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The testicles produce 90 to 95 percent
of the male body’s testosterone, which fuels the
growth of prostate
cancer. Prostate cancer hormone therapy works by
removing the testicles and “starving” the
prostate cancer by depriving them of testosterone. The
removal of testosterone from the body will slow the
growth of the prostate, but the removal will not destroy
cancer. Eventually the body will readjust and the prostate
cancer will continue to grow.
Castration is also called orchiectomy
or surgical castration. Surgical castration is the removal
of the testicles, not the scrotum, which is a sac that
contains the testicles. Patients who undergo surgical
castration may also opt for testicular
prosthesis, which is made out of silicone.
There are no studies that show silicone prostheses having
any negative effect on general health, as in the case
of silicone breast implants.
For the operation, some men do not
require general anesthesia, but light sedation and local
anesthesia. The surgeon makes a small incision in the
scrotum, through which the testicles are eased out.
The surgeon then clamps and sutures the blood vessels,
removes the testicles, then closes the incision. Most
patients return home the same day or the next, depending
on their general health before the operation.
The goal of surgical castration
is to have the testosterone level drop to what is called
castration level. Since the testicles make about 90
percent of the body’s hormones, testosterone drops
within 3 to 12 hours. Patients with prostate cancer
bone
metastasis often immediately feel symptoms
such as bone pain, but it will begin to subside. Researchers
are still debating whether or not the 5 to 10 percent
that’s left circulating in the body have a significant
affect on the desired results. If orchiectomy patients
opt for an anti-androgen to ablate the remaining
testosterone, it is called combined androgen blockade.
Orchiectomy was once the only option
for hormone therapy in prostate
cancer treatment. Hormone therapy, therefore, was
used only as a last resort because the effects of surgical
castration are not reversible. Understandably, many
men today will opt for chemical castration through the
LHRH and GnRH antagonists and agonists because their
effects are reversible once medication is stopped.
Castration is
not reversible, though some men opt for orchiectomy
because LHRH and GnRH agonists and antagonists can be
very costly, in addition to causing more unpleasant
and severe side effects.
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