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Ask Lisa, MSN, FNP-BC, CCRN Your Own Ques...
Lisa, MSN, FNP-BC, CCRN, Nurse Practitioner
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Will there be any need for orchioectomy after prostate removal?

Resolved Question:

Will there be any need for orchioectomy after prostate removal?
Submitted: 6 years ago.
Category: Health
Expert:  Lisa, MSN, FNP-BC, CCRN replied 6 years ago.



Thank you for writing in today. Generally, when there is a resection of the prostate, testicle removal in not necessary. This would not be a common occurrence. Usually testicles are only removed due to testicular cancer (not prostate cancer) or necrosis. I hope this helps. If you have any additional questions or concerns, please let me know. Lisa

Customer: replied 6 years ago.

The patient is my father who had problem urinating. The doctor diagnosed prostate enlargement, a surgery was coducted to remove the prostate, hence the patient complained of swelling in one of the testes, the doctor now said that he had performed histological tests on the removed prostate and found it to be cancerous, so he is advising that the testes be removed to avoid the spread of cancer because prostate cancer is hormone dependent and that testis supply the hormone i.e androgens.

My question is - would orchioectomy be neccesary since the cancerous prostate has been removed or the doctor is just trying to coverup complications that he cannot explain as a result of the swollen testis?

Expert:  Lisa, MSN, FNP-BC, CCRN replied 6 years ago.

Thank you for responding. I've done some research on the subject. First of all, I suspect he may have had a partial resection of the prostate, rather than having the whole prostate removed. If this is the case, then testicular removal would be indicated, to reduce circulating androgens and reduce the rate of cancer growth in the prostate. Now, if his entire prostate was removed, hormone therapy, such as removing the prostate may be indicated if there is concern that the cancer has spread to the surrounding pelvic area, etc. Also, if the swelling of the testicle is suspicious for possible metastatic cancer, then this too would be an indication for the testicle removal. At this point, again, testicle removal is not the more common approach. Generally, hormone therapy, injections, medications, and implants are more common; however, in your Dad's case, I suspect there is reasonable rationale. I suspect he may have some partial prostate tissue or there is concern for metastatic disease. At this point, I would discuss the issue with his urologist. Also, you and your father may want to discuss a second opinion for another urologist before committing to the procedure. Most providers understand when a patient wants a second opinion. When it comes to procedures, particularly those that are non-reversible, a second opinion is understandable. Also, you may talk with his urologist about other options, such as hormonal therapies via implants and injections. There may be an option to controlling his androgen level other than the testicle removal. I hope this helps. If you have other questions or need clarification, please let me know. Lisa
Customer: replied 6 years ago.

Thank you

Is there a link between the prostate and the androgens? and if there is, the doctor said the prostate was removed, so why should we worry about prostate cancer? He specificaly said we are not dealing with testicular cancer, the logic here is that if the prostate is cancerous and has been removed, would there be any need to control the supply of androgens from the testes or is it the androgens that is causing the cancer?

Expert:  Lisa, MSN, FNP-BC, CCRN replied 6 years ago.

Thank you for responding. Yes, prostate cancer is an androgen based cancer. Just as breast cancer can be related to high levels of estrogen, prostate cancer can be influenced by androgens. Generally, prostate cancer is treated with medications to reduce androgen levels. This hormone therapy is usually done with oral, injection, or implanted medication; however, testicular removal is done in some cases. Overall, the latter treatment is far less common than hormonal therapy with the oral, injection, or implanted medication. With this being said, if his prostate was only partially resected (meaning some prostate tissue remains), then removing the testes (removing the testosterone) would reduce the risk of cancer growth in the remaining tissue. If he did have a total prostatectomy, then hormone therapy (in the form of the testicle removal) may be indicated if there is concern for metastatic cancer. At this point, since the prostate has been removed, there may be some concern for metastatic disease, which would indicate a need for hormone therapy. Now, the exact rationale for the testicle removal, rather than more conservative measures to control the testosterone level, may be a bit dependent on the tumor grade and his risk. Also, if the testicular swelling is concerning for possible cancer or metastatic disease, this too would be an indication for the surgery. The rationale for this exact recommendation should really be discussed with his urologist. In particular, you may want to ask why he recommends the surgery. Also, you may want to ask why this procedure is recommended over the other more common, conservative hormone therapy treatments. I hope this helps. I do want you to be comfortable with this information, so please let me know if you have additional questions. Lisa
Customer: replied 6 years ago.
Thank you Lisa, is there a way to save this correspondence for latter reference? You have answered my questions, and i wish i could do a conference call meeting between you and this doctor who resdes in West Africa. It has been the most trying year for me and my family because of my father's illness and the fact that i am not there is not helping matters. The prostatectomy cost me more than $1200, i dont know how much the orchioectomy will cost, i just feel like dying myself
Expert:  Lisa, MSN, FNP-BC, CCRN replied 6 years ago.
I am glad the information is helpful. You will always have access to this thread. When you log on to this site, you will be able to reference the thread in your history. Feel free to discuss this information with his provider. Unfortunately, due to the limitations of the internet, we cannot serve as primary providers, so we aren't able to do conference calls, referrals, or prescriptions; however, this information will always be available to you, and you should discuss it with his provider. Also, if cost is an issue, you should discuss this with his provider too. There may be a less costly alternative. I hope it all works out. Take care and Happy Holidays! Lisa
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