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

Abstract

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.

Castration of Dogs Using Local Anesthesia After Sedating With Xylazine and Subanesthetic Doses of Ketamine

“…Orchiectomy in other species can be performed painlessly after injecting the testes or spermatic cords with local anesthetic. Men can be castrated using local anesthesia, often without sedation (1)(2)(3)(4). Stallions also are often castrated while they are standing by using only sedation, local anesthesia, and a lip twitch for restraint (5).…”

Perineural Invasion in Prostatic Carcinoma as Detected by S100 and its Implication in Prognosis

“…Surgical and medical castration is considered to increase overall survival rate [11]. Rud O et al stated that advantages of orchidectomy are rapidly effective in lowering testosterone level which is achieved between 3 to 12 hours after surgery and is related with good compliance [12]. Goldenberg et al added that this form of therapy improves quality of life when the patient is androgen hormone receptor sensitive by giving them life with therapy free interval [13,14].…”

Comparison of Subcapsular and Total Orchiectomy in Patients with Prostate Cancer

“…Patients in our study were asked during follow-up whether they experienced this distress, and we found that 19% of patients who underwent the subcapsular technique and 60% of those who underwent the total technique were not psychologically satisfied with the procedure. In other studies comparing these techniques, psychological problems are mentioned but the patients were not asked to rate their satisfaction (1,8).…”

“…It accounts for 28% of all cancers in males. Although the introduction of the prostate-specific antigen (PSA) test in the 1960s has facilitated the diagnosis of prostate cancer, 5-10% of these patients are diagnosed with distant metastasis (1). Diethylstilbestrol treatment was first prescribed after it was discovered that prostate cancer is an androgen-dependent condition.…”

“…Surgical castration is preferred due to the late onset of effect and high cost of medical castration. The only reason explaining the avoidance of surgical castration is shown to be the psychological distress that can result from having an empty scrotum (1). With this in mind, Riba (5) first described subcapsular orchiectomy in 1942.…”