Most of our testosterone is made in out testicles, so the first stage of hormone therapy to treat prostate cancer is to prevent them from making any androgens. Testosterone is said to “feed” prostate cancer, so stopping the creation of testosterone controls prostate cancer progression.

We have a number of ways to limit the production of testosterone by the testicles. The oldest method is by surgical castration (orchiectomy) where the testicles are surgically removed.   An orchiectomy of a man with advanced metastatic prostate cancer is associated with lower risks for adverse effects compared to men who underwent medical castration with gonadotropin-releasing hormone agonist (GnRHa) therapy (chemical castration), according to an article published online by JAMA Oncology.

In the United States, the use of bilateral orchiectomy has been nearly eliminated because of cosmetic and psychological issues felt by many men. In less developed nations an orchiectomy is more common because of its lower cost.

Quoc-Dien Trinh, M.D., of Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, and coauthors compared adverse effects of GnRHa and bilateral orchiectomy in 3,295 men with advanced prostate cancer between 1995 and 2009. The researchers evaluated six major potential adverse effects, which were selected based on their effect on a man’s quality of life and the poten