ADT versus Oriectomy

Hi fellas,

Been awhile since I posted, but have been keeping up. Since my last post, I finished by SRT and am currently getting a Firmagon shot every month. Have about another 15 to go before I'm finished. Two PSA tests since SRT/ADT and both undetectable. When I first began the shots, it was no big deal other than the welts on the stomach at the injection site. Of course, I have the hot flashes, have gained 15 lbs, and my muscle mass is suffering. The last two shots; however, have caused me to get sick with flu like symptoms for two days afterwards and then it clears up and I"m ok.

I'm thinking about oriectomy - I'm 66 yrs old, wife is 70....of course we have no sex life since RP etc., as nothing helped and we have resigned ourselves that it's just good to be alive. So, wondering why I continue to go through the shots and side effects - why not just get these bad boys taken out? I"m wondering about several things tho - will I continue to gain weight once off shots? Will I still get hot flashes? I'm pretty sure muscle mass deal will be about the same given no testosterone....I"d welcome any comments and would like to hear from you that have had them removed and how you feel now. Thanks!!!!

Hi, TeeItUp—

Try searching “orchiectomy” (watch the spelling) on this website using the search box in the upper right corner of the page, you’ll get hits for several threads on this topic.

I haven’t had an orchiectomy, but I can tell you that the side effects that are bothering you (weight gain, hot flashes) come from zero testosterone, so it’s likely you’d continue to have them after an orchiectomy removes your T factory.

An orchiectomy is usually an option a guy will consider when he’ll be on continuous (lifetime) ADT, without a holiday. You’re on ADT as an adjunct to salvage radiation. If your PSA has been undetectable during this round of ADT after salvage RT, you’ll need to get off ADT at some point to see if the salvage worked.

Sounds like you’re not altogether thrilled with the monthly Firmagon injections. As I recall from earlier posts, your RO recommended Firmagon as better tolerated by most of his patients. Perhaps ask him if you can switch to leuprolide (Lupron or Eligard). Lupron and Eligard are available in 3-month and 6-month injections. That could reduce the number of remaining injections from 15 to 3. I was on Eligard for 12 months, had four 3-month injections, very little soreness from any of them, dropped my T to 4 and it stayed there.

Hang in there!

Thanks for all the replies. They are very helpful. Yes, I have mets. 3 yrs after RP, PSA started going up again and went SRT/ADT. SRT is over, ADT for another 15 months (Firmagon). Mets were shown in PET scan as in my pelvic area and one lymph node. Have had one T level test - less than .3. I opted for Firmagon as my research has shown less harmful to my heart, bones and liver. URO agreed with that thus shots every month. Plans for continued ADT are unknown at this point given I have another 15 months to go. Guess I need to rethink this whole thing again and ask more questions. Again, I sincerely appreciate the answers/opinions provided thus far - feels good to talk to someone who is going through the same problem as me....

Thanks, Sai Pan - I do not have an MO at this time....I asked my URO as well as my GP who is also following my situation and both opined I did not need an MO anytime soon..... Funny you should say the RO is done with his job - I thought so too....but he had me make an appt with him 6 mos after last radiation appt. I really didn't understand why I needed to make that appt and, after making it, felt like the RO was just generating $$. It lasted 10 min, and after asking me how I felt tried to convince me to go vegan.....I doubt I'll make the appt he made for me a year from now.

I am going to make an appt with my URO to get his opinion about the orchiectomy. I'm sure he's going to want me to stay the course of the ADT and then take a vacation (if my PSA cooperates). Your advice about waiting to see what happens during that vacation before seriously considering orch is well taken - thanks again.

Firmagon is only available in one month shots, unlike lupron

My RO prefers it. It drops T down to castrate levels on average in 3 days, vs average of 28 days for Lupron. My understanding is that it also has less adverse effects, particularly on cardiovascular risk, than Lupron.

Pratoman said...
My RO prefers it. It drops T down to castrate levels on average in 3 days, vs average of 28 days for Lupron. My understanding is that it also has less adverse effects, particularly on cardiovascular risk, than Lupron.

Odd....didn't you switch from Firmagon to Lupron due to your adverse side effects??

Whatever the future holds, I'll be buried with my testicles intact. There is a limit to what this disease, and it's questionable treatments, can have!!!

“Whatever the future holds, I'll be buried with my testicles intact.”

Yeah, I have a rough time with the idea of orchiectomy. It may be practical for some guys - but there ain’t any going back! The psychology of it is too much.

a friend of mine had a subcapsular orchiectomy. he said they did not remove the entire testicles. anyone had this operation?

F8 said...
a friend of mine had a subcapsular orchiectomy. he said they did not remove the entire testicles. anyone had this operation?

Yes, as I alluded to in my post above... most of my right testicle was removed around 9/11 following a groin injury in the late '90's. The remainder of my right testicle was removed in 2012. Following that procedure my PSA skyrocketed, which is what made me interested in Dr Morgentaler's observations regarding the possible link between hypogonadism and PCa.