Permanent ADT means permanently eliminating testosterone, no matter how it's done. Chemical and surgical means are available.
Surgery is even less expensive if done under local anesthetic (as mine was). No more injections. (Oh, and no more sweet revenue stream for the doctors that do the injections, nor the pharmaceutical companies selling them.)
Conclusion from the study:
"In less than a year, the median chemical ADT patient charges were greater than surgical castration. The NPV of electing surgery over ADT was the highest with leuprolide. Despite under-utilization, surgical castration remains a medically appropriate and cost-effective option for permanent ADT."Significant financial differences of chemical and surgical androgen deprivation in a contemporary cohort