HRT V/S Castration--which best for impotent guy?

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James C.
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Date Joined Aug 2007
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   Posted 11/4/2010 2:41 PM (GMT -6)   
Ok, let's say a guy has been down the surgery/radiation road, in any of its forms, and still has active cancer growth. The oncologist is suggesting hormone therapy or surgical castration for a 66 years old fellow. This guy is completely impotent from the surgery, nerves spared but even after 7 years there's still absolutely no response to anything but penile injections, which get the job done when needed. He says he doesn't miss sex that much and his libido is really down. If left to his own devices, he'd musterbate once in a while to relief the pressure. His wife considers the situation a blessing in disguise, as she has no interest in lovemaking.

He's concerned about the physical and mental side effects of HRT and wonders if surgical castration wouldn't be preferrable, considering his sex life and situation as it is now. Just what differences would be experienced, both physically or mentally (turning weepy, etc, watching HGTV, you know what I mean) if he chose castration rather than HRT. Is there anything about HRT, rather than the obvious regaining erection ability possibly in the future for someone who is able to do that, to indicate he should choose HRT instead? . Any other things that the procedure would do, plus or minus, that would allow him to avoid the horrors (to him) of HRT?

If it were you, what would you choose? devil
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh
ED continues: Bimix .30cc & Trimix .15cc PRN

Post Edited (James C.) : 11/4/2010 1:44:20 PM (GMT-6)


142
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Date Joined Jan 2010
Total Posts : 7078
   Posted 11/4/2010 2:57 PM (GMT -6)   
Wow. A question that came to mind while grossly over-thinking what will happen if I see a PSA rise.
 
I would, based on what I am getting as the side-effects from HT, still prefer to do something that is reversible. Who knows what next month or next year will bring.
So, if those were my only two choices, I would probably go the HT route until I could decide that I could/could not take the side-effects.
Cutting is so permanent -

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/4/2010 3:03 PM (GMT -6)   
James, I am not capable of answering or giving a good guess to your question, but I found it a thought provoking question. Will be interested in seeing what responses it draws.

david
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 374
   Posted 11/4/2010 3:12 PM (GMT -6)   
Interesting hypothetical, James. I'm going to pose this one to a guy in my local PCa support group who's actually had an orchiectomy and underwent radiation as a primary treatment. He's 80 now, mind you, but doesn't look or act a day over 65....he's quite an active advocate nationally, and provides a different perspective at our meetings-----13 yr. survivor who had metastatic cancer when diagnosed.
 
Arnie

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 11/4/2010 3:19 PM (GMT -6)   
James, tough question.

I just wanted to wish you good luck for your November PSA test (referenced in your "my turn in the barrel?" thread...

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 11/4/2010 3:36 PM (GMT -6)   
I would go with HT no matter what. I can't imagine physical castration even though that same question was posed to me when I started ADT3 but there was not a scenerio that existed that would have caused me to have those wonderful objects removed. So with that for me it is a simple question whether you are having sex or not. Again though this is just me

peace to you
dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009. I am currently (7-22-2010) not on any medication.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
PSA July 22nd of 2010 is .71
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 11/4/2010 4:26 PM (GMT -6)   
Before the advent of the chemical castration drugs, orchiectomy was the standard treatment. It has several advantages..It's cheap. It's fast acting. it results in the lowest possible "T" count and there are no side-effects from drugs. No recurring costs or blood tests to verify testosterone levels..

The downside is the psychological impact of castration and the permanent nature of the procedure..But many, many PC patients will tell you that after two or three years on Lupron, the effect of the drug might as well be permanent..Even if discontinued, (a long-shot) libido and sexual potency seldom return..Younger men stand a better chance of recovery but for those over 65, the road back can be a steep climb..Men like to dream of what it was like when they were 18 and Lupron lets them do that. It's also a multi-billion dollar a year industry which creates a big headwind against surgery..

