Before there were drugs to suppress androgen levels, ADT was achieved by surgical removal of the testes. This is formally called an orchiectomy. Orchiectomies are now uncommon in the more affluent portions of the world, but they’re still a standard treatment for androgen suppression in poor countries where many patients cannot afford the expensive ADT drugs.
It is often assumed by both patients and physicians that a surgical castration is more traumatic than getting the depot injections of the commonly used ADT agents. Interestingly though, two papers actually show the opposite. For patients who are going on ADT long-term, an orchiectomy is not only cost effective, but is associated with higher health-related quality of life compared to men on the depot injections (e.g., Lupron). A question, though, is: “How often are patients even told about the surgical option?”
There is a new study out of Iowa that asked two related questions of 68 men on standard ADT drugs:
1. Do you recall having a discussion with your physicians about surgical castration as an alternative to the drugs you are now taking?
2. Would you be interested in an orchiectomy, if the alternative was presented to you?
In terms of the first question, only a third of the patients recalled having any discussion about the option of an orchiectomy. However, 40% of those patients said that they would have been interested, if the option had been presented to them.
If you are a patient who is going to be on ADT long-term and your oncologist has not discussed with you the option of an orchiectomy, you might want to raise the question about what they see as the pros and cons of this option for androgen suppression.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/33971188/
Schubbe ME, Gellhaus PT, Tobert CM, Mott SL, Garje R, Erickson BA. Knowledge and Attitudes Regarding Surgical Castration in Men Receiving Androgen Deprivation Therapy for Metastatic Prostate Cancer and Their Relationship to Health-Related Quality of Life. Urology. 2021:S0090-4295(21)00368-X. doi: 10.1016/j.urology.2021.04.027. Epub ahead of print. PMID: 33971188.