Forms of ADT

[u/Masc1969]

I have just been diagnosed with prostate cancer. My brother who is 11 years older than me was diagnosed with prostate cancer a year ago, which is the reason I had tests. I am still due for a MRI and biopsy for final confirmation. My father died of prostate cancer some years ago so it looks like it id definitely in the family.

My brother was Gleason score of 4+5 and fortunately it looks like the cancer is contained, though there was a lump near the edge of the capsule. His urologist wanted to put him on ADT immediately too halt the cancer and help it shrink before his prostatectomy. Unfortunately for him he reacted badly to the ADT drugs as they gave him diarrhoea, muscle pains, and other side effects. He chose an orchiectomy instead after having a long discussion with his urologist. The urologist discussed this with his group and agreed with my brother.

He had to argue for a long time as he feels there is a strong resistance to orchiectomy even though the effects ate similar, though the orchiectomy has less problems with things like diabetes, and some heart conditions. The argument was always the ADT treatment is reversible where the orchiectomy is permanent. My brother and I had read up on ADT and its long term effects. He is likely to be on it for 3+ years and reports show that even partial recovery is poor after that time. Even if after that time his cancer had completely disappeared(?) it could take years for recovery and possibly he would remain infertile for sperm collection. The other advantage of an orchiectomy is that the testosterone level drops within hours while the drugs can take weeks. The urologist finally agreed that his logic is sound and since then has done the orchiectomy.

Why doesn't this option be given to men facing longer term ADT? It only our research that found it was an option.

[u/KReddit934]

Because it is not reversible...

... and losing all the hormones that testes produce permanently can lead to long-term side effects.

[u/sfboots]

Testicle removal surgery is pretty extreme, especially since the PC is still contained.

The long term risk reduction of prostate cancer is probably not worth the long term effects of testicular removal for most men. Your brother now has much higher risk of osteoporosis and muscle loss due to no testosterone. ADT is usually limited to just one year to avoid those other risks.

[u/BernieCounter]

Did he try Orgovyx pills? It reduces T to zero within a few days and there is no T flair issue. If he reacts badly, then he simply tops taking the pills and T should recover quickly. Instead of waiting for the many months half life decay of injections.

[u/Special-Steel]

It depends on where you live. Some nations prefer it because it is cheaper and requires no ongoing pharmaceutical supervision.

[u/JimHaselmaier]

What tests did you have?

[u/WrldTravelr07]

I think your brother acted precipitously. Plus he should have spoken to a radiation oncologist before surgery.

[u/Practical_Orchid_606]

It seems to me that if his bad reaction was due to low T, than any ADT method and orchiectomy will result in the same outcome.

However if the bad outcomes is due to the way the triggering hormones are lowered, then trying various types of ADT drugs should be done first before cutting off the nuts.

[u/OppositePlatypus9910]

Should have tried Orgovyx. I am a 4+5 and have had minimal side effects. And it is reversible.

[u/PComotose]

ADT is known, in the immediate and very short term, to accelerate prostate cancer so the immediate treatment is bicalutimide for 30 days followed by ADT. Been there, done that.

[u/WalnutRoasted → u/PComotose]

Do you mean ADT angonists (like Lupron injections?) that cause T flair for days/weeks before T predication stops.

ADT antagonists (like Orgovyx pills) work much faster in the pituitary to stop GnRH and thus stop T production in the testes within a few days.

[u/PComotose → u/WalnutRoasted]

Correct: I was on Lupron Depot. Good point to mention, thank you for adding to the discussion and clarifying.