Treatment of by Castration?

When treatment time and choice need to be decided it looks like I will need to have a very lengthy list of questions to first be answered. Many of these result from the helpful community postings for which I’m very grateful, so thanks to all.

Mike

There are a number of support groups spread around the country - if you google 'prostate cancer support group local' it should bring up a list. Many groups have been meeting on Zoom during the pandemic though. Andy (a member here) also runs or is involved in a support group in his area which has attracted men from all over the country for its virtual meetings.

I was diagnosed in 2017 age 59 with stage 4 metastatic Gleason 9 PCa, and started Prostap jabs. 
Severe acute idiopathic pancreatitis in November 2018 - considered unlikely to be associated with the Prostap, but possible. A very nasty life threatening event which saw me opt for a bilateral subcapsular orchidectomy in February 2019. The Consultant Urologist said castration was all they used to do. They have plenty enough practice both back then, and with testicular cancer now. He said they’d not been asked for it for about twenty years for PCa, but commented that he thought they ought to do more of them. They don’t bother to offer the option as so very few would take it. 
I remember a retired GP on here a few years ago who was determined he wanted it. He didn’t like pharmaceuticals. Ironic. 

The very vast majority of the subcapsular tissue is the glandular testosterone making stuff. They may or may not even bother to leave to remaining bit that make sperm at the end; Rendered useless anyway.
At first the capsules are engorged with blood, and it’s like being billy big b*ll*s, however this subsides slowly - it takes months, maybe a year or so, and there’s not much left then to be honest.
It all carries on shrivelling away to nothing anyway just the same as the jabs.

One doctor told me that she thought orchidectomy has fewer side effects because all chemicals have other side effects that those intended, although of course the main “side effects” of the treatment are simply the effects of no testosterone.

Personally I don’t think it makes much difference really. Bear in mind, it’s not quite the minor procedure you may think it is, and it may take a few weeks to fully recover. It’s not hard core, but distinctly uncomfortable if you cross your legs wrong etc., for a while.

My PSA has been on the rise, and I’m quite poorly now really. I’ve had my maximum two high dose pelvic palliative radiotherapies, and am on Enzalutamide. Consultant Onco. says it’s a matter of symptom control now.

Fortunately the nasty symptoms are a bit better now than they were in November-December, and I don’t know, but  after that bout of real awfulness, I do wonder whether if, or when, the time comes when I want to throw the towel in, I’ll regret having had surgical castration…? 

All in all and in my opinion, I don’t think it makes much difference really which you choose. Either works, it’s the same treatment. It’s not wrong to have castration, it’s the most common form of treatment worldwide.

Edited by member 21 Feb 2022 at 15:59  | Reason: Not specified

This has been a depressive read Michael, I can see that you have had a very rough time and you have my sympathy. Your comment at the end is intriguing, “when the time comes to throw the towel in” etc. What difference at that stage would the choice you made affect the outcome?

Keep positive, Mike

Hi again J,I’ve now been able to read the info on the link you provided and once beyond the reams of statistical jumbo-jumbo the summary is very specific in that surgical castration has some significant benefits over the chemical option. At the moment unless I discover, or perhaps advised by my Consultant, that this isn’t advisable I’ll go for surgery. Frankly I have no need to consider anything for this other than learning that the aftermath of surgery can result in very bad side effects in a significant percentage of such treatment. I would hope that the consultant, since agreeing to carry out the operation, having since learned this would be duty bound to tell me before treatment starts. I certainly now have a long list of questions to ask before treatment starts, this helped by all the responses by those on this Forum - many thanks to all.