Androgens mainly testosterone plays an important role in development of prostate cancer .Hence, Androgen deprivation therapy (ADT) is a corner stone therapy for this disease.

At the outset one needs to be informed that both surgery as well as Long term hormonal therapy are a part of hormonal treatment, hence we need to divide these modalities as surgical castration or medical castration.

ADT includes:

1. Bilateral orchiectomy (surgical removal of the testicles), also called surgical castration.
2. Luteinizing hormone-releasing hormone (LHRH) agonists are drugs that lower the body's production of testosterone by stopping the testicles from making testosterone also called as medical castration.
3. Anti-androgen drugs.
4. Combined androgen blockade (CAB) is a combination of an anti-androgen drug and either surgery or an LHRH agonist drug.

Some common side effects of hormone therapy may include:

1. Psychological effects resulting from testicle removal
2. Loss of sex drive
3. Erectile dysfunction (inability to have erections)
4. Hot flashes
5. Tiredness
6. Mood changes
7. Muscle shrinkage
8. Enlarged and/or tender breast

Now to answer to your question so as to which form of therapy is better between orchidectomy or LHRH therapy. There are certain points which need to be considered.

1. If ADT is required for a certain period of time like for 2 years in adjuvant setting, LHRH agonist are used because they can be stopped after a certain time and the side effects can then wean off.
2. However one has to realise that if we want an immediate release in testosterone levels surgical castration is the preferred choice.
3. Whenever we use LHRH agonists there in a temporarily increase in symptoms called as FLAIR which can be devastating in case there is an impending neural compromise etc. In surgical castration there is no similar effect.
4. And the last but most important factor in Indian scenario is cost. Orchidectomy is a simple one time procedure but LHRH agonists need to be taken throughout the duration of treatment.