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Subcapsular orchiectomy versus total orchiectomy and LHRH analogue in the treatment of hormone-sensitive metastatic prostate cancer: a different perspective in evaluation of the psychosocial effects

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Abstract

Purpose

We aimed to compare total orchiectomy, subcapsular orchiectomy, and luteinizing hormone-releasing hormone (LHRH) analogue treatment in patients with hormone-sensitive metastatic prostate cancer in terms of efficacy of androgen deprivation treatment (ADT), patient satisfaction, health-related quality of life (HRQoL), development of phantom testis syndrome (PTS), and post-traumatic stress disorder (PTSD).

Method

Among 272 patients treated between July 2015 and January 2019, 189 patients were enrolled in this prospective, cohort study and the patients were divided into three groups: group I, bilateral total orchiectomy (n 66); group II, bilateral subcapsular orchiectomy (n 63); and group III, LHRH analogue treatment (n 60). The adequacy of ADT was routinely monitored every 3 months and clinical parameters were evaluated. After 6 to 36 months following ADT, questionnaires were used to evaluate PTS, PTSD, and HRQoL during outpatient visits. The patient satisfaction was questioned as yes/no.

Results

Adequate castration was provided with all three treatments, while the presence and frequency of PTS and severity of PTSD were lower, and patient satisfaction related to ADT and all components of HRQoL were better in patients undergoing subcapsular orchiectomy than those undergoing total orchiectomy. All findings except for PTS were similar in patients undergoing subcapsular orchiectomy and LHRH analogue treatment. In analysis of all patients, total incidence of PTS was 43.4% and PTSD was reported to be 48.7%. A strong relationship was found between PTSD and phantom testis pain (r 0.621, p < 0.001).

Conclusions

Subcapsular orchiectomy has less psychosocial side effects than total orchiectomy and is similar to LHRH analogue treatment. It can be a reliable, cheaper, and fast-acting alternative to LHRH analogue treatment.

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Authors and Affiliations

  1. Department of Urology, Karabuk University Training and Research Hospital, 78200, Karabuk, Turkey

    Ismail Selvi

  2. Department of Urology, Health Science University Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey

    Halil Basar

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  1. Ismail Selvi
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  2. Halil Basar
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Correspondence to Ismail Selvi.

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The authors declare that they have no conflict of interest.

Ethical approval for research involving human participants

The study was approved by the local ethics committee (protocol number: 2018-07/56) at Health Science University Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital. All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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A formal written informed consent was obtained from all individual participants included in the study. The data of patients who did not consent was not used.

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Selvi, I., Basar, H. Subcapsular orchiectomy versus total orchiectomy and LHRH analogue in the treatment of hormone-sensitive metastatic prostate cancer: a different perspective in evaluation of the psychosocial effects. Support Care Cancer 28, 4313–4326 (2020). https://doi.org/10.1007/s00520-019-05266-2

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