Reviewed July 2005

First-line treatment of metastatic prostate cancer is orchidectomy. This can be done under local or regional anesthesia and remains the standard, as it is permanent and cost-effective. Surgical complications are minimal. In the short term, there are minimal side-effects (loss of libido, impotence, and hot flushes). Long term androgen deprivation may result in anemia, osteoporosis, lipid profile changes and loss of muscle mass. There is no role for routine addition of steroidal or nonsteroidal antiandrogens following orchidectomy. Indications for the use of antiandrogens following orchidectomy are outlined on the page Indications for Antiandrogen Use.