Orchiectomy
is the surgical removal of the testicles, which produce the
majority of the body’s testosterone. Although a surgical
procedure, orchiectomy is considered hormone therapy because
its purpose is to stop testosterone production.
Orchiectomy
is a relatively simple surgery that is usually performed as
an outpatient procedure. The operation may be performed under
local or general anesthetic. A small incision is made in the
scrotum, the sac that contains the testicles. The testicles
are detached from blood vessels and the vas deferens
(the tube that carries sperm to the prostate before ejaculation)
and the sac is sewn back up.
After surgery
- To
reduce post-operative swelling, ice packs should be applied
to the scrotum for the first 48 hours following surgery.
The ice pack should not be placed on the scrotum without
an intervening, protective layer of clothing or cloth.
- The
site of the incision should be kept clean and dry. In the
days following the procedure, the site should be washed
with a diluted hydrogen peroxide solution. An antibiotic
ointment may also be recommended.
- Patients
should avoid heavy lifting and strenuous activity for one
to two weeks following surgery.
Possible risks and complications
The
primary risks of orchiectomy, infection and bleeding, are
extremely rare occurrences. Death is a risk of all surgery
involving general anesthesia, but is an extremely rare occurrence
with this procedure.
Advantages of orchiectomy
The
procedure is relatively inexpensive, simple and has few risks.
It needs to be performed only once and is effective almost
immediately. Testosterone levels drop dramatically and the
patient often has rapid relief from cancer symptoms.
Disadvantages of orchiectomy
Many
men are very uncomfortable with the idea of this kind of surgery.
Orchiectomy is an irreversible operation. Concerns about body
image or self-image may lead men to choose a non-surgical
option. Surgery, even a relatively simple procedure, carries
risks related to anesthesia and bleeding.
Testicular prosthesis
Some
men opt to have a testicular prosthesis, or artificial
testicles, placed inside the scrotum to replace the testicles
removed during surgery. The prosthesis makes the scrotum look
much as it did before surgery. Men interested in this option
should speak to their urologist.
Follow-up testing
- PSA blood levels are initially monitored every
one to three months and then every three to six months.
- Since
anemia is a common side effect of long-term androgen deprivation,
blood tests are taken periodically after surgery.
- Dual
energy x-ray absorptiomety, or DEXA scanning
is a common test for osteoporosis, in which an x-ray machine
measures bone mineral density.
Side effects of orchiectomy
- Diminished
libido (sexual desire) occurs in 90 percent of
men undergoing hormone therapy.
- Erectile dysfunction
(inability to achieve or maintain an erection adequate
for intercourse) occurs in 90 percent of men undergoing
hormone therapy.
- Hot
flashes are similar to those experienced by women
during menopause. They are characterized by a sudden spread
of warmth to the face, neck and upper torso, usually followed
by profuse sweating. Although uncomfortable, hot flashes
pose no health risk. Their effects may be controlled with
medication.
- Weight
gain of 10 to 15 pounds is a common occurrence.
- Mood
swings are common with hormone therapy.
- Depression
may occur with hormone therapy. It may be attributed
to a variety of causes, including the treatment itself,
reaction to side effects, or other cancer-related issues.
Symptoms of depression include feelings of hopelessness,
loss of interest in usually enjoyable activities, inability
to concentrate and changes in appetite and sleeping patterns.
Men experiencing depression are advised to speak to their
physician or other member of their health care team about
available resources for depression.
- Fatigue
is a feeling of extreme tiredness that may not
be alleviated by rest or sleep. It is caused by decreased
testosterone production.
- Anemia
is a deficiency of red blood cells in the bloodstream,
resulting in reduced oxygen to tissues and organs and
feelings of tiredness or weakness. Anemia can be treated
with medications, vitamins and minerals.
- Loss
of muscle mass may manifest as decreased strength
or weakness. A careful exercise program with progressive
weight-bearing activities will improve strength.
- Osteoporosis,
a long-term effect of hormone therapy is a
loss of bone mineral density where the bones become thinner,
more brittle and at increased risk for breaking. It is
the same condition experienced by women in menopause.
Osteoporosis can be treated with medications, calcium
and vitamin D. An exercise program with progressive weight-bearing
activities will also help strengthen bones.
The
Prostate Cancer pages of this Web site are part of the Comprehensive
Prostate Cancer Awareness Program (CPCAP), a major regional
effort to reduce the rates of death and illness caused by
prostate cancer in southwestern Pennsylvania. Funding for
CPCAP is provided by a grant from the Commonwealth of Pennsylvania.
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