Many men can still achieve erection after orchiectomy, but there is almost always a decline in sexual drive. Men who cannot achieve erection may be candidates for a penile implant. Patients do not experience a reversal of sex characteristics; the voice does not change and body hair is not affected.
Disease Progression and Androgen-Independent Cancer
Unfortunately, in advanced disease, prostate cancer usually returns within about 18 months after antiandrogen treatments. In such cases, the condition is referred to as androgen-independent, and the tumors are not responsive to antiandrogen therapy. The reason for this is still unknown. One theory is that once androgen-sensitive cells have been blocked, cells that are resistant to androgen are stimulated to grow, and the cancer returns. Some studies have detected overexpression of genetic mutations in patients with androgen-independent tumors that signals the cancer cells to grow in response to other hormones even in the absence of androgen. Researchers are continually searching for drugs to treat relapses and act against these androgen-independent tumors.
Choosing Hormonal Treatments
Hormonal therapies may be appropriate for men with locally advanced prostate cancer before they have radiation therapy (neoadjuvant therapy). These men call also receive hormonal therapy following radiation therapy (adjuvant therapy). Studies suggest that these therapies improve survival in men at high-risk for cancer progression. Men with metastatic cancer (cancer that has spread beyond the prostate gland) also receive hormonal treatments. Doctors vary widely on their opinions of androgen suppression therapy. A 2006 study found that the decision to use hormonal therapy depends more on a patient’s urologist than on the patient’s tumor or other factors.
Hormonal Treatment Before or After Surgery. Some studies suggest benefits from using hormone therapy before surgery (neoadjuvant therapy) to reduce the tumor size, although it is not clear yet if this approach has survival benefits. Hormonal treatment may be useful after surgery in men who have high-grade tumors or tumors that have invaded the semen-carrying vessels or lymph nodes. Such men have a risk for failure after surgery of 50 - 80%.
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