Diagnosed metastatic: is orchiectomy (physical castration) a good option?

[JimJimJimJim]

Jim Marshall (not a doctor) said ...

A member initially diagnosed with a single metastasis was advised to have hormone treatment by his specialist. He was offered a choice of an orchiectomy (removal of testes) or regular androgen deprivation therapy (ADT). He would like to talk to a man with experience of this treatment. (Contact me if you have had an orchiectomy and can help.)

Seldom used these days as primary treatment, a recent study suggests that, in troubled financial times, it might be a reasonable option if a man's initial diagnosis was metastatic to bone.

 

Orchiectomy: Physical castration

Anachronistic: Out of place in modern times

Note that there is a suggestion elsewhere that orchiectomy may result in sudden cardiovascular problems, but this has not been studied.

... end Jim

 

Hindawi Publishing Corporation Advances in Urology

Volume 2012, Article ID 190624, 5 pages doi:10.1155/2012/190624

Clinical Study

 

Subcapsular Orchiectomy in the Primary Therapy of Patients with Bone Metastasis in Advanced Prostate Cancer: An Anachronistic Intervention?

Oleg Rud,1 Julia Peter,1 Reza Kheyri,2 Christian Gilfrich,1 Ali M. Ahmed,1 Wieland Boeckmann,2 Paul G. Fabricius,2 and Matthias May1

1 Department of Urology, St. Elisabeth Klinikum Straubing, St. Elisabeth Straße 23, 94315 Straubing, Germany 2 Department of Urology, Vivantes-Klinikum Berlin-Neuko ̈lln, 12351 Berlin, Germany

Correspondence should be addressed to Matthias May, matthias.may@klinikum-straubing.de

Received 1 July 2011; Accepted 3 July 2011

Academic Editor: Maximilian Burger

Copyright © 2012 Oleg Rud et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

 

Background. The therapeutic impact of palliative androgen deprivation in metastatic prostate cancer is indisputable. Bilateral orchiectomy represents the traditional method of AD but was reduced during the last years in favor for treatment with LHRH analogues. Due to limited economic resources of the health care system, the economically priced definite surgical castration might experience a renaissance. Methods. In this single-center retrospective study, 83 consecutive patients with osseous metastasized prostate cancer were evaluated, who had primarily been treated by subcapsular bilateral orchiectomy. Response to therapy, time until therapy failure, overall survival time, psychological disorders due to loss of organ, and disease-associated and postoperative surgical complications were recorded. The median followup was 35 months (IQR: 26–46). Results. Patients’ mean age at surgery was 72.1 (54–91) years. Six patients (7.2%) displayed immediate tumor progression after orchiectomy. Median time of tumor remission and overall survival time were 29 and 36 months, respectively. 14% of the study group showed minor postoperative complications. No psychological problems occurred following bilateral orchiectomy. Conclusion. Due to an effective and persistent oncological effectiveness, less morbidity, and absence of psychological implications, bilateral subcapsular orchiectomy seems to be a practicable and advisable alternative in the first-line therapy of metastasized PCa.

 

This extract can be found on http://PubMed.com, and is in the public domain.

On PubMed.com there will be a link to the full paper (often $30, sometimes free).

Full paper:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172971/pdf/AU2012-190624.pdf

Paper suggesting cardiovascular risk:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843654/pdf/ad-2013-04-06-381.pdf

 

Any highlighting (except the title) is not by the author, but by Jim Marshall. Jim is not a doctor.