Simple orchiectomy for prostate cancer
A short operation to remove both testicles through a small cut in the scrotum. It lowers testosterone, the hormone that feeds most prostate cancers, quickly and permanently, and takes the place of hormone shots or pills.
Also called Bilateral orchiectomy, Bilateral simple orchiectomy, Orchidectomy, Subcapsular orchiectomy, Surgical castration, Surgical hormone therapy, Surgical ADT, Castration
- Where
- Outpatient surgery center or hospital
- Anesthesia
- General or spinal anesthesia, or local numbing with sedation
- Time in the room
- About 30 to 45 minutes
- Hospital stay
- Same day
- Back to normal
- About 1 to 2 weeks
- Back to work
- A few days to 1 week for desk work
Overview
Most prostate cancers need testosterone to grow. About 90 to 95 percent of a man's testosterone is made by the testicles. Removing both testicles lowers testosterone to very low levels, called castrate levels, within about half a day, and keeps it there for good.
This is one form of androgen deprivation therapy (ADT), also called hormone therapy. It lowers testosterone as well as hormone shots such as leuprolide or degarelix, or the daily pill relugolix. As a one-time operation, it does not depend on remembering appointments or medicines, and it costs less over time.
It is permanent. Testosterone does not come back, so the effects of low testosterone, such as hot flashes, loss of sex drive, tiredness and bone thinning, are also permanent. Men who might want a break from hormone therapy later, or who are unsure, often choose shots instead.
An orchiectomy handles the hormone part of treatment only. Many men with advanced cancer also take another medicine, such as abiraterone, enzalutamide, apalutamide or darolutamide, or chemotherapy, along with it, exactly as they would with hormone shots.
The parts of your body involved
The two testicles sit in the scrotum and make sperm and most of the body's testosterone. Each hangs from a spermatic cord, which carries its blood vessels, nerves, and the vas deferens, the tube that carries sperm. The adrenal glands, above the kidneys, make a small amount of male hormones that an orchiectomy does not remove.
- Testicles
The two oval glands in the scrotum that make most of your testosterone and all of your sperm.
- Scrotum
The pouch of skin that holds the testicles. The incision is made here.
- Spermatic cord
The bundle of blood vessels, nerves and the vas deferens that each testicle hangs from. It is tied and cut during surgery.
- Epididymis
A coiled tube on the back of each testicle where sperm mature. It is usually removed with the testicle.
- Adrenal glands
Small glands on top of the kidneys that make a little male hormone. Some prostate cancer medicines also block this source.
Why it’s done
When prostate cancer needs long-term hormone therapy, an orchiectomy is a reliable, one-time way to lower testosterone. Your oncologist or urologist will discuss whether it fits your situation and your wishes.
- Fast testosterone drop
Testosterone falls to castrate levels within about 12 hours. Hormone shots of the most common type cause a short rise in testosterone first, called a flare, which an orchiectomy avoids. This can matter when cancer is pressing on the spinal cord or causing other urgent problems.
- No more injections
Hormone shots are given every 1 to 6 months, for years. An orchiectomy replaces them with one short operation.
- Reliable
There are no missed doses or late appointments. Testosterone stays low for good.
- Lower cost
Over time, it costs much less than years of shots or pills, which can matter where medicines are hard to get or afford.
- Fewer visits
For men who live far from care or find frequent visits hard, it removes the need to come in for injections.
Other options
- LHRH agonist shots
Injections such as leuprolide, goserelin or triptorelin given every 1, 3, 4 or 6 months. They cause a short testosterone flare at the start, so an anti-androgen pill is often given for the first weeks. Their effect wears off if stopped.
- GnRH antagonist shot
Degarelix, given monthly, lowers testosterone within days without a flare.
- Relugolix pill
A daily pill that lowers testosterone quickly without a flare. Testosterone recovers sooner after stopping than with shots.
- Intermittent hormone therapy
For some men, hormone shots or pills can be paused when PSA is low and restarted when it rises, giving breaks from side effects. This is not possible after an orchiectomy.
- Subcapsular orchiectomy
A version of the same operation that removes only the inner tissue of each testicle and leaves the outer shell, so the scrotum looks and feels more natural.
Getting ready
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Weeks before
The day before
The morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
You are put to sleep, given a spinal anesthetic, or given sedation with local numbing. You lie on your back, and the scrotum and groin are cleaned and covered with sterile drapes.
After the operation
Right afterward
- Recovery room
You are watched for about an hour as you wake. Ice packs are placed on the scrotum.
- Passing urine
If you had a spinal anesthetic, the team makes sure you can pass urine before you leave.
- Pain control
Most men do well with acetaminophen and an anti-inflammatory, if allowed, with a few stronger pills for the first day or two.
- Going home
Most men go home the same day. Someone must drive you.
At home
- Pain
Soreness is usually mild to moderate for 2 to 3 days and then fades. Take pain medicine as directed.
- Swelling and bruising
The scrotum often swells and may turn purple or blue for 1 to 2 weeks. Use a cold pack wrapped in a cloth for 15 to 20 minutes at a time, several times a day for the first 2 days, and wear snug support.
- Wound and showering
You can usually shower after 24 to 48 hours. Pat the area dry. Avoid baths and swimming for about 2 weeks. Stitches dissolve on their own in 1 to 3 weeks.
- Activity
Walk as you like. Avoid heavy lifting over 10 to 15 pounds (4.5 to 7 kilograms), straddling activities and bicycle riding for about 2 weeks.
- Driving
Most men drive again after a few days, once they are off strong pain medicine and can brake without discomfort.
- Work
Desk work is often possible after a few days. Physical work may need 1 to 2 weeks.
- Hormone effects
Hot flashes can start within days to weeks. Tell your team if they are bothersome, as there are treatments that help.
- Bone, heart and body
Keep active with walking and strength exercise, take calcium and vitamin D as advised, and keep up with blood sugar, cholesterol and bone density checks. Some men are offered a bone-strengthening medicine.
- Sex
Sex drive usually falls, and erections often weaken. Sexual activity is safe once the wound has healed, if and when you want it.
Recovery timeline
- Day 0Surgery day
The operation takes about 30 to 45 minutes, and you go home the same day.
- Day 1Testosterone is low
Testosterone has usually reached castrate levels within about 12 hours.
- Days 2 to 3Swelling peaks
Swelling and bruising are often at their worst, then start to fade.
- Weeks 1 to 2Healing
The incision heals, and most men are back to normal activity.
- Weeks 2 to 6Hormone changes begin
Hot flashes, lower sex drive and tiredness often appear during these weeks.
- 1 to 3 monthsPSA check
PSA and testosterone are checked. In most men the PSA falls substantially.
- Long termOngoing care
PSA and testosterone are checked every few months, along with bone density and heart health. Other cancer medicines are added as needed.
What it feels like
The operation itself is short and the physical recovery is usually easy. The bigger adjustment is emotional, and the gradual changes that come with low testosterone.
Making the decision
Many men feel a deep sense of loss, or worry about what it says about their manhood, even when they know it is the practical choice. Some feel relief at being done with injections.
What helpsTake the time you need. Talk with your partner, and ask about implants or a subcapsular operation if appearance matters to you. Speaking with another man who has had it can help.
Waking up
Soreness and a tight, swollen feeling in the scrotum. Some men are surprised by how normal they feel otherwise.
What helpsKeep ice on, wear the support, and take pain medicine on schedule for the first day.
The first week
Swelling and dark bruising can look alarming. Sitting and walking may feel awkward.
What helpsRest with your feet up, use cold packs, and wear snug briefs. The bruising fades over 1 to 2 weeks.
Hot flashes
Sudden waves of heat and sweating, often at night, that can disturb sleep.
What helpsLayer clothing, keep the bedroom cool, and limit alcohol and caffeine. Ask about medicines that reduce hot flashes if they are bothersome.
Changes in body and mood
Tiredness, weight gain around the middle, loss of muscle, breast tenderness, and sometimes low mood or trouble with focus. These can creep up over months.
What helpsRegular exercise, especially strength training, helps energy, mood, muscle and bones. Tell your team about low mood; support and treatment help.
Intimacy
Desire often fades, and erections become harder to get. Some couples feel distance grow without meaning to.
What helpsTalk openly with your partner. Closeness, touch and affection can continue. Erection treatments and counseling help some couples.
Seeing the PSA fall
For many men, the first PSA result after surgery brings real relief.
What helpsAsk what PSA level your team hopes to see and how often it will be checked.
How well it works
Success means testosterone stays at castrate levels and the PSA falls, showing the cancer is responding to hormone treatment.
- Testosterone
Castrate level is usually defined as below 50 ng/dL, and most men after orchiectomy are well below that.
- PSA
In most men, PSA falls substantially over the first months. A low PSA usually means good control of the cancer.
- Ongoing tests
PSA and testosterone are checked every few months, with bone density and heart risk checks over time.
- When cancer adapts
After months or years, many advanced cancers find ways to grow despite low testosterone, called castration-resistant prostate cancer. Other treatments are then added, and the orchiectomy keeps doing its job in the background.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Swelling and bruising of the scrotum for 1 to 2 weeks.
Waves of heat and sweating, which may lessen over time but can persist.
Desire usually falls and erections weaken. This is permanent unless testosterone is replaced, which is not done for prostate cancer.
Lower energy and stamina, sometimes with a mild drop in red blood cells (anemia). Regular exercise helps.
Weight gain, loss of muscle, and softer skin over months.
Less common
Bleeding after surgery can cause the scrotum to swell up quickly and painfully. Most settle with rest and support; a few need another operation to drain them.
Redness, warmth or drainage from the incision, treated with antibiotics.
Some men develop tender or enlarged breast tissue.
Bones gradually thin over years, raising the risk of fractures. Exercise, calcium, vitamin D, and sometimes medicines help prevent this.
Low mood, irritability, or trouble with memory or focus can occur.
Low testosterone can raise blood sugar and cholesterol and may increase heart risk, so these are monitored.
Rare
A large hematoma that needs to be drained in the operating room is rare.
Persistent pain in the scrotum or groin after healing is rare.
Call your care team or go to the emergency room if
- The scrotum swells quickly to a large size, becomes very tense, or is very painful.
- Fever of 101°F (38.3°C) or higher, or shaking chills.
- Spreading redness, pus or a bad smell from the incision.
- Bleeding that soaks through the dressing.
- You cannot pass urine.
- Swelling or pain in one calf, or sudden shortness of breath or chest pain (call 911).
- New back pain with leg weakness, numbness, or trouble controlling your bladder or bowels. This can be a sign of cancer pressing on the spinal cord and needs emergency care.
Questions to ask your surgeon
- Why do you recommend an orchiectomy over hormone shots or pills for me?
- Will I also need other cancer medicines along with it?
- Can I have a subcapsular orchiectomy, or testicle implants?
- What will you do to protect my bones and heart?
- How will you treat hot flashes if they bother me?
- How often will you check my PSA and testosterone?
- What happens if my cancer stops responding?
- Will I be awake or asleep for the operation?
- How long until I can return to my usual activities?
Words you may hear
- Orchiectomy
- Surgery to remove a testicle. A bilateral orchiectomy removes both.
- Testosterone
- The main male hormone, made mostly by the testicles, that feeds most prostate cancers.
- Androgen deprivation therapy (ADT)
- Treatment that lowers male hormones to control prostate cancer, by medicine or surgery.
- Castrate level
- A very low testosterone level, usually below 50 ng/dL.
- Spermatic cord
- The bundle of blood vessels, nerves and the vas deferens that each testicle hangs from.
- Subcapsular orchiectomy
- Removing the inner tissue of each testicle while leaving the outer coat.
- Testicular prosthesis
- A silicone implant shaped like a testicle, placed in the scrotum for appearance.
- LHRH agonist
- A hormone shot that lowers testosterone after a short initial rise (flare).
- Flare
- A short rise in testosterone in the first weeks of some hormone shots.
- Hematoma
- A collection of blood under the skin, here in the scrotum.
- Castration-resistant prostate cancer
- Prostate cancer that grows even though testosterone is very low.
- Bone density scan
- A quick, low-dose X-ray that measures bone strength.
Common questions
Will I look different?
The scrotum will look and feel empty unless you have testicle implants or a subcapsular operation. The penis itself is not changed by the surgery.
Can I still have an orgasm?
Many men can, though desire is usually lower and erections weaker. Semen volume becomes very small or none.
Can it be reversed?
No. Testosterone will not come back. If you are unsure, hormone shots or pills let you keep that option open.
Will this cure my cancer?
It controls prostate cancer, often for years, but it does not cure cancer that has spread. Other treatments are often added along with it or later.
Will my voice change?
No. Your voice stays the same. Over time you may notice less body hair growth, softer skin, and sometimes breast tenderness.
Is it as effective as hormone shots?
Yes. It lowers testosterone at least as reliably as shots, and medicines added on top work the same way.
Sources this page draws on
- American Urological Association, American Society for Radiation Oncology and Society of Urologic Oncology, Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline
- European Association of Urology, EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer
- American Cancer Society, Hormone Therapy for Prostate Cancer
- National Cancer Institute, Hormone Therapy for Prostate Cancer (fact sheet)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.