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Orchidectomy for prostate cancer: how it controls the hormone | CION Cancer Clinics
For prostate cancer, an orchidectomy removes both testicles so the body stops making testosterone, the hormone most prostate cancers grow on. It is a hormone treatment done as one small operation, not a treatment of the prostate itself. It does the same job as hormone injections, but permanently. This page explains how it compares with injections, what changes afterwards, who it does not suit and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What does an orchidectomy do for prostate cancer?
- Operation or injections: how do they compare?
- What actually happens during the operation?
- What changes when testosterone is gone?
- Who is this operation not right for?
- Which words will you meet, and what do they mean?
- Four things families tell us, and what is actually true
- Common questions about orchidectomy for prostate cancer
The short answer
What does an orchidectomy do for prostate cancer?
For prostate cancer, an orchidectomy removes both testicles so the body stops making testosterone, the hormone most prostate cancers feed on. It is a hormone treatment done with a small operation. It does not remove the cancer itself.
Why testosterone matters here
Most prostate cancers grow faster when testosterone is present and slow down when it is taken away. Doctors call this hormone therapy, or androgen deprivation therapy (ADT). The testicles make almost all of the body's testosterone, so removing them brings the level down fast and keeps it down. Regular injections reach the same result. The operation is the permanent way of doing the same job.
Why it is still offered
Injections must be repeated for as long as treatment continues, often for years. Each one needs a clinic visit and a bill. The operation is done once. For a man far from a cancer centre, or a family watching the cost of every injection, that difference matters.
What this page cannot tell you
It cannot tell you whether this operation is right for you or your father. That depends on the stage, the other treatments planned and what the man himself wants.
The operation done for testicular cancer removes one testicle for a different reason, and is covered on its own page.Side by side
Operation or injections: how do they compare?
Orchidectomy
Hormone injections
One small operation, done once
An injection every few months, for as long as treatment continues
Permanent. Testosterone does not come back
Reversible. Stopping lets testosterone slowly return
Testosterone falls within a day or so
Some injections cause a short rise first, so a tablet is given alongside
A single bill for this part of treatment
A recurring cost, and a clinic visit, at every dose
Visible change to the body
No visible change, though the testicles shrink over time
Cannot be paused if the team later wants a break
Can be paused and restarted if treatment is planned in blocks
Not sure whether this applies to you?
Ask an oncologistOn the day
What actually happens during the operation?
Before you go in
Blood tests, a heart check and a talk with the anaesthetist usually happen a few days before. Tell the team about every medicine you take, especially blood thinners and diabetes tablets. They decide what to do about each one. Do not stop anything yourself.
The anaesthetic
Many men have this under a spinal or local anaesthetic, awake but feeling nothing below the waist. A general anaesthetic is used if the team prefers it or you would rather be asleep. The operation itself is short.
The cut
For prostate cancer the cut is usually in the scrotum, not the groin. The surgeon may remove each testicle whole, or remove only the hormone-making tissue inside and leave the outer shell. The second way, called subcapsular, leaves the scrotum looking fuller.
Going home
Most men go home the same day or the next morning, with pain relief, wound-care instructions and a date to come back. Loose clothing and a supportive pair of briefs make the first week easier.
Afterwards
What changes when testosterone is gone?
These effects come from losing the hormone, not from the cut. Men on injections get the same ones. Most build up over weeks and months.
Hot flushes and sweats
Sudden waves of heat, often at night, are the most common complaint. They usually ease with time. If they are wrecking your sleep, tell your oncologist. There are medicines that help.
Sex drive and erections
Interest in sex usually falls, and erections become harder to get or keep. This is the effect men most often hide. It is expected, it is not a sign the cancer is worse, and the team has heard it many times.
Bones, muscle and weight
Over months, bones thin and muscle gives way to fat around the waist. Walking, light weights, calcium and vitamin D slow this down.
Worth asking about
- A bone density scan
- Bone-protecting medicines
- Blood sugar and cholesterol checks
Mood and energy
Tiredness and low mood are common, and often blamed on the cancer when the hormone change is the cause. Breast tenderness can also happen. Do not wait for the next visit if mood drops sharply.
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Honest limits
Who is this operation not right for?
It does not suit every man with prostate cancer, and it is not a replacement for treating the prostate itself. Your team weighs several things before raising it.
When the team may plan a break
Some men are given hormone therapy in blocks, with gaps to let side effects settle. Others need it only for a fixed period alongside radiation therapy. In both cases the permanence of the operation is a drawback, because there is no way to switch it off. Injections fit those plans better.
When the cancer has stopped responding
Some prostate cancers keep growing even with testosterone at its lowest. Your report may call this castration-resistant, meaning the cancer no longer depends on the hormone. Removing the testicles then adds little, and other medicines become the focus.
When the loss feels unacceptable
For some men, and some marriages, the idea of the operation is simply too much, whatever the medical logic. That is a valid reason to choose injections. Saying so early is more useful than agreeing and regretting it.
Whether to have this operation, injections, or neither is a decision for you and your treating team together. This page cannot make it for you.On your report
Which words will you meet, and what do they mean?
- ADT
- Androgen deprivation therapy. Any treatment that removes or blocks testosterone, by operation, injection or tablet.
- Bilateral orchidectomy
- Removal of both testicles. For prostate cancer this is the usual form, because one testicle alone would go on making testosterone.
- Subcapsular
- Removing only the hormone-making tissue inside each testicle and leaving the outer shell, so the scrotum looks less empty.
- Castrate level
- The very low testosterone level the treatment aims for. A blood test confirms the operation has worked.
- PSA
- Prostate-specific antigen, a blood test that tracks how the cancer is responding. It usually falls after testosterone is removed.
- Castration-resistant
- A prostate cancer that keeps growing even at castrate level. Hormone treatment alone is no longer enough, but treatment has not run out.
Commonly believed
Four things families tell us, and what is actually true
"The operation removes the cancer."
It does not. The cancer is in the prostate, and often beyond it. The operation takes away the hormone the cancer grows on. It slows the disease and can shrink it, but the team will usually plan other treatment alongside it.
"He will stop being a man."
The body changes, and the change is real. Sex drive drops and erections become difficult. But his voice, his mind, his strength for daily life and his place in the family do not change. Many men go back to work and everything else they did.
"Injections are modern, so the operation must be old-fashioned."
Both bring testosterone down to the same level, and both are still used. The operation is chosen less often now mainly because it cannot be reversed, not because it works less well.
"After the operation, no more hospital visits."
Follow-up continues. PSA is checked regularly, bone strength may be scanned, and if the cancer later stops responding, other medicines are started. The operation ends the injections, not the visits.
Questions we are asked
Common questions about orchidectomy for prostate cancer
Is orchidectomy the same as hormone therapy for prostate cancer?
Yes, it is one form of it. Hormone therapy means taking away or blocking testosterone. Injections do that with medicine that has to be repeated. The operation does it once by removing the organs that make the hormone. The effect on the cancer is much the same either way.
Will my father have to stay in hospital?
Usually not for long. Many men go home the same day, and most others the next morning. An overnight stay is more likely if a general anaesthetic was used, if he has heart or breathing problems, or if he lives far from the centre.
How quickly does it work?
Testosterone falls sharply within a day or so, faster than most injections. PSA takes longer, usually falling over the following weeks. Bone pain from the cancer often eases over the same period. Your team will check the PSA at follow-up to confirm the response.
Can it be reversed later if he changes his mind?
No. Once the testicles are removed, the body cannot make testosterone again. This is the main reason some men and some teams prefer injections. If there is any chance the plan will involve pausing hormone therapy, say so before the operation, not after.
Will the scrotum look empty?
It depends on how the operation is done. If the surgeon leaves the outer shell of each testicle, the scrotum looks fuller. If both are removed whole, it will look and feel empty. Ask which approach is planned and why. Artificial testicles exist, and you can ask about them.
Does he still need tablets or injections afterwards?
Often yes, but not the injections that lower testosterone. Depending on the stage, the team may add tablets that block the hormone further, bone-protecting medicine, or other treatment. The operation replaces one part of the plan. Everything else is decided on the scans and PSA, as before.
Is it cheaper than the injections?
Over a long course it usually is, because the operation is paid for once and the injections every time. The size of the difference depends on which injection was planned, how long treatment will run, and whether Aarogyasri, CGHS, ECHS, EHS or insurance cover either option. Ask for a written estimate of both.
What should we ask the surgeon before agreeing?
Ask whether the plan is lifelong hormone therapy or a fixed course, because that decides whether permanence is a problem. Ask how the operation will be done, what the scrotum will look like, what anaesthetic is planned, and what would be different if he chose injections instead.
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Sources
- National Cancer Institute — Hormone Therapy for Prostate Cancer
- American Cancer Society — Hormone Therapy for Prostate Cancer
- Cancer Research UK — Prostate cancer
- NHS — Prostate cancer: treatment
- Macmillan Cancer Support — Prostate cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Bilateral Orchidectomy: What ChangesWhat life is like once both testicles are removedTestosterone After OrchidectomyHow the hormone drop shows up in the bodyTesticular Prosthesis: Is It Available in India?If the look of the scrotum matters to youOrchidectomy Cost in HyderabadWhat shapes the bill and what schemes coverDeciding on Cancer SurgeryHow to weigh an operation against the alternatives
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