Rapid drop in serum testosterone after bilateral subcapsular orchiectomy.

Bilateral subcapsular orchiectomy was performed in six patients with metastatic prostatic carcinoma. In these patients the serum levels of testosterone were determined serially up to twenty-four hours. Castrate levels of testosterone were achieved in about two and one-half hours. This is the first published report of such a rapid decrease in serum testosterone. Castrate levels of serum testosterone using the luteinizing hormone releasing hormone (LH-RH) agonists are achieved in fourteen to twenty-one days. The relative cost of orchiectomy and LH-RH agonists, for thirty-six months, was $2,042.00 and $12,780.00, respectively. LH-RH agonists may be effective for only a year. Urologists are urged to continue using bilateral subcapsular orchiectomy and not use LH-RH agonists in the management of metastatic prostatic carcinoma.