Comparing chemical and surgical castration for prostate cancer

December 23, 2015

Surgical castration to remove the testicles (orchiectomy) of men with metastatic prostate cancer was associated with lower risks for adverse effects compared with men who underwent medical castration with gonadotropin-releasing hormone agonist (GnRHa) therapy, according to an article published online by JAMA Oncology.

Androgen-deprivation therapy (ADT), which is achieved through surgical or medical castration, has been a cornerstone in the management of metastatic prostate cancer (PCa) for the past 50 years. But the use of bilateral orchiectomy has been nearly eliminated in the U.S. because of cosmetic and psychological concerns.

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 metastatic PCa (66 or older) between 1995 and 2009. The authors analyzed six major adverse effects, which were picked based on their effect on a patient's quality of life, the potential for increased health care costs, and on a previously described association with ADT use. The six adverse effects were: any fractures, peripheral artery disease, venous thromboembolism, cardiac-related complications, diabetes and cognitive disorders.

Of the 3,295 men, 87 percent (n=2,866) were treated with GnRHa and 13 percent (n=429) were treated with orchiectomy. The overall three-year survival was 46 percent for GnRHa treatment and 39 percent for orchiectomy.

The study indicates surgical castration through orchiectomy was associated with lower risks of any fractures, peripheral artery disease and cardiac-related complications compared with medical castration with GnRHa. No statistically significant difference was found between orchiectomy and GnRHa for diabetes and cognitive disorders.

Men treated with GnRHa for 35 months or more were at the greatest risk of experiencing any fracture, peripheral artery disease, venous thromboembolism, cardiac-related complications and diabetes, according to the results.

The authors note limitations to the study, primarily its retrospective design which relies on historical data.

"In some patients who need permanent androgen suppression, surgical castration may represent a suitable alternative to GnRHa. However, other considerations must be contemplated when deciding between medical or surgical castration (i.e., young age, intermittent ADT)," the study concludes.

(JAMA Oncol. Published online December 23, 2015. doi:10.1001/jamaoncol.2015.4917. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: The study includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Chemical or Surgical Castration - Is This Still an Important Question?

"Despite their retrospective nature, studies such as this are critically important, because they increase awareness of these concerns. Because men with metastatic PCa [prostate cancer] are living longer than ever, it is imperative that we minimize the risk of harm from therapies. Physicians treating patients with PCa must familiarize themselves with how to prevent and treat these complications ... The current article by Sun et al adds fuel to an already controversial debate and the discredit brought by the reimbursement issues. When there is more than one reasonable option, clinical decisions must be guided by the patient's values and preferences. In the absence of clear evidence to the contrary, patients are likely to continue to overwhelmingly favor GnRHa over orchiectomy," Johann S. de Bono, M.B., Ch.B., M.Sc., F.R.C.P., Ph.D., F.Med.Sci., and coauthors from the Institute of Cancer Research and the Royal Marsden National Health Service Foundation Trust, England, write in a related editorial.

(JAMA Oncol. Published online December 23, 2015. doi:10.1001/jamaoncol.2015.4918. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
-end-
Media Advisory: To contact corresponding author Quoc-Dien Trinh, M.D., call Johanna Younghans at 617-525-6373 or email Jyounghans@partners.org. To contact editorial Johann S. de Bono, M.B., Ch.B., M.Sc., F.R.C.P., Ph.D., F.Med.Sci., email johann.de-bono@icr.ac.uk

The JAMA Network Journals

Related Peripheral Artery Disease Articles from Brightsurf:

Heart attack prevention lags for people with stroke, peripheral artery disease
Although all three conditions can lead to heart attack, people with stroke or peripheral artery disease were less likely to receive preventive treatments to prevent heart attack than people with coronary artery disease.

Prime time for lower extremity artery disease
This article provides an overview of the indications and techniques of lower extremity revascularisation, and an in-depth analysis of the available evidence regarding type and duration of antiplatelet and anticoagulant treatment following endovascular and surgical revascularisation.

Work-related stress linked to increased risk for peripheral artery disease
People who reported work-related stress were more likely to be hospitalized for treatment of peripheral artery disease compared to those who did not report work-related stress.

Associations between vaspin levels and coronary artery disease
In a new publication from Cardiovascular Innovations and Applications; DOI https://doi.org/10.15212/CVIA.2019.0565, Lutfu Askin, Okan Tanriverdi, Hakan Tibilli and Serdar Turkmen from the Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey consider associations between vaspin levels and coronary artery disease.

Study maps landmarks of peripheral artery disease to guide treatment development
Novel biomedical advances that show promise in the lab often fall short in clinical trials.

Cocoa could bring sweet relief to walking pain for people with peripheral artery disease
Patients with peripheral artery disease (PAD) who consumed a flavanol-rich cocoa beverage three times daily for six months saw significant improvements in their 6-minute walking distance compared to a placebo, in a small, phase II randomized study.

15-year study finds treatment gaps exist for patients with peripheral arterial disease
In a new 15-year study, researchers at the Intermountain Healthcare Heart Institute in Salt Lake City found that patients with eripheral arterial disease may not be prescribed life-saving medications at the same rate as for other heart conditions.

Peripheral artery disease risk hinges on health factors and demographics, including race
The lifetime risk of lower-extremity peripheral artery disease (PAD), in which leg arteries narrow abnormally, is about 30 percent for black men and 28% for black women, with lower but still-substantial risks for Hispanics and whites, according to a study led by scientists at the Johns Hopkins Bloomberg School of Public Health.

Study quantifies smoking's strong link to peripheral artery disease
A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health found that cigarette smoking boosts the risk of peripheral artery disease, and this elevated risk can persist up to 30 years after smoking cessation.

Cigarette smoking associated with increased risk of peripheral artery disease in African-Americans
African-Americans who smoke cigarettes are more likely than those who don't to have peripheral artery disease (PAD).

Read More: Peripheral Artery Disease News and Peripheral Artery Disease Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.