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Orchiectomy for the Treatment of Advanced Prostate Cancer

Last Revised November 25, 1995
[Procedures & recommendations may have changed.]

Introduction | What are the advantages of orchiectomy? | What are the disadvantages of orchiectomy? | Some things to think about


Certainly until the late 1980s or even the early 1990s there was no doubt whatsoever that orchiectomy was the gold standard for the hormonal treatment of advanced prostate cancer. By carrying out the surgical removal of a man's testes, the physician was able to completely shut down the synthesis of testosterone, thus removing testosterone stimulation of the prostate cancer growth and progression of the disease. Even today the medical community still considers the development of every new form of treatment for advanced prostate cancer in terms of its effectiveness and safety compared to orchiectomy.

What are the advantages of orchiectomy?

  • First, it is a single, simple, surgical procedure with a very low risk of problems and 100% effectiveness.

  • Second, it can be carried out in ways which are not physically evident. In other words, it is possible to carry out what is known as a subcapsular orchiectomy, in which the cores of the two testes are removed while the capsules remain in the scrotum. This means that the man still appears to be an "intact" male.

  • Third, the side effects are limited to those resulting from the absence of testosterone: the two most important of these are impotence and gynecomastia (tenderness and swelling of the nipples and breasts), and both of these conditions are treatable.

What are the disadvantages of orchiectomy?

  • The major disadvantage appears to be the psychological one associated with "loss of manhood." For many men this loss appears to be all but unbearable. Interestingly, the loss of "manhood" is not usually a problem for the partners of most prostate cancer patients when compared to the possibility of loss of life. However, the male association between his theoretical ability to be able to have sexual intercourse and his sense of self worth appears to be astonishingly strong, regardless of the truth about his actual level of sexual activity.

  • The only other disadvantage is that the procedure is not reversible. However, since cases of complete remission of advanced prostate cancer are almost completely unheard of and certainly not well documented, it would appear that the need for reversing this operation is about as close to zero as one can get!

Some things to think about

If you are unfortunate enough to have advanced prostate cancer, we know that at present there is no cure for your disease. Orchiectomy (especially subcapsular orchiectomy, which allows the patient to retain the appearance of complete maleness) is still a very reasonable option. It is a great deal lower in cost over time than monthly injections of LHRH agonists and the patient can avoid the necessity of regular visits for monthly injections of LHRH agonists. However, it is well known that, presented with the choice, seven out of ten men will select LHRH therapy rather than orchiectomy.

It needs to be understood that there is a very real difference between an orchiectomy and emasculation. After an orchiectomy (even an orchiectomy in which the testes are completely removed), the patient still retains full use of his penis, the scrotum is still present, and to all but the closest scrutiny a man still looks completely "male." Interestingly, there are rare but well documented cases of patients who retained sexual potency even after orchiectomy. This would appear to be impossible to explain. However, it introduces a fascinating series of possible speculations on the nature of sexual function.

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The content in this section of the Phoenix 5 site was originally developed by CoMed Communications (a Vox Medica company) as part of The Prostate Cancer InfoLink. It is reproduced here with the permission of Vox Medica.

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