Men who were treated with GnRHa for 35 months or more had an increased risk of diabetes mellitus as well as elevated risk of experiencing any fractures, peripheral arterial disease, and cardiac-related complications. However, the 3-year overall survival rate was higher for patients treated with GnRHa (46%) than surgical castration (39%).

“I think these findings are important,” said Dr Trinh. “Orchiectomy has almost disappeared as a treatment option for men requiring permanent testosterone blockade. I find it disconcerting that a perfectly reasonable, cost-effective surgical treatment with potentially less adverse effects and compliance issues than its pharmacologic equivalent has disappeared from medical practice for non-scientific reasons.”

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Michael Kolinsky, BSc, MD, Pasquale Rescigno, MD, and Johann S. de Bono, MB, ChB, MSc, FRCP, PhD, FMedSci, all of The Institute for Cancer Research and The Royal Marsden National Health Service Trust in London, England, wrote an editorial that accompanied the research.3

In it, they wrote that “ADT remains essential” for patients with metastatic prostate cancer, and called for a focus on harm reduction in treating this population.

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“Because men with metastatic prostate cancer are living longer than ever, it is imperative that we minimize the risk of harm from therapies,” they wrote. “Physicians treating patients with prostate cancer must familiarize themselves with how to prevent and treat these complications. When there is more than one reasonable option, clinical decisions must be guided by the patient’s values and preferences.”

Dr Trinh said that “patients and providers should be aware of and at least offer this option to their patients, when indicated.”

References

  1. Sun M, Choueiri TK, Hamnvik OPR, et al. Comparison of gonadotropin-releasing hormone agonists and orchiectomy: effects of androgen-deprivation therapy [published online ahead of print December 23, 2015]. JAMA Oncol. doi: 10.1001/jamaoncol.2015.4917
  2. Byar D, Corle D. Hormone therapy for prostate cancer: results of the Veterans Administration Cooperative Urological Research Group studies. NCI monographs. Pub Natl Cancer Inst. 1988;7:165-170.
  3. Kolinsky M, Rescigno P, de Bono JS. Chemical or surgical castration – is this still an important question? [published online ahead of print December 23, 2015]. JAMA Oncol. doi:10.1001/jamaoncol.2015.4918.

Topics:

Male Reproductive Cancers Prostate Cancer