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Surgical castration less risky treatment for prostate cancer

Chemical treatment carries more risk for side effects, but most patients choose aesthetics and the psychological preference of not having their testicles removed.

By Stephen Feller
Surgical castration less risky treatment for prostate cancer
Not only did most patients in the study opt for chemical treatment, but those who chose chemical over surgical castration survived three years at higher rates than those who had their testicles removed. Photo by Image Point Fr/Shutterstock

BOSTON, Dec. 24 (UPI) -- Androgen-deprivation therapy is a basic method of managing metastatic prostate cancer, and can be achieved through surgical or medical castration, though surgical castration is rarely used because of cosmetic and psychological concerns.

Researchers at Brigham and Women's Hospital, Dana-Farber Cancer Institute and Harvard Medical school found in a recent study that removal of the testicles, or orchiectomy, was associated with lower risks for adverse effects than chemical castration using gonadotropin-releasing hormone agnonist therapy, or GnRHa, to manage cancer.

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ADT is regularly prescribed, but brings the risk of fatigue, hot flashes, decreased libido and sexual potency, in addition to less known potential for fractures, diabetes, cardiovascular disease and other conditions. While patients prefer drug therapy to having their testicles removed, researchers caution that increased survival rates for prostate cancer mean the potential fallout from long-term use of drug treatments can be far greater than psychological or aesthetic concerns.

In the study, published in the Journal of the American Medical Association, researchers analyzed data on 3,295 men with metastatic prostate cancer collected between 1995 and 2009 as part of the Surveillance, Epidemiology, and End Results database.

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Of the men included in the study, 87 percent were treated with GnRHa and 13 percent were treated with orchiectomy. The three-year survival rate for patients was 46 percent for those treated chemically and 39 percent who had their testicles removed.

While chemically castrated patients lived longer, they also were 80 percent more likely to have a fracture, more than twice as likely to develop an arterial disease, 50 percent more likely to have circulation issues, 69 percent more likely to develop a heart condition, and 88 percent more likely to develop diabetes.

In an editorial published in JAMA alongside the study, researchers from the Institute of Cancer Research note that some of the associated health risks also come with older age and other conditions. For younger patients, though, the risk of keeping their testicles may be worth it.

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