Breast cancer is treated much the same way...But a females hormone levels are much more complex and changes with the moon..Drugs are available, but surgical removal of the ovaries is the most effective method to achieve BC remission..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
age 61: 5.2
age 64: 7.5, DRE "Abnormal"
age 65: 8.5, " normal", biopsy, 12 core, negative...
age 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
age 67 4.5 DRE "normal"
age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 11/4/2010 4:45 PM (GMT -6)   
Casey59, thanks for the wishes, but my Nov. test was taken early (Oct. 3) so I could have a current one, sorta, for the Radiation Oncologist referral. I cancelled the Nov. one. It was another .09, matching my GP's Sept. test. Any of that make sense? My next tests will be in Feb. one from the GP and the Urologist. The rad. oncologist and I agreed to start 4 months testing and see what happens. He is of the conservative camp of wanting to see at least one .2 before doing anything, but I am now setup , foot in the door and ready, if I need to go that route. He said he has had several guys referred to him early in their progression that reach a nadir of around .1 and stayed there for years. So we will see.
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh
ED continues: Bimix .30cc & Trimix .15cc PRN

Post Edited (James C.) : 11/4/2010 3:48:52 PM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/4/2010 4:49 PM (GMT -6)   
OK, thanks for update. I was out-of-the-loop for a period between that ealier "barrel" thread and now, and must have lost track then. Hang in there...

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 11/4/2010 5:13 PM (GMT -6)   
After rereading my question and a little thought, I think what I wanted to ask was does HRT offer anything extra, more or add anything chemically to fight PCa , other than reducing testostrone, thus starving the PCa cells? Is the operation the same result as obtained by the HRT?

On further thought, I wonder if the operation is a one shot deal, whereas there are different forms of HRT to go through before you become resistant? Would using varying forms of HRT extend the fight, or does the operation cut (sorry) to the root of it all and stop it dead, until reoccurance?
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh
ED continues: Bimix .30cc & Trimix .15cc PRN

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/4/2010 5:32 PM (GMT -6)   
James,
My treasurer at UsTOO was faced with this decision and he elected to have the orchiectomy. But his circumstances were extreme. Basically he was on ADT3 and was being treated by Mark Scholz for 5 years. He stopped the ADT3 about 2 years ago but relapsed last December. He switched doctors to Nick Vogelzang and Nick told him that he would remain on homonal therapies for the remainder of his life. He suggested that instead of the chemical castration that he would do better with the orchiectomy since the SE's of ADT were a bad experience for him. After he had his orchiectomy he also tried Nilandron, DES, and currently he is on round 3 of Provenge. If they don't get it here he is headed to chemo.

He said the orchiectomy was a breeze and he does not have as many side effects as when he was on ADT3.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 11/4/2010 5:39 PM (GMT -6)   
Interesting post James. I have actually thought along the same lines. A thread by Luvmydad on 5/10 raised the HT question. Some felt it could be effective for 5 years, some 10.

So, if I am 66, and I am on HT for 5 to 10 years before the PC goes refractory, I may be 71 to 76 before I begin to get my T back, in the midst of PC going refractory. Odds are I won't need my nuts thenm either. And if mama isn't interested now, she surely won't be in 5 to 10 years. I probably won't too many years with PC left, or whatever other 75 yr old malady i may have.

Would I have hot flashes ? Probably not as severe as the Lupron caused ones. Plus there is all the other data about heart attack and stroke, etc. cause d by HT. I am going to assume those problems are caused by the HT drug, not the lack of testosterone.

It really is not an illogical thought. The biggest hurdle is probably psychological, having your nuts cut off. Maybe I could have the dock out a couple of steel abll bearings in there. Then I could brag about balls of steel. Won't the TSA person at the airport be impressed ?
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 11/4/2010 5:44 PM (GMT -6)   
Are the side effects of castration the same as ADT? In what way are they different?

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2217
   Posted 11/5/2010 5:54 AM (GMT -6)   
There are:
a risk issue - surgery may result in complications. Drugs may cause health problems (not HT side effects but nastier stuff) I know of a guy who had terrible complications from a vasectomy for instance.

a reversibility issue - what if a super new drug/treatment comes along just after you've had surgery? If you're on the "old" drug you can stop and switch to the new one.

Psychological/Masculinity issues: ED can depress guys, loosing the nuts can too. (if the no-testosterone life makes you "weepy" you may give yourself something very big to weep about too.)

comparison of side effects: does the removal of testosterone, by which ever means, result in the same side effects and the same severity of side effects due to the hormone-related alterations to your body chemistry (weight gain, loss of bone, loss of muscle, hot flushes, emotions, etc etc)

It needs some kind of mathematical model/nomogram into which you can enter a variety of factors and not just one or two.

I'm not there yet, but personally I'd not opt for surgery on the basis of what I know and how I feel in 2010.

Alf

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 11/5/2010 4:08 PM (GMT -6)   
Suppose a guy has the orchiectomy, and that controls his PCa. Could he then have intermittent testosterone therapy, a sort of reverse ADT? If the side-effects of that therapy are much less than those of ADT, that is a plus factor for the orchiectomy.
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