If you prefer not to undergo surgical hormonal therapy, there are drugs which can stop the production of androgens. The most common drugs are LHRH agonists and LHRH antagonists. The aim of these drugs is to stop the growth of the tumour by chemical castration. How they do this varies for each group of drugs. Each drug is different in how it is applied. If you have a history of cardiovascular disease, your doctor will advise you to see a cardiologist before starting with hormonal drug therapy.
With time, prostate cancer cells become resistant to hormonal therapy, and the cancer will start to grow again. This is known as castration-resistant prostate cancer. To delay castration resistance, your doctor may recommend to pause the hormonal drug therapy. This is called intermittent hormonal therapy.
How is bilateral orchiectomy performed?
During surgery, you will lie on your back. You generally receive local or spinal anaesthesia. In some cases your doctor may recommend general anaesthesia. The surgeon makes an incision in the scrotum to remove both testicles. Because the tissue that surrounds the testicles is not removed, the scrotum will not look totally empty.
How do I prepare for the procedure?
Your doctor will advise you in detail about how to prepare for the procedure. If you need general anaesthesia, you must not eat, drink, or smoke at least for 6 hours before surgery. If you are taking any prescribed medication, discuss it with your doctor. You may need to stop taking it several days before surgery. Your doctor will advise you on when you can start taking it again.
What are the side effects of chemical castration?
Hormonal therapy stops the production or blocks the action of male hormones, and causes castration. Your body can react to castration in different ways.
The most common side effects of castration are:
Lower sex drive
Increased risk of heart disease
You could also experience pain, for example in your joints, your back, your bones, or muscles.
Changing hormone levels can affect your blood and cause high blood pressure, dizziness, and bruising. You may also be at higher risk of infection, especially in the nose or throat, or urinary tract infections.
Loss of appetite and weight loss can also be a result of castration. These may be related to diarrhoea, constipation, or vomiting caused by the hormone changes.
Other side effects may include coughing, shortness of breath, headaches, and peripheral oedema.
The different treatments may cause side effects as well.
LHRH antagonists may cause an allergic reaction.
Anti-androgens may cause swelling of your breasts. This is called gynaecomastia and can be painful in some cases. To prevent gynaecomastia your doctor may recommend radiation therapy of your chest before the start of the hormonal therapy. In rare cases, you may need surgery to remove the mammary glands.
Anti-androgens could worsen hot flushes. These can be treated with low-dose oestrogens. Oestrogens can increase the risk of heart disease. Flutamide can cause diarrhoea.
How bothersome the side effects of hormonal therapy are, and when they appear, varies from person to person. This is related to your general health and the type of treatment you get.