Most of our testosterone is made in out testicles, so the first stage of hormone therapy to treat prostate cancer is to prevent them from making any androgens. Testosterone is said to “feed” prostate cancer, so stopping the creation of testosterone controls prostate cancer progression.
We have a number of ways to limit the production of testosterone by the testicles. The oldest method is by surgical castration (orchiectomy) where the testicles are surgically removed. An orchiectomy of a man with advanced metastatic prostate cancer is associated with lower risks for adverse effects compared to men who underwent medical castration with gonadotropin-releasing hormone agonist (GnRHa) therapy (chemical castration), according to an article published online by JAMA Oncology.
In the United States, the use of bilateral orchiectomy has been nearly eliminated because of cosmetic and psychological issues felt by many men. In less developed nations an orchiectomy is more common because of its lower cost.
Quoc-Dien Trinh, M.D., of Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, and coauthors compared adverse effects of GnRHa and bilateral orchiectomy in 3,295 men with advanced prostate cancer between 1995 and 2009. The researchers evaluated six major potential adverse effects, which were selected based on their effect on a man’s quality of life and the potential for increased health care costs. They selected:
- Any fractures
- Peripheral Artery Disease
- Venous Thromboembolism
- Cardiac-related Complications
- Cognitive Disorders.
Of the 3,295 subject men evaluated 87% (n=2,866) were treated with a GnRHa (chemical castration and 13% (n=429) were treated surgically.
They found that the overall three-year survival was 46% for those men chemically treated with a GnRHa medication and 39% those treated surgically.
The study conclusion is that surgical castration through orchiectomy was associated with lower risks of fractures, peripheral artery disease and cardiac-related complications compared with medical castration with a GnRHa drug.
They did not find any statistically significant difference between those men treated with an orchiectomy and GnRHa for the side effects of diabetes and cognitive disorders.
They also found that those men who were treated with a GnRHa drug for 35 months or more were at the greatest risk of experiencing a fracture, peripheral artery disease and venous thromboembolism, cardiac-related complications and diabetes, according to the results.
The authors note that since the study was designed as a retrospective study the results have limited use in clinical practice, however in those men who need to have continuous hormone therapy surgery should be considered as an alternative to chemical castration.
JAMA Oncol. Published online December 23, 2015. DOI: 10.1001/jamaoncol.2015.4918