Surgical castration

Surgical removal of the testicles, known as bilateral orchiectomy, is the easiest and oldest way to interrupt the effect of testosterone on prostate cancer cells. The operation can be performed in about 20 minutes under spinal or local anesthesia, and the patient can usually go home the same day. People on anticoagulant therapy may not be candidates for surgical castration, since they are at risk for uncontrolled bleeding.

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Surgical castration involves making a small incision in the scrotum and removing each testicle. Neither the operation nor the recovery is painful. In a variation of this procedure, called a subcapsular orchiectomy, only the contents of the testicles are removed. The empty shell of each testicle is left in place, resulting in a more satisfactory outward appearance. However, some surgeons do not use this technique because there is a risk that some testosterone-producing cells may be left behind. The effect of orchiectomy is almost immediate. Within 12 hours of the procedure, testosterone levels fall to what is known as the castrate range. Because it is so effective, orchiectomy is the standard to which all other hormone therapies are compared.

Even though it is the most effective and least expensive form of hormone therapy, only about a quarter of men choose surgical castration. Obviously, psychological issues influence the decision to have this operation, which cannot be reversed. Men who are psychologically troubled by orchiectomy may prefer medical castration. Medical treatments can be as effective as orchiectomy, and the side effects are similar. Despite these side effects, hormone therapy—whether surgical or medical—prolongs the life of most men.