Treatment of by Castration?

Interesting paper on this. It suggests Orchiectomy has several advantages over chemical castration but means Intermittent HT holidays can't be taken with Orchiectomy. https://prostatecancerinfolink.net/2015/12/30/surgical-orchiectomy-vs-medical-castration-in-treatment-of-metastatic-prostate-cancer/

Edited by member 15 Feb 2022 at 21:03  | Reason: to highlight link

Hi,

I have recently been advised that I need to go back on HT for life. PSA now 3.6 following prostatectomy in 2017. Follow up RT and 22mth HT in 2018. Awaiting results of CT and Bone scans currently. I asked about the option of surgical castration instead of medical. My  Oncologist discussed with senior and they were OK with that option and have referred me to urology team.

I am (only) 64, married and sexually active but think it would be the best treatment choice for me based on my earlier HT experience and what Info I have found.

It is one treatment option that doesn't have a lot of documented personal experience on this site. So if nothing else I might be able to add a personal perspective for reference by others.

Will keep you posted.

Regards

J

The side effects of hormone therapy are not directly due to the drugs, but due to loss of Testosterone, so I really doubt they'll be much different with castration. I have talked with a few guys considering castration to avoid the side effects, but I think that's incorrect logic. As pointed out, castration doesn't give you the option of intermittent hormone therapy either, or possibly other treatments not yet developed.

At this point it might be helpful if you gave us some more information on your PCa. I'm not sure what you mean about slow progress with your PSA score. You don't appear to be on a testosterone inhibitor, so are you talking about it going up or down?

For comparison, I'm 74, have a Gleason score of 9 and have had radiotherapy followed by HT [Zoladex]. Like you, I don't rate sexual performance as vital. What I've found with Zoladex is that while it does a great job of keeping my psa down post RT, it does have some undesirable side effects, both physical and mental, that I could well do without. If indeed castration would have the same effect it would not be a great deal of fun.

As others have suggested above, it might be worth trying out the injections first before you make your decision.

Responses to treatment vary between people so you might find a drug like Zoladex to be quite acceptable long term. Another factor here could be your current testosterone level. At 87 it might already be quite low so you might have less trouble adjusting to its disappearance than others who have a higher testosterone level.

Jules

Thanks for responding. I was diagnosed with prostate cancer in August 2017 with a PSA marker of 11. Due to age/84 and low PSA and my wish of life quality not quantity I was put on their ‘watch & wait’ prog., initially with blood tests every 6 months then as the count steadily rose this changed to 3 monthly, specifically around the time when the laser op in February 2020 revealed the level of cancer aggressiveness. 

During the height of pandemic I was placed into the care of my local surgery with a request to transfer me back to my Consultant when score reached 30. This happened in late March at score 35. Scores for 2021: Jan 27  Mar 35 June 39  Oct 38(?)  Dec 45. The stated intention has been to start treatment of 3 monthly hormone injections at PSA level 50. In a recent telephone discussion with my consultant I suggested a surgical rather than chemical option. He readily agreed to do this and has confirmed this in writing to my local  doctor. I’m only committed unless adverse information emerges. Bear in mind that my prednisolone medication has resulted (it now appears) as my having some experience of chem. cast.

Take care,  Mike

Hi Jules, the only trial report I was able to find so far is fortunately displayed on Old Barry’s comments recently displayed. It is quite detailed and the bottom line is an overal better outcome but a higher incidence of deaths. Unfortunately there is no detail regards age/health of the comparison groups, but as I seek quality rather than life quantity that doesn’t relate to me. There have been other published reports of disquieted relating to why this isn’t a more wide spread option.

Take care,  Mike

Hi Dave, thanks for your response. I can see from your displayed photo that your situation and needs differ considerably from mine so that needs to be borne in mind. Kind regards,  Mike

Thanks for your response Lyn, but it does raise the question of why I was advised that my treatment would be injections rather than ‘these are your options’?.

