Surgical removal of a man’s testicles (also called an orchiectomy) is the easiest and least expensive way to control testosterone. As surgical procedures go, it’s simple. The operation can be performed under spinal anesthesia or, if the patient is not strong enough to tolerate this, even a local anesthetic. This is what happens: A surgeon makes a small incision in the scrotum, and brings out each testicle individually through this opening. Then the surgeon cuts the vas deferens and blood vessels that supply each testicle, and the testicles are removed. Some surgeons perform what’s called “subcapsular orchiectomy.” In this operation, the surgeon opens the lining to the testicles and empties the contents of each testicle. The lining is closed again, and this empty shell is placed back inside the scrotum—so nothing looks different; in other words, no one can tell from outward appearance that there’s nothing inside the scrotum. The basic differences here are cosmetic—and therefore psychological—and for some men, this makes the thought of castration easier to accept. However, some surgeons don’t like to perform this operation because they worry that some testosterone-producing cells may be left behind.

After surgery, patients usually can go home from the hospital the same day—or, at the very latest, the next day. The only major complication to worry about with surgical castration is bleeding. However, this shouldn’t be a problem if the surgeon makes a point of checking that all bleeding is stopped before the scrotum is closed, and that a compression dressing is left in place to control the smaller, harder-to-see blood vessels.

Castration works fast; it reduces the body’s amount of testosterone by 95 percent almost immediately, and permanently. Boom—within about three hours after surgery, testosterone levels begin to plummet to a level called the “castrate range.” This is considered the gold standard, an important point of comparison in monitoring hormone therapy—as certain drugs are judged by their ability to reduce testosterone to this range.

Some doctors used to believe that several months after castration, the body began producing more testosterone at other sites—and that this was the reason prostate cancer continued to grow This is not true. There is no delayed increase in testosterone and anyway, that’s not why prostate tumors keep growing—they continue to spread because of the cancer cells that are not affected by hormone therapy.

What happens to the prostate tumor after castration? It begins to shrink, and men with symptoms of obstruction or pain caused by the cancer begin to feel better right away.

Castration’s advantages are that it’s effective almost immediately and that its results are permanent—there’s no need to take daily medication. And, because it is a “one-shot” treatment, it’s relatively inexpensive.

*170\201\8*

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