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The testicles produce 90 to 95 percent of the male body’s testosterone and testosterone 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 prostheses, which
are made out of silicone. There are no studies that
show silicone prostheses have 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, 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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