ADT or Orchidectomy?

This was one of the first questions I asked my oncologist, during that early phase when you want everything whipping out if it saves you (I'm T4 N1 M1b). The reply was "why would you want that!?". Back then, 3 months ago, I wasn't sure of an answer, but now I can think of 3:

1. If the nurse injects into blood and not fat then I might not receive the full 28-days HT protection. The drug's instruction leaflet says to withdraw some solution and check for blood in the syringe and discard the whole thing if there is. None of the nurses do this, nor do online training videos, it's just treated like a standard subcutaneous injection, like anti-blood clotting agent. My last inj. left a massive bruise with blotchy reddening at the skin surface, besides the usual swelling lasting 10 days, so I'm awaiting my next PSA to see if this affected things.

2. The disease and the HT can make you forgetful. I'm also on Apalutamide (Erleada) and that is one of its side-effects, although for me the main issue has been chronic exhaustion, which I'm hoping is a phase I will pass through as it's becoming an issue of QoL. The glossy booklet for the drug advises you have your partner remind you to take the pills, but I live alone, and you must take them at the same time each day or you may under or 'overdose' in terms of the therapeutic benefit. Similarly it is left to me to arrange my Degarelix inj. each month, making the appointment, ordering the 'script (this can be a nightmare), collecting it and taking it to the nurse as an injectible for them to mix up. If I had my doo-dah's out there'd be none of this palaver; I'd just be forgetful without risk of my testosterone levels and PSA rising.

3. Having found a Management Plan document online for my NHS region, which appears to suggest that patients should be moved off Degarelix after 6 months and onto something cheaper, saving I think around £600 per patient, I'd like to be certain that the efficacy of the new regime was as good. If my testicular-particulars were out there'd be none of these cost-saving concerns. I next see the onco in October, which will be 6 months from first injection, so will await to see if she suggests I change med's then.

Against having the procedure - and I claim no medical expertise here, only referencing what I have read, but an orchidectomy is said to remove 90-95% of testosterone, the adrenal glands will keep producing some, and some patients may need a further procedure, adrenal ablation, if this becomes an issue? If you're older and your cancer's not as advanced or as aggressive then this is a risk you can possibly afford to take, along with regular blood tests, but not someone in my position.

Edited by member 29 Jul 2023 at 19:23  | Reason: Not specified

I am 77 and have been on ADT now for six years since diagnosis and following surgery.  My PSA has, thankfully, remained undetectable.  I had a RP but unfortunately the subsequent PSMA scan showed some remaining micro lymph node involvement so am on Decapeptyl for life. Since I had a (very) radical prostatectomy with no nerve sparing I have no remaining sexual function, added to the fact that both my penis and testicles have atrophied significantly because of the ADT.  I am starting to wonder whether I might just as well have an orchidectomy and save the hassle of regular six monthly Decapeptyl injections.  Generally I prefer not to inject substances into my body if I can avoid it.  Are there any contra-indications to physical castration that I am missing?

Fascinating answer Eurocentric, I think if I had to be put on ADT permanently this is something I would look into.

I wonder How many of the side effects (flushes, joint pain, brain fog, loss of libido, anxiety) are down to loss of Testosterone and how many are caused directly by the drug? Every time I get a new injection I seem to get a new side effect and some subside a little…my hot flushes seem a bit better since my last jag.

I’m on Sertraline for anxiety which was brought on by HT. I’m not sure how much of my loss of libido are due to the sertraline and how much loss of testosterone? I suspect I won’t know until I stop one of them and I’m certainly not stopping the sertraline at this anxious time of my ordeal….and I’ve got another 2 years of HT to look forward to.😟

Yes, of course, but as I said, my GP practice’s computer gave the nurse a 26 week interval since the Decapeptyl packet says ‘6 months’!! I know it is 24 weeks but she doubted me until I showed her the Decapeptyl leaflet.  
The issue is that a ‘month’ is not absolutely defined in UK medical practice or so it seems.  My GP practice assumed that,  “If a year is 12 months then six months is half a year . If there are 52 weeks in year then there are 26 weeks in six months”!!  However my Denosumab osteoporosis injection is every six months and the company says that means every 26 weeks! Hey Ho!!