Castration & Prostate Problems

There are three common disorders of the prostate that primarily afflict older men: prostatitis, or inflammation of the prostate; benign prostatic hyperplasia (BPH); and prostate cancer. Prostatitis is generally treated with antibiotics. Castration--typically chemical but sometimes physical--is sometimes used to help treat prostate cancer by reducing the level of androgens (male sex hormones) in the bloodstream, and some studies have examined the utility of chemical castration in treating BPH as well.

Androgen Deprivation Therapy (ADT)

Androgen deprivation therapy (ADT) or "chemical castration" is one approach to controlling or managing prostate cancer. Physicians administer drugs including leuprolide, goserelin, triptorelin or degarelix that block the production or activity of androgens (male sex hormones). Because androgens promote cell division in the prostate, reducing androgen levels in the bloodstream often slows the growth of prostate cancers. ADT is generally used as an adjunct to other treatments. There is some controversy among physicians about the appropriate time to begin ADT and whether intermittent ADT is better than continuous treatment.

Orchiectomy and Prostate Cancer

Orchiectomy is the surgical removal of the testicles (physical castration); like chemical castration, orchiectomy reduces the levels of androgens in the bloodstream and thus is sometimes used to help manage prostate cancer. It's irreversible, however, so it's a far less common approach than "chemical castration" or ADT. Nonetheless, orchiectomy remains an option for patients who so choose. Doctors can typically replace the testicles with silicone sacs to preserve a normal appearance.

BPH and Chemical Castration

Benign prostatic hyperplasia (BPH) is a condition characterized by an enlarged but noncancerous prostate; difficulty in urinating is a common symptom. It is noteworthy that neutered dogs are at much lower risk for BPH, and that castrated men seldom if ever develop BPH in old age. A few studies have sought to assess whether "chemical castration" might be a viable therapeutic approach for treatment of BPH; a 2006 study published in the "Journal of Clinical Endocrinology," for example, tested the effects of a drug that suppresses testosterone production in healthy men. In general, however, BPH is usually treated with drugs such as finasteride, with surgery or with a conservative "wait-and-watch" approach for mild symptoms rather than with the kind of drugs used as part of ADT for prostate cancer.

Benefits

Chemical or physical castration, collectively called ADT, reduce the levels of androgens, such as testosterone, in the bloodstream. Androgens promote cell growth in the prostate, so ADT can help to manage prostate cancer and is indeed a common approach for that condition. ADT is generally used in conjunction with other treatments such as chemotherapy, surgery or radiotherapy.

Side Effects

Chemical or physical castration for prostate cancer can cause a number of side effects, including reduced or absent libido, impotence and hot flashes. Many men may find these side effects distressing. If you have any questions about chemical or physical castration and your condition, consult your doctor.

References

• American Cancer Society: Detailed Guide: Prostate Cancer Hormone (Androgen Deprivation) Therapy
• "Reviews in Urology"; Androgen Deprivation Therapy in the Treatment of Advanced Prostate Cancer; Perlmutter & Lepor; 2007
• IDEXX VetConnect: Prostatomegaly
• "The Journal of Clinical Endocrinolgoy & Metabolism"; Persistent...; Lin Page, et al.; 2006
• National Institute of Diabetes and Digestive and Kidney Diseases: BPH

Resources

• Cancer Research UK: Orchidectomy & Prostate Cancer