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In breast carcinoma

Physical castration is generally delivered by radiotherapy or more rarely by coelioscopy. Nowadays, it is performed to a lesser extent in breast carcinoma, mainly due to the simplicity of use of antioestrogen drugs.

However, it still constitutes an excellent treatment modality for breast cancer bone metastases (if no previous treatment with antioestrogens has been administered): a very powerful and rapid analgesic effect is generally obtained with tumour regression and often prolonged survival.

There are major side effects among young non-menopaused women, due to the abrupt menopause induced by castration and its often severe psychological consequences.

(see next page for information on chemical castration)

In prostate cancer

In prostate cancer, castration has a very strong positive effect on local relapse (disappearance of most urinating difficulties) as well as distant bone metastases (very early pains sedation).

Adding castration to local treatment does not appear to be of any value (despite a recent trial demonstrating benefit with an association of radiotherapy and hormonal therapy for large T3 prostate cancer).

Diagram of the action of castration on prostate cancer.

Castration of men is a very simple surgical procedure which can be performed with virtually no hospitalisation and without any major surgical risk. Its cost is very low compared to other treatments proposed further on.

Many of side effects of castration are similar in male and female patients alike. The sudden hormonal deprivation leads to very severe hot flushes, more or less severe hypogonadism (small penis, disappearance of male body hair, softening of the skin, as well as frequent loss of libido with more or less complete impotence (which may already exist in prostate cancer).

There are also many psychological effects: many patients consider castration as an attack on their integrity (many physicians are reluctant to propose such ‘mutilation’ and prefer ‘chemical castration’ which, during the first months at least, appears less aggressive.

Pulpectomy is another possible method, consisting in the removal of the testicular parenchyma whilst conserving the testicular capsule, thus giving a false impression of organ conservation. Some surgeons also suggest replacing testes by prostheses.