Utilization and Outcomes of Surgical Castration in Comparison to Medical Castration in Metastatic Prostate Cancer

Abstract

Androgen deprivation therapy is the gold standard for metastatic prostate cancer, which can be achieved either by surgical or medical castration. In this study of 33,585 patients in the National Cancer Database, there was significant decline in the trend of utilization of surgical castration from 8.6% in 2004 to 3.1% in 2014. However, there was no survival difference with surgical castration when compared with medical castration. Increasing the utilization of surgical castration could help reduce health care expenditures. Patients and physicians need to be aware of treatment options and their financial implications. Background: Androgen deprivation therapy (ADT) is the gold standard for metastatic prostