Dear Dr G,

I am a cancer survivor who was diagnosed with prostate cancer two years ago.

Following a prostate cancer awareness week, I built up the courage to go for a PSA blood test.

To my horror, my PSA was at least four times higher than normal.

I went for a biopsy and scans, which confirmed stage III prostate cancer.

The doctor said it was too late for robotic surgery, but the cancer was still amenable to cure by radiotherapy.

As part of the treatment, I was given hormonal therapy and radiotherapy.

The radiotherapy itself was fine and I really did not experience adversity initially.

It’s been two years since my treatment and the PSA is now thankfully normalised.

I am so pleased the doctors said the cancer is most likely cured, however I must continue with the injections for one more year.

I recently read up about the hormonal treatment and was shocked to realise the injections are, in fact, equivalent to castration.

Since the injections started, I began to get low sexual libido, erectile dysfunction, and, in most instances, no ejaculations at all.

I would like to put Dr G on the spot for the issues of chemical 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 the hormonal treatment?

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

I really want my fountain of youth back, can you help?

Castrated Casey

Since the 1940s, researchers Charles Huggins and Clarence Hodges 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 so significantly important 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 testosterone levels in the body to slow the cancer’s progression. In fact, such belief also leads to concerns that 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 higher risk of prostate cancer among men with low testosterone. Therefore the link between testosterone and prostate cancer may not be so straightforward.

Hormone therapy for prostate cancer aims to stop the body from producing the male hormone and avoiding 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 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 luteinizing 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 the 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 ejaculate.

Other bodily changes such as the loss of muscle mass, increase in bodily fat and bone thinning with risk of fractures can also occur. Symptoms also include fatigue, hot flushes 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 the cancer sufferers.

A healthy lifestyle is absolutely 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 is known to enhance sex drive.

Lastly, medications such as the little 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.

It is indeed traumatic for men suffering from prostate cancer to face the initial challenges of treatments such as radical surgery and radiotherapy, then further obstacles of adjuvant treatments such as hormonal manipulations.

The medical or surgical depletion of testosterone is equivalent to the trauma of castration, robbing men of their manhood. For some men, such intervention may be of a transient interval of two to three years, for others the treatment is lifelong. Despite losing their fountain of youth, most men still manage to enjoy reasonable libido and erections with a healthy lifestyle, medication and the right mentality.

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 put 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 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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