“A old man don’t need his testicles….but they do tend to dress a fella out!”
When I was a urology resident at the Medical College of Georgia in the late 1980’s if a man had prostate cancer that had spread to his bones…quess what we did to treat it? At the V.A. there we did orchiectomies under local in the urology clinic. I bet I did several hundred.
Most of a man’s testosterone comes from the testicles…a small portion comes from the adrenal glands. On looking back, those patients did quite well and it was a very cost effective way to treat metastatic prostate cancer. I don’t remember those patients complaining of hot flashes like the patients of today who have most commonly had one of the LHRH agonists. Same net effect of lowering testosterone but done in a different way. The orchiectomy removes the testicles and the body’s ability to produce the hormone, the LHRH drugs tell the brain to stop producing leutinizing hormone which in turn tells the testicles to stop making testosterone.
I do about one orchiectomy a year for metastatic prostate cancer. So patients have read about it and request it. Most however want to keep the testicles and take a shot. In some cases Casodex, an anti androgen, can be used instead of an LHRH agonist. Sometimes it is a patients choice.
Since LHRH agonists will cause a bump up for about 2 weeks in testosterone and possibly worsen the bone pain associated with prostate cancer in the bone…Casodex can be given for a couple of weeks to blunt that effect and then stop it.
Total androgen ablation uses both Casodex and a LHRH agonist.
Intermittent therapy (I prefer this) will knock the PSA down and only regive the treatment if the PSA rises. This may be at the time the shot ran out but often times the shot will work much longer than the amount of time is was designed for. I have one patient whose PSA is down to a negligible amount and we are out 2 years from a 6 month shot.
So hormone therapy is used when prostate cancer is metastatic, and can be used in the elderly male who is not a candidate for “curative therapy.” Hormone therapy knocks it back…it does not cure prostate cancer.