Introduction

Androgen deprivation therapy (ADT) remains the mainstay of treatment for metastatic prostate cancer (mPCa) but is associated with significant morbidities. Comparisons of medical castration (MC) and surgical orchidectomy (SO) have yielded varied results. We aimed to evaluate the oncological outcomes, adverse effect (AE) profiles and costs of MC and SO in patients with mPCa.

Methods and materials

We reviewed 523 patients who presented with de novo mPCa from a prospectively maintained prostate cancer database over 15 years (2001–2015). All patients received ADT (either MC or SO) within 3 months of diagnosis. The data were analyzed with chi-square, binary and logistics regression models.

Results

One hundred and fifty one (28.9%) patients received SO while 372 (71.1%) patients had MC. The median age of presentation was 73 [67 –79] years old. The median prostate-specific antigen (PSA) was 280ng/ml [82.4–958]. Three hundred and thirty one patients (66.3%) had high volume bone metastasis and 57 patients (10.9%) had visceral metastasis. Clinical demographics and clinicopathological were similar across both groups. Similar oncological outcomes were observed in both groups. The proportion of PSA response (PSA <1ng/ml) was 65.6% for SO and 67.2% for MC (P = 0.212). Both therapies achieve >95% of effective androgen suppression (testosterone <50ng/dL). Time to castrate-resistance was similar (18 vs 16 months, P = 0.097), with comparative overall survival (42 vs. 38.5 months, P = 0.058) and prostate cancer mortality (80.1 vs. 75.9%, P = 0.328).

Similarly, no difference was observed for the 4 AE profiles between SO and MC respectively; change in Haemoglobin (-0.75 vs. -1.0g/dL, P = 0.302), newly diagnosed Diabetes mellitus (4.6 vs. 2.9%, P = 0.281), control measured by HbA1c (0.2 vs. 0.25%, P = 0.769), coronary artery disease events (9.9 vs. 12.9%, P = 0.376) and skeletal-related fractures (9.3 vs. 7.3%, P = 0.476).

After adjusting for varying governmental subsidies and inflation rates, the median cost of SO was $5275, compared to MC of $9185.80.

Conclusion

Both SO and MC have similar oncological outcomes and AE profiles. However, SO remains a much more cost-effective form of ADT for the long-term treatment of mPCa patients.

中文翻译：

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基于大型前瞻性转移性前列腺癌注册资料的手术性睾丸切除术和medical割术在治疗效果，不良反应和费用方面的比较研究。

介绍

雄激素剥夺疗法（ADT）仍然是转移性前列腺癌（mPCa）治疗的主要手段，但其发病率很高。医学去势术（MC）和外科手术性睾丸切除术（SO）的比较得出了不同的结果。我们旨在评估mPCa患者的肿瘤学结局，不良反应（AE）概况以及MC和SO的费用。

方法和材料

我们从前瞻性维护的前列腺癌数据库中回顾了523例从头维持mPCa的患者，历时15年（2001-2015年）。所有患者在诊断后3个月内均接受ADT（MC或SO）。使用卡方，二元和后勤回归模型分析数据。

结果

一百一十五（28.9％）患者接受了SO，而372（71.1％）患者接受了MC。报告的中位年龄为73 [67 –79]岁。中位前列腺特异性抗原（PSA）为280ng / ml [82.4–958]。331例（66.3％）发生高骨转移，57例（10.9％）发生内脏转移。两组的临床人口统计学和临床​​病理学相似。两组均观察到相似的肿瘤学结果。SO的PSA响应比例（PSA <1ng / ml）为65.6％，MC为67.2％（P  = 0.212）。两种疗法均能实现> 95％的有效雄激素抑制（睾丸激素<50ng / dL）。抵抗去势的时间相似（18个月对16个月，P  = 0.097），总生存期比较（42个月对38.5个月，P  = 0.058）和前列腺癌死亡率（80.1比75.9％，P  = 0.328）。

同样，在SO和MC之间的4个AE轮廓上也没有观察到差异。血红蛋白变化（-0.75 vs.-1.0g / dL，P  = 0.302），新诊断的糖尿病（4.6 vs. 2.9％，P  = 0.281），对照通过HbA1c测得（0.2 vs. 0.25％，P  = 0.769） ，冠状动脉疾病事件（9.9比12.9％，P  = 0.376）和骨骼相关骨折（9.3比7.3％，P  = 0.476）。

在调整了不同的政府补贴和通货膨胀率之后，SO的中位数成本为5275美元，而MC的中位数成本为9185.80美元。

结论

SO和MC具有相似的肿瘤学结果和AE分布。但是，对于mPCa患者的长期治疗，SO仍然是一种更具成本效益的ADT形式。