Prostate Cancer: Surgical Castration Linked to Fewer Adverse Events Than Chemical Castration

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Bilateral orchiectomy is as effective as gonadotropin-releasing hormone agonists in controlling prostate cancer.
Bilateral orchiectomy is as effective as gonadotropin-releasing hormone agonists in controlling prostate cancer.

Bilateral orchiectomy is as effective as treatment with gonadotropin-releasing hormone agonists (GnRHa) in controlling prostate cancer and is associated with fewer clinically relevant adverse events, a population-based study has found.1

Androgen-deprivation therapy (ADT) with surgical or pharmacological castration has long been a mainstay of treatment for metastatic prostate cancer.2 However, due to concerns about cosmetic and psychological effects of surgical castration, that practice has been nearly eliminated in favor of medical castration.

“Given that these are 2 accepted alternative means to achieve testosterone blockade, it is important to understand the differences in side effects to properly counsel patients about their choices,” said Quoc-Dien Trinh, MD, of Brigham and Women's Hospital and Dana-Farber Cancer Institute in Boston, MA, in an interview with Cancer Therapy Advisor.

A total of 3295 men with metastatic prostate cancer 66 years or older were selected using the Surveillance, Epidemiology and End Results (SEER) database between January 1995 and December 2009. The men either were treated with GnRHa (2866 patients) or underwent bilateral orchiectomy (429 patients).

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Primary endpoints included 6 major adverse events: any fractures, peripheral arterial disease, venous thromboembolism, cardiac-related complications, diabetes mellitus, and cognitive disorders. The researchers chose these endpoints based on their impact on quality of life, potential to increase health care costs, and association with ADT use.

Men who underwent surgical castration had significantly lower risks of experiencing any fractures, peripheral arterial disease, and cardiac-related complications than those who were treated with GnRHa.

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