There are three types of debulking treatments: surgical debulking (i.e. orchiectomy), pharmacological debulking and estrogen therapy. The tumor-related survival and progression-free survival rates of patients with all three treatment modalities are basically the same. Surgical debulking can rapidly reduce androgens to very low levels, but it also has its obvious side effects, such as psychological disorders, sexual dysfunction, osteoporosis, easy fatigue, etc. Estrogen therapy is rarely used nowadays due to its obvious side effects, and pharmacological debulking is now a more common means in clinical practice, which not only can save patients from surgical pain, but also can avoid the psychological effects of orchiectomy. However, orchiectomy still has great application, especially for patients with risk of fracture (not suitable for pharmacologic debulking), and some scholars believe that orchiectomy is still effective even for hormone-resistant patients after initial treatment with pharmacologic endocrine therapy. However, orchiectomy, being irreversible, does not allow for flexible adjustment of the regimen in treatment, so pharmacologic debulking should be considered first if available.