Surgical versus medical castration in prostate cancer

Surgical castration for metastatic prostate cancer has declined rapidly in recent years but may be an under-utilised option for some men, according to researchers from the USA.

Although medical castration for advanced prostate cancer is the most common form of androgen deprivation, surgical castration represents a less costly and potentially better-tolerated treatment, they say.

In their study the researchers retrospectively identified 24 805 men with metastatic prostate cancer from 2004 to 2016. Of these, only 5.4% underwent surgical castration. The number of castrations fell significantly over this time period from 8.5% in 2004 to 3.5% in 2016.

After a median follow up of 30 months castration type was not associated with differences in survival (surgical versus medical hazard ratio 1.02, 95% CI 0.95–1.09, p=0.6).

Commenting on the study, Michael H. Johnson, Assistant Professor of Urology and Oncology, Johns Hopkins Hospital, Baltimore, says: ‘Further research is needed to understand factors driving treatment choices regarding androgen deprivation. Although the concept of surgical castration may be undesirable to some patients, other men may find this an acceptable or preferred option. From the standpoint of utilisation of healthcare resources, surgical castration for men who certainly need lifelong androgen deprivation may be a preferred option.’

Patients with Medicaid or no insurance were more likely to have surgical castration than patients with Medicare. There was no significant difference in survival between medical and surgical castration at 30 months.

As the authors correctly state, further research is needed to understand factors driving treatment choices regarding androgen deprivation. Although the concept of surgical castration may be undesirable to some patients, other men may find this an acceptable or preferred option. From the standpoint of utilisation of healthcare resources, surgical castration for men who certainly need lifelong androgen deprivation may be a preferred option.

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