Orchiectomy, a form of hormone therapy, involves surgically removing the testicles. Orchiectomy, or surgical castration, immediately and permanently deprives cancerous prostate cells of testosterone.

What should I know?
Prostate cancer is a hormone-sensitive cancer, meaning its development is stimulated by male hormones, specifically androgens and testosterone. Often used in the treatment of more aggressive or advanced cancers, hormone therapy works by preventing your body from secreting or using these hormones, slowing the growth and spread of your cancer.

Used alone, hormone therapy doesn’t cure prostate cancer, but it can shrink tumors, control cancer, and help extend your life. There are three main types of hormone therapy for prostate cancer:

• Injections to stop testosterone production;
• Tablets to block the effects of testosterone;
• Surgery, called orchiectomy, to remove the testicles.

If you are considering orchiectomy, your doctor may recommend trying injections first for a certain period. This allows assessing your response to the side effects of low testosterone.

Rarely considered nowadays
Today, reducing testosterone levels is more commonly achieved with medication rather than testicle removal.

Although generally unpopular, orchiectomy may be considered for patients who cannot receive hormone therapy, those no longer willing or able to travel for injections, those intolerant to injections, or for men with prostate cancer requiring lifelong hormonal treatment who prefer an alternative to regular injections.

Procedure overview
This procedure is performed under regional anesthesia as an outpatient surgery and takes less than 30 minutes. It involves making a small incision in the scrotum and removing both testicles. The empty scrotum is then closed, and the scar is barely larger than that of a vasectomy. Typically, this operation does not require hospitalization. It is well-tolerated, and most patients can resume normal activities within two or three weeks.

Post-surgery risks
Surgical castration entails very few complications. Typically, postoperative pain, scrotal swelling, and wound bleeding are minimal. As with any surgical procedure, there is a risk of infection at the incision site. You will receive detailed instructions on your recovery process and when to consult your doctor immediately. These instructions may include:

• Wearing a jockstrap or snug underwear for a few days to help reduce swelling;
• Using ice to reduce swelling;
• Keeping the incision clean and dry;
• Taking ibuprofen or another non-steroidal anti-inflammatory drug (e.g., Advil, Motrin) for pain and swelling;
• Avoiding intense physical activities, such as lifting heavy objects and jogging;
• Drinking plenty of water and eating fiber-rich foods to maintain regular bowel movements.

Contact your doctor if you notice increased swelling, pain, or fluid leakage at your wound site; this could indicate a wound infection requiring antibiotic treatment.

Hormone therapy-related side effects
After an orchiectomy, various hormone therapy-related side effects may occur, including hot flashes, erectile dysfunction, decreased libido, weight gain, and others. It is essential to discuss these effects with your doctor to establish appropriate management. This guide on hormone therapy also aims to provide useful tips for managing your side effects and taking care of yourself.

Is it reversible?
It is crucial to note that orchiectomy is not reversible, requiring thoughtful decision-making. Although considered minor, this operation requires a thorough understanding of its implications, such as the permanence of side effects. Therefore, you will need to take the time to discuss it with your doctor before consenting to this intervention.

What if cancer continues to develop?
Depending on your specific situation and treatment goals, additional treatments may be prescribed in addition to orchiectomy. Your doctor will discuss your treatment plan with you.

References
Prostate Cancer – Understand the disease and its treatments; Fred Saad, MD, FRCSC and Michael McCormack, MD, FRCSC, 4^th et 5^th editions
Treatment options: Hormone therapy

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All About the Effects of Hormone Therapy

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