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A 68-year-old male asked:

My dad is 68 years old. recently, he was dignosed with advanced prostate cancer with skeletal bone metastasis. what kind of hormone therapy shall he use? is orchiectomy ok?

4 doctor answers6 doctors weighed in
Dr. Terence Chapman
Urologic Oncology 27 years experience
Yes: Orchiectomy is nearly instantly effective in reducing testosterone levels and can be done as an outpatient. Alternatives include injections (lhrh agonists) to reduce testosterone levels. These are relatively expensive over the long term, but preserve the testicles which is why many men prefer this option. Surgery is permanent whereas shots can be withheld, but permanent may be best with bone mets.
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Dr. Thomas Namey
Rheumatology 49 years experience
Disagree...: As mentioned orchiectomy is permanent. There are other chemical options, including estrogen therapy as well as drugs which de-stimulate the pituitary from making lh and fsh. No direct proof confirms that testosterone per se is a cause. It may more be 5-dht. Men who lack 5-a-reductase do not get bald or prostate ca. Therefore drugs that block conversion to 5-dht may be used in tandem.
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Dr. Liawaty Ho
Hematology and Oncology 24 years experience
D/W your oncologist: Many options available for metastatic prostate ca- medical and surgical therapy. Orchiectomy can be done and will be for sure decrease testosterone permanently. Anti androgen tx like- Lupron (leuprolide) injection, oral casodex- or the newer oral agents that are more sensitive like x-tandi , abiraterone- are available. Not too forget- vaccine & chemo are available as well.Pls d/w oncologist in detail.
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Dr. Liawaty Ho
Dr. Liawaty Ho commented
Hematology and Oncology 24 years experience
Provided original answer
in addition, zometa or x-geva would be something that your father needs to get as well for his bone metastases.
Nov 8, 2012
Dr. Erik Goluboff
Urology 32 years experience
Orchiectomy OK but: The standard of care is an lhrh agonist (such as lupron, zoladex) injection combined with a drug taken by mouth called casodex. The Casodex should be used for a minimum of 1 month and then can be stopped. The advantage is that these injections can be as little as once every 6 months. Alternatively, a drug called Firmagon (degarelix) (an lhrh antagonist) can be given monthly without the casodex.
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Last updated Jan 5, 2019

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