Orchiectomy for the Treatment of Advanced Prostate Cancer
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
- 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.