Also, with the potentially huge numbers of men in the countries you indicate having initially the only option of surgery, are they now offered both treatments to choose from? Are there any resulting statistical data of the individual treatment outcomes in terms of side affefects during treatment and on-going survival?

You too take care, Kind regards,  Mike

Mike, I read through the study link given by Old Barry and so far as I can see castration appears to have several advantages ... reduced chance of fractures, lower risk of peripheral arterial disease and lower risk of cardiac related complications. I couldn't see anything a higher incidence of death. Are you talking about risk involved with the operation/general anaesthetic? The advantages are surprising, given you lose testosterone either way but there is a rather technical description of why that might be the case in this article:

https://jamanetwork.com/journals/jamaoncology/fullarticle/2476248

Looks like a good option!

Jules

Edited by member 20 Feb 2022 at 02:47  | Reason: Not specified

When treatment time and choice need to be decided it looks like I will need to have a very lengthy list of questions to first be answered. Many of these result from the helpful community postings for which I’m very grateful, so thanks to all.

Mike

I was diagnosed in 2017 age 59 with stage 4 metastatic Gleason 9 PCa, and started Prostap jabs. 
Severe acute idiopathic pancreatitis in November 2018 - considered unlikely to be associated with the Prostap, but possible. A very nasty life threatening event which saw me opt for a bilateral subcapsular orchidectomy in February 2019. The Consultant Urologist said castration was all they used to do. They have plenty enough practice both back then, and with testicular cancer now. He said they’d not been asked for it for about twenty years for PCa, but commented that he thought they ought to do more of them. They don’t bother to offer the option as so very few would take it. 
I remember a retired GP on here a few years ago who was determined he wanted it. He didn’t like pharmaceuticals. Ironic. 

The very vast majority of the subcapsular tissue is the glandular testosterone making stuff. They may or may not even bother to leave to remaining bit that make sperm at the end; Rendered useless anyway.
At first the capsules are engorged with blood, and it’s like being billy big b*ll*s, however this subsides slowly - it takes months, maybe a year or so, and there’s not much left then to be honest.
It all carries on shrivelling away to nothing anyway just the same as the jabs.

One doctor told me that she thought orchidectomy has fewer side effects because all chemicals have other side effects that those intended, although of course the main “side effects” of the treatment are simply the effects of no testosterone.

Personally I don’t think it makes much difference really. Bear in mind, it’s not quite the minor procedure you may think it is, and it may take a few weeks to fully recover. It’s not hard core, but distinctly uncomfortable if you cross your legs wrong etc., for a while.

My PSA has been on the rise, and I’m quite poorly now really. I’ve had my maximum two high dose pelvic palliative radiotherapies, and am on Enzalutamide. Consultant Onco. says it’s a matter of symptom control now.

Fortunately the nasty symptoms are a bit better now than they were in November-December, and I don’t know, but  after that bout of real awfulness, I do wonder whether if, or when, the time comes when I want to throw the towel in, I’ll regret having had surgical castration…? 

All in all and in my opinion, I don’t think it makes much difference really which you choose. Either works, it’s the same treatment. It’s not wrong to have castration, it’s the most common form of treatment worldwide.

Edited by member 21 Feb 2022 at 14:59  | Reason: Not specified

This has been a depressive read Michael, I can see that you have had a very rough time and you have my sympathy. Your comment at the end is intriguing, “when the time comes to throw the towel in” etc. What difference at that stage would the choice you made affect the outcome?

Keep positive, Mike

Hi again J,I’ve now been able to read the info on the link you provided and once beyond the reams of statistical jumbo-jumbo the summary is very specific in that surgical castration has some significant benefits over the chemical option. At the moment unless I discover, or perhaps advised by my Consultant, that this isn’t advisable I’ll go for surgery. Frankly I have no need to consider anything for this other than learning that the aftermath of surgery can result in very bad side effects in a significant percentage of such treatment. I would hope that the consultant, since agreeing to carry out the operation, having since learned this would be duty bound to tell me before treatment starts. I certainly now have a long list of questions to ask before treatment starts, this helped by all the responses by those on this Forum - many thanks to all.