Surgical and pharmacological treatments have their advantages and disadvantages, but both can be used to achieve debulking.
The orchiectomy is simpler, and as the testicles are removed, the androgen levels in the body drop rapidly to achieve the goal of treatment. It is less expensive than injections, less of a financial burden to the patient, and avoids the hassle of repeated injections over time. However, orchiectomy can be psychologically traumatic for the patient, and young patients can lose their sexual ability permanently, affecting their quality of life.
And the advantages of pharmacologic debulking are.
- Safe medication, reversible action, and timely adjustment of the regimen;
- It can be applied long-term or intermittently, and can significantly improve the quality of life of patients compared to orchiectomy.
The disadvantages are mainly:
- The initial use of the drug can cause a transient rise in testosterone, which can worsen symptoms and require additional drugs, and should be used with caution in patients with spinal cord compression due to bone metastases;
- It takes time to reach depot levels with drugs;
- The drugs are more expensive and require long-term use, which is unaffordable for some patients with poorer financial status.
So, medication debulking should generally be considered first when conditions allow, and the most appropriate debulking treatment should be selected clinically based on the patient’s different treatment needs and personal financial ability.