Orchiectomy Versus Goserelin Each Plus Bicalutamide in Patients with Metastatic Adenocarcinoma of the Prostate: Adverse Events Highlighted

Abstract

Background: Androgen deprivation therapy (ADT), palliation for advanced/metastatic prostate cancer can be medical or surgical. This study compares the results of goserelin injection to orchiectomy each in combination with bicalutamide in patients diagnosed with metastatic adenocarcinoma of the prostate highlighting the adverse events.Methods: Ninety-six patients with histologically diagnosed adenocarcinoma of the prostate, were prospectively randomized into two arms. Medical arm patients had subcutaneous goserelin injection plus bicalutamide. Surgical arm patients had bilateral orchiectomy plus bicalutamide. A nadir serum prostate specific antigen (PSA) of 0.2ng/ml was chosen and response to treatment was by determining total serum PSA levels at 3 and 6 months. The student's t test, chi-squared test and Kaplan-Meier survival analysis were the instruments for statistical analysis.Results: Follow up was between 6-30 months. There were 11 (23%) and 9 (19%) deaths in the surgical and medical arms respectively. At 6 months serum PSA levels of ≤ 0.2ng/ml was noted in 44 (92%) and 45 (94%) patients of the medical and surgical castrations respectively. Anemia, impotence, hot flushes were some of the adverse events noted in both groups during the study worse with medical castration. Conclusion:There was no statistical difference between the oncological efficacy and survival of both arms of treatment but a statistical difference in the adverse events