Table of Contents

Chapter 6: Using Hormone Therapy

i. Orchiectomy

When prostate cancer treatments were first being developed in the 1940s, the goal was clear—eliminate the testosterone and the tumor stops growing. The obvious solution therefore was to surgically remove the testicles that produce the testosterone. Over the years, however, as researchers began to understand better the dynamics behind testosterone production, they realized that surgery might not always be necessary, and that drug therapy can be equally effective. Nevertheless, the surgery, known as orchiectomy, is still done. If your doctor recommends surgery, don’t automatically assume that he or she is out of the Dark Ages. After discussing the pros and cons, you might find that surgery is right for you.

In men who choose this path, the surgeon will remove both testicles from within the scrotum. To preserve a more natural look, prosthetic silicone-based testicles can be placed within the scrotum. Alternatively, a subcapsular procedure can be done, whereby only the tissue inside the testicle’s capsule, or outer casing, is removed; because the capsule is left inside the sac, the testicle retains its shape. Regardless of how the procedure is done, recovery from surgery tends to be rather quick and no further hormone therapy is needed, making orchiectomy a very attractive choice for someone who prefers a low-cost, one-time procedure rather than undergo regular injections of LHRH agonists. Note that because sperm are generated in the testicles, men who undergo bilateral orchiectomy are rendered irreversibly infertile. (A discussion of ways to preserve sperm before treatment is in Chapter 3.)