Why Is Orchiectomy Used for Prostate Cancer?

What is an orchiectomy?

An orchiectomy is a surgical procedure that may be performed on men with prostate cancer. However, instead of operating on prostate cancer cells or developed tumors, the surgery involves the removal of the testicles or the tissues that line the testicles that produce testosterone.1

How does it affect prostate cancer?

An orchiectomy serves as a type of treatment option in the form of hormone therapy. Removing the testicles, or the tissue that lines the testicles and produces testosterone can lower overall levels of testosterone in the body. Prostate cancer cells are often fueled to grow by androgens like testosterone. When the supply of testosterone is depleted or reduced, tumor cells may be “starved off” and stop growing.1,2

The procedure itself

Orchiectomies are often inexpensive when compared to other hormonal, surgical, chemotherapy, or radiation treatment options, and the procedure is generally performed as an outpatient procedure, meaning it does not require an overnight hospital stay and an individual is home the same day. The procedure itself lasts around 30 minutes to complete and is performed while the individual getting operated on is under anesthesia. A urological surgeon or plastic surgeon often perform orchiectomies.

Depending on how far advanced an individual’s prostate cancer is, and what treatment effect the procedure is aiming for, different approaches may be used. Most commonly, these approaches include the simple orchiectomy (removing the testicles entirely), or the subcapsular orchiectomy (removing tissue surrounding the testicles and their lining that produce testosterone). Your provider will help you determine which option is right for you, and you will visit them for a follow-up appointment (or potentially multiple appointments) within several weeks.

It is important to note that orchiectomies are not intended to cure your cancer, but rather is performed to try to shrink existing tumors, prolong survival, and relieve pain. While having an orchiectomy may cut back on money, time, and other treatment hassles, it is important to recognize that the results of an orchiectomy are permanent. When hormone replacement therapy is administered using medications only, the side effects of treatment aren’t permanent and have the potential to reverse after treatment is stopped. With an orchiectomy, these side effects and life changes are permanent. Your provider will also help you weigh the pros and cons of each option to determine what is appropriate for your specific case and quality of life concerns.3

Physical appearance afterwards

Although every case may be different, basic recovery from an orchiectomy is expected within a week or two, with a full recovery expected in under a month. The penis is unaffected during an orchiectomy, and generally the scrotum (the skin sack that holds the testicles) is in tact as well. While sexual dysfunction may occur as a side effect of the procedure, the procedure does not affect the penile functioning. Additionally, a man who has had a simple orchiectomy where the entirety of the testicles are removed can also opt to have plastic or reconstructive surgery afterwards, and have artificial testicles inserted into the scrotum. Although the appearance will remain the same, the artificial testicles will not produce testosterone.

Risks and side effects of the procedure

The side effects of an orchiectomy are primarily related to sudden hormonal changes in the body. These changes include:

  • Hot flashes
  • Gynecomastia (enlargement of breast tissue)
  • Erectile dysfunction
  • Reduced sex drive
  • An increase in weight
  • Thinning of the bones (osteoporosis)
  • Reduction of muscle mass
  • Sterility

The major risks that can happen when having an orchiectomy include reactions to the anesthesia or other medications related to the procedure, bleeding, or infections. It is important to talk with your provider about any other medications or supplements you are taking prior to the procedure, as well as to disclose your full medical history. This is not an exhaustive list of potential side effects or risks of an orchiectomy. For a full list or to determine what side effects or risks may be the most pertinent or concerning for you, consult your provider.2,3

Combination therapy

Depending on your specific situation and what the aims of your treatment are, you may be prescribed additional treatments on top of the orchiectomy. These treatments may include radiation, chemotherapy, additional surgery, or additional hormone therapies in the form of medications. The best treatment plan for you will be discussed between you and your healthcare team, and will be constructed based on the stage of your cancer, the aggressiveness of your cancer, the side effects you’re concerned about, and potential effects to your fertility, among others. Much research has been done to evaluate different combinations of therapies, as well as to make attempts to minimize quality of life-impacting side effects and fertility concerns.4,5

Written by: Casey Hribar | Last reviewed: October 2017
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