6:17 PM (GMT 0)
Always great to glean feedback here ... "the wisdom of the crowd" ... with essential first-hand knowledge and experience.

Going forward, what does your ONCOLOGIST and medical team suggest and envision for you --- if a "next step" treatment is needed?

Keep us posted, and let us know how you're faring ---- wanting all the very best for you, looking forward!

With my best,
CYCLONE ••• # Iowa State University
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