After my orchiectomy, one of my doctors said to me that I would now probably never get prostate cancer. But I've also read that this belief has been rejected by many others in the medical profession. I know that this surgery often extends the life of males with advanced prostate cancer. What is the theory behind the notion that such precautionary surgery for someone with an-elevated PSA score, who might be precancerous, would not benefit from it? Why wait until the cancer appears and grows if it can be prevented, especially in older men who are not sexually active anymore? For me, my prostate is now very small and my PSA score is below normal, when it otherwise should be rising for someone of my age. Anyone knowledgeable in this topic care to comment on this disparity of thought?

unencumbered (imported) wrote: Tue Jul 22, 2014 4:25 am Anyone knowledgeable in this topic care to comment on this disparity of thought?

I might add that a fellow member mentioned to me that the testicles also produce a blood enzyme that may be the root cause of prostate cancer and not necessarily testosterone.

While prostate cancer is certainly less likely for someone who has been castrated, it is not impossible. There are at least a half dozen or so documented cases of Male-to-Female transsexuals in the medical literature – castrated and on estrogen - who have been diagnosed with PCa. One of my colleagues just last week saw a 70 year-old MtF with PCa, though she had only been castrated a few years before.

Castration, at least castration after puberty, will not prevent prostate cancer in all cases, but it will certainly reduce the odds of it occurring. The earlier the castration, the less likely that prostate cancer will occur. The reality is that castration can neither prevent nor absolutely cure prostate cancer. But, there's no question that castration, whether chemical or surgical, reduces the chances of the disease arising and significantly slows the progression of the disease should it occur.

It can also work in the opposite direction. Female-to-Male transsexuals may sometimes get cancer of the Skeen Gland, the female homologue to the prostate gland. There is also one documented case of a prepubertal eunuch (castrated at age 5 because of an accident) who was first put on testosterone at age 74 to treat diabetes. He quickly got an aggressive case of prostate cancer (Arai, et al. 2013).

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Arai, S., et al. (2013). Development of prostate cancer in a patient with primary hypogonadalism: Intratumoural steroidogenesis in prostate cancer tissues. Andrology 1: 169-174.

JesusA (imported) wrote: Tue Jul 22, 2014 2:06 pm While prostate cancer is certainly less likely for someone who has been castrated, it is not impossible. ...

Castration, at least castration after puberty, will not prevent prostate cancer in all cases, but it will certainly reduce the odds of it occurring. The earlier the castration, the less likely that prostate cancer will occur. .. But, there's no question that castration, whether chemical or surgical, reduces the chances of the disease arising and significantly slows the progression of the disease should it occur...

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Arai, S., et al. (2013). Development of prostate cancer in a patient with primary hypogonadalism: Intratumoural steroidogenesis in prostate cancer tissues. Andrology 1: 169-174.

This suggests to me that testosterone, while being the fuel for PC, may not necessarily be the initial agent. If there is an enzyme that is produced by the testicles, which triggers the cancer, then preemptive castration prior to being diagnosed having the disease would seem to be advisable in certain cases, for instance where a man's Gleason score is rising or his male siblings have a high instance of PC or even when he has reached middle age, before the inevitable cancer has a chance to take hold. If the enzyme is indeed the culprit, which has yet to be determined by the medical profession, then it would seem to me a low dose of HRT following a preventive orchiectomy, to avoid the negative side effects of the surgery, would not be inadvisable.

There is a lot of research to show that testosterone is an antagonist to prostate cancer, but does not cause it. Experts think that 5-15% of prostate cancers are linked to inherited gene changes that increase the risk of developing it. There isn’t a specific prostate cancer gene to explain most cases of hereditary prostate cancer. Instead, it’s thought that variations in several genes may be involved. Each variation only has a very small effect on a man’s risk. But men who have inherited several of these genetic variations may have a significantly increased risk of prostate cancer.

Reduction of testosterone is not a guarantee that you won't get prostate cancer. However, there is clear research that shows that prostate cancer patients with naturally low testosterone are less likely for it to spread outside the prostate before it is diagnosed.

The problem for most men is that by the time they are diagnosed it has already spread, usually to the bones or pelvic area, by which time it is too late.

I think the good news for eunuchs or those with low testosterone is that if the genes do get activated it is much more treatable.

jcat (imported) wrote: Thu Aug 14, 2014 6:26 am I think the good news for eunuchs or those with low testosterone is that if the genes do get activated it is much more treatable.

I think the question that remains unanswered is if castration keeps one's PSA score low and shrinks one's prostate to become tiny, do those indications in themselves mean that a eunuch will not contract prostate cancer ever in his future? If that is true, then prophylactic orchiectomies might be recommended for those men who are at higher risk of getting the disease in their mid-years.

unencumbered (imported) wrote: Thu Aug 14, 2014 1:03 pm I think the question that remains unanswered is if castration keeps one's PSA score low and shrinks one's prostate to become tiny, do those indications in themselves mean that a eunuch will not contract prostate cancer ever in his future? If that is true, then prophylactic orchiectomies might be recommended for those men who are at higher risk of getting the disease in their mid-years.

Castrated men do get prostate cancer. It may well be the case that it is due to the fact that it started before castration. The prostate is such an isolated organ with little blood supply, cancer can be growing for a long time before we are aware of it and the fact is that little is known about the 'incubation' period.

If Angelina Jolie can have her breasts removed because of a family predisposition to breast cancer.....

However, for men, preventative castration is not a consideration because of the origin of species theory about survival.....we are very reluctant to attack the jewels of civilisations survival!

All one can say is that castration lowers the risk.