The prostate gland is part of the male reproductive system. Located bellow the bladder, near the rectum and around the urethra, the prostate is responsible for producing a fluid that nourishes and protects sperm and is expelled with the sperm as semen during the ejaculation. Diseases of the prostate are particularly common among older men, and prostate cancer is the second most common type of cancer among Americans. There are, nonetheless, numerous treatment options to address the condition, including watchful waiting, surgery, radiation therapy, cryotherapy, hormone therapy, chemotherapy, vaccine treatment, and bone-directed treatment.
Testosterone and dihydrotestosterone (DHT) are the two main male sex hormones and are called androgens. These androgens are produced by the testicles, adrenal gland and prostate cancer tumor itself, and they promote the growth of both healthy and cancerous prostate cells. Therefore, hormone therapy, also called androgen deprivation therapy (ADT) or androgen suppression therapy, focuses on decreasing the levels of androgens in the body or on stopping them from affecting prostate cancer cells. Hormone therapy can be conducted with drugs or surgery. It does not cure cancer, but it is particularly indicated for patients whose cancer has spread too far to be cured by surgery or radiation or whose cancer remains or reoccurs after other treatments.
Orchiectomy Procedure in Patients with Prostate Cancer
Orchiectomy is the name given to the surgical procedure to remove the testicles. The procedure is considered a type of hormone therapy, since its main purpose is to reduce the production of testosterone by the body. There are two types of orchiectomy. During a simple orchiectomy, the surgeon removes both testicles by making an incision in the front of the scrotum, while a subcapsular orchiectomy consists of the removal of the tissue from the lining of the testicles, which is where testosterone is produced. In either of the cases, both the penis and the scrotum remain intact. This procedure is considered a simple surgery, no more complicated than a vasectomy.
It usually takes less than 30 minutes and can be performed as an outpatient procedure or with a short hospital stay. In the case of simple orchiectomy, patients may have artificial testicles (saline implants) placed during the surgery, but it is not necessary in the case of a subcapsular orchiectomy because the scrotum remains nearly normal-looking. Patients are often able to return to their normal activities one or two weeks after the surgery and full recovery is expected two to four weeks following the orchiectomy. However, orchiectomy is becoming less common with the development of drugs to reduce testosterone levels. Some patients may feel more comfortable by keeping their testicles, while others may prefer one procedure to a continued treatment with injections.
Benefits and Risks of Orchiectomy to Treat Prostate Cancer
“Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens (testosterone and DHT) are made,” states the American Cancer Society, emphasizing the advantages and disadvantages of this procedure. “This causes most prostate cancers to stop growing or shrink for a time. This is done as an outpatient procedure. It is probably the least expensive and simplest form of hormone therapy. But unlike some of the other treatments, it is permanent, and many men have trouble accepting the removal of their testicles. Some men having this surgery are concerned about how it will look afterward. If wanted, artificial testicles that look much like normal ones can be inserted into the scrotum.”
In 90% of the men who undergo an orchiectomy, the tumor stops growing and starts to shrink. The main benefits associated with an orchiectomy are the decrease of testosterone production and suppress cancer growth, which is expected to relieve the symptoms of the disease, prevent complications and prolong survival in patients with advanced prostate cancer. It may be used in combination with radiation therapy in patients with high risk of cancer recurrence or before radiation to shrink the cancer and improve the effectiveness of the treatment. However, there are also risks and adverse effects associated with the procedure, including sterility, lower libido (loss of sexual interest), erectile dysfunction, hot flashes, larger breasts (gynecomastia), weight gain, loss of muscle mass, and thin or brittle bones (osteoporosis). The emotional burden associated with the removal of the testicles should also be considered prior to the procedure.
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