✦ Prostate Cancer Treatment

Bilateral Orchiectomy (androgen deprivation)

Q: Is bilateral orchiectomy reversible?

No — bilateral orchiectomy is permanent; LHRH analogue injections are reversible if androgen deprivation needs to be stopped temporarily.

Q: What are the side effects of surgical castration?

Side effects include hot flushes, reduced libido, erectile dysfunction, fatigue, and bone density loss — identical to chemical castration.

Q: Can testicular prostheses be inserted?

Yes — silicone testicular implants can be inserted at the same operation for patients concerned about cosmetic appearance. Your consultant will provide specific guidance based on your individual clinical situation and recovery.

Surgical Castration for Hormone-Sensitive Advanced Prostate Cancer

30–45 min PROCEDURE

Day Care HOSPITAL STAY

>95% SUCCESS RATE

1–2 Weeks RECOVERY

What is Bilateral Orchiectomy (androgen deprivation)?

Bilateral Orchiectomy for androgen deprivation involves surgical removal of both testes (or the testicular pulp) to eliminate testosterone production, which drives prostate cancer growth. It produces immediate and permanent castration, offering reliable, cost-free androgen deprivation without the need for monthly injections. It is the fastest method to achieve castrate testosterone levels and is preferred in patients requiring rapid hormone control. The procedure is performed under general or spinal anaesthesia with a hospital stay of Day Care. Success rates reach >95% in appropriately selected patients at experienced centres.

Men with metastatic or locally advanced hormone-sensitive prostate cancer, spinal cord compression, or those requiring rapid castration without reliance on medication compliance. Patients must be adequately fit for anaesthesia and free from active systemic infection before proceeding.

How the Procedure Works

Positioning & Incision

The patient is positioned supine under spinal or general anaesthesia. A midline scrotal or bilateral hemiscotal incision is made.

Testicular Delivery

The gubernaculum is divided and the testis, epididymis, and proximal spermatic cord delivered through the wound.

Cord Ligation

The spermatic cord is transfixed and ligated with 0-vicryl at the level of the external inguinal ring.

Bilateral Completion

The contralateral testis is delivered through the same midline incision or a second hemiscotal incision and the same steps repeated.

Closure & Recovery

The scrotal wounds are closed with absorbable sutures to dartos and skin. Saline-filled testicular prostheses may be inserted if requested.

Outcomes

30–45 minDURATION

Day CareHOSPITAL STAY

>95%SUCCESS RATE

1–2 WeeksFULL RECOVERY

Who Needs This Treatment?

→Men with metastatic hormone-sensitive prostate cancer who require immediate testosterone suppression.
→Patients who prefer a single definitive surgical procedure to ongoing monthly injections.
→Those with severe pain from bone metastases requiring the fastest possible castration.
→Patients in low-resource settings where the recurring cost of LHRH injections is prohibitive.
→Men who have experienced testosterone surge flare on LHRH agonist initiation.
→Those requiring androgen deprivation urgently before starting docetaxel or abiraterone.

"Surgical castration remains the most reliable, immediate, and cost-effective form of androgen deprivation. For patients requiring rapid testosterone suppression, nothing works faster."

— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon

Common Questions

Frequently Asked

Is bilateral orchiectomy reversible?+

What are the side effects of surgical castration?+

Can testicular prostheses be inserted?+

Not sure which treatment is right for you?

Book a consultation with Dr. Vipin Reddy and get a personalised treatment plan.

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