Dear Dr G

I was diagnosed with prostate cancer a few months ago. Following a prostate cancer awareness week, I built up the courage to go for a PSA blood test. I was shocked when I realised my PSA was more than 100, when the normal is just less than 4. I went for a biopsy, which confirmed high-grade prostate cancer.

Sadly, the follow-up scans all confirmed the cancer had spread to the bones. The doctor said it was too late for robotic surgery or radiation, however, he assured me the cancer is still treatable with hormones. Although I was relieved, the cancer was still treatable, I am still rather concerned about the treatment planned for me.

I was given the choice to have the injections or the removal of my testicles. Clearly, most men would opt for simple injections, rather than castrations. Since the injections started, I began to get significant side effects.

I experience low sexual libido, erectile dysfunction, and most instances no ejaculations at all. I am so sorry for what the long-term side effects may be, that I contemplate not having the injections at all. I would like to put Dr. G on the spot for the issues of castrations for prostate cancer.

Why is castration necessary for the treatment of prostate cancer?

How long is the normal treatment for hormonal manipulation?

What are the usual side effects of hormonal treatment?

If the injections are technically castration, does that mean I am “ballless” forever?

I want my fountain of youth and my sex life back, can you help?

Regards

Castrated Christopher

HORMONE therapy for prostate cancer aims to stop the body from producing the male hormone avoiding the growth of prostate cancer cells. This is applicable in advanced (metastatic) prostate cancer to shrink the cancer cells and relieve signs and symptoms.

The therapy is also useful in the treatment of cancer if the prostate-specific antigen (PSA) level remains high or starts rising. In locally advanced prostate cancer, two to three years of hormonal treatment can make external beam radiation therapy more effective in reducing the risk of recurrence. Therefore, hormonal manipulation plays a vital role in the overall treatment of prostate cancer.

The acute reduction of bodily testosterone can be achieved by various modalities. Surgical removal of the testicles or castration reduces testosterone levels in your body quickly and significantly.

However, surgery to remove the testicles is permanent and irreversible, and may not be acceptable for most men. Certain medications, known as luteinising hormone-releasing hormone (LHRH) agonists and antagonists can prevent the brain from receiving messages to make testosterone. As a result, regular injections of such hormones can stop the testicles from producing testosterone and suppress cancer growth. The depletion of testosterone will certainly result in symptoms equivalent to menopause.

These include loss of sex drive, erectile dysfunction and depletion of ejaculation. Other bodily changes such as the loss of muscle mass, increase in bodily fat and bone thinning with risk of fractures. Symptoms also include fatigue, hot flashes and depression.

For most men, the initial effects of such treatment may be transient. However, persistent loss of testosterone is also known to cause significant impairment in quality of life for cancer sufferers. These may include osteoporosis and even depression.

Since the 1940’s, researchers Charles Huggins and Clarence Hodges have already discovered the curious link between testosterone and prostate cancer. The study revealed when men’s testosterone production dropped, their prostate cancer stopped growing. The researchers also found that giving testosterone to men with prostate cancer made their cancer grow.

They concluded that testosterone promotes prostate cancer growth. The finding of this link was significantly important in that Charles Huggins was awarded the Nobel Prize in Physiology or Medicine in 1966. Since the landmark discovery of the link, one of the main treatments for prostate cancer is lowering the testosterone levels in the body to slow the cancer progression

In fact, such belief also leads to concerns testosterone replacement therapy may fuel cancer cell growth in men with a family history of prostate cancer. In recent years, researchers have also challenged the link between testosterone and prostate cancer, as some studies contradict the link and demonstrated a higher risk of prostate cancer among men with low testosterone.

Therefore the link between testosterone and prostate cancer may not be so straightforward. In recent years, intrinsic immunity and overall health in men are also well-recognised for suppressing the progression of prostate cancer. A healthy lifestyle is crucial to counteract the adversity of hormonal manipulation in prostate cancer. Regular exercise can reduce bodily fat, increase metabolism and strengthen the bones.

Balanced dietary intake such as fruits and vegetables can also boost immunity and known to enhance sex drive. Lastly, medications such as blue pills are also well recognised to give the vital lift between the sheets for men encountering erectile dysfunction due to hormonal treatment for prostate cancer.

Therefore, despite the depletion of the male hormones for the treatment of cancer, many men continue to have a reasonable quality of life with an active lifestyle and supplementary medications.

Developing Nations like Malaysia continue to observe two-thirds of men are diagnosed with late-stage prostate cancer. Unlike other aggressive cancers such as lung and pancreatic cancers, the life expectancy in stage IV prostate cancer is much longer comparatively. However, hormonal treatment of prostate cancer is still considered palliative, and it is still traumatic for men to face the initial challenges of treatments.

The medical or surgical depletion of testosterone is equivalent to the trauma of castration, robbing men of their manhood. Despite losing their fountain of youth, most men still manage to enjoy reasonable libido and erections with a healthy lifestyle, medication and positive mental attitude. The American Author, Dave Pelzer once said: “You can be a victim of cancer or a survivor. It’s a mindset”. Therefore, when men enduring the dark days of chemical castration for prostate cancer are putting Dr. G on the spot for the light at the end of the tunnel.

His view is “With the right mindset, healthy lifestyle and seeking help from the doctors for the treatment of sexual dysfunction, a prostate cancer survivor can certainly continue to be a fighter between the sheets.”

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