The fate of the medically castrated testis: expectation versus reality

Cosmetic expectation has a major role in influencing patient choice between medical and surgical castration, and yet to our knowledge the fate of the medically castrated testis has never been accurately tested and documented in the literature. We determined the weight of testes in patients receiving medical castration and compared it to that in a control group receiving primary surgical castration.

We performed a retrospective analysis of 88 patients with prostate cancer who underwent bilateral simple orchiectomy with epididymal sparing. The study was done at Veterans Administration Medical Center, Atlanta, Georgia. All procedures were performed using local anesthesia in an outpatient clinical setting. Patients were divided into 2 groups, namely 52 receiving luteinizing hormone releasing hormone (LH-RH) agonist therapy prior to the procedure and 36 controls who were not. The weight of the testes was compared between the 2 groups.

Median testicular weight significantly decreased following treatment with LH-RH agonist compared to the control group. Median weight of the testis was 7.0 gm (range 0.5 to 22.0) in the LH-RH agonist group compared to 15 gm (range 4.0 to 44.0) in the control group (p = 0.0049 x 10).

Medical castration with LH-RH agonist therapy significantly decreases the weight of testes and compromises the cosmetic outcome. Since cosmetic expectation has a major role in influencing patient choice between medical and surgical castration, patients should be fully informed about the significant testicular atrophy associated with medical castration before making their decision.