Outcomes of surgical castration in comparison to medical castration in metastatic prostate cancer

Abstract

Background: Prostate cancer (PCa) is the second most prevalent malignancy in males globally, accounting about 1.2 million new cases in every year and 0.36 million mortalities mostly from metastatic PCa (mPCa). The gold standard treatment of metastatic hormone sensitive prostate cancer (mHSPC) is androgen deprivation therapy (ADT) or castration, achieve medically or surgically. According to recent evidence, surgical castration (SC) may have certain benefits such as permanence which can lessen the impact of medication non-adherence, a decreased risk of specific side effects as well as a lower cost for long-term treatment and follow-up. In developing countries like Bangladesh, most people live below poverty line, there is no health screening program, no health insurance coverage and metastases were found at the time of presentation in about 85% of patients. Objective: To evaluate the oncological outcomes and comparison of treatment cost between surgical and medical castration in patients with mHSPC. Materials and Methods: A total of 40 participants were selected by purposive sampling technique and allocated into SC group and MC group from March 2022 to August 2023 at Department of Urology, NIKDU, Dhaka-1207. Participants who were diagnosed as de novo metastatic prostate cancer and planned for primary androgen deprivation therapy were included in this study. SC was achieved by bilateral simple orchiectomy and MC was achieved by GnRH agonist (Goserelin 10.8 mg). All participants were regularly followed up 3 monthly up to 1 year. All data were analyzed by appropriate statistical tests. Results: Two participants from SC and 3 from MC group were lost during follow-up. So a total of 35 participants (SC=18 and MC= 17) were actually studied. The mean age of presentation was 64.28±7.74 (54-82) and 64.12±7.78 (51-75) years in SC and MC group respectively and statistically not significant (p=0.952). Mean BMI was 22.78±2.63 (18.23-28.33) kg/m2 in SC group and 22.22±2.09 (18.54-25.31) kg/m2 in MC group and was changed significantly within the groups throughout the follow up period. There is statistically significant difference (p=0.001) in VAS score (2.0[1.0-2.0] vs 2.0 [2.0-3.0]) for bone pain between groups and surgical castration significantly reduced bone pain than medical castration at 3rd month of follow up. PSA parameters between groups (0.14[0.08-0.19] vs 0.24[0.16-0.43]) also shows statistically significant difference (p= 0.036) where nadir PSA (