Decreased Prostate Glandular Volume (Answer: B)
Bilateral orchiectomy eliminates the primary source of testosterone production, which directly causes decreased prostate glandular volume due to androgen deprivation. 1
Physiologic Consequences of Bilateral Orchiectomy
The removal of both testicles creates a state of surgical castration with profound hormonal consequences:
Testosterone Deficiency Effects
- The loss of testicular testosterone production leads to prostate gland atrophy, specifically affecting the glandular tissue that is androgen-dependent 1
- This mechanism was historically exploited as treatment for advanced prostate cancer, demonstrating the direct relationship between testosterone and prostate glandular volume 1
Why Other Options Are Incorrect
Subcutaneous fat (Option A): Testosterone deficiency actually increases subcutaneous fat, not decreases it. Hypogonadal men experience unfavorable body composition changes with fat accumulation.
Lean body weight (Option C): Testosterone deficiency decreases lean body mass and muscle mass, not increases it. Loss of anabolic testosterone effects leads to sarcopenia.
Trabecular bone density (Option D): This is the opposite of what occurs. Testosterone deficiency leads to decreased trabecular bone density, resulting in increased fracture risk in hypogonadal men 1. This represents a significant long-term morbidity concern requiring monitoring and intervention.
Prostate stroma volume (Option E): While stromal tissue may be less androgen-dependent than glandular tissue, there is no evidence that stroma volume increases after castration. The dominant effect is glandular atrophy.
Critical Management Considerations
Testosterone Replacement Therapy
- Testosterone replacement therapy should be initiated after bilateral orchiectomy to prevent adverse metabolic, cardiovascular, and bone health consequences of hypogonadism 1
- Regular monitoring is essential to address the multiple physiologic derangements that occur with surgical castration 1
Fertility Preservation
- Sperm banking should have been performed before orchiectomy in this patient with bilateral cryptorchidism, as these men have a six-fold increased infertility risk 1
- This represents a critical quality of life consideration that should be addressed preoperatively 2
Common Pitfall
The most important clinical pitfall is failing to recognize that bilateral orchiectomy creates permanent, complete hypogonadism requiring lifelong testosterone replacement 2. Without replacement therapy, patients face increased risks of osteoporosis, cardiovascular disease, metabolic syndrome, sexual dysfunction, and decreased quality of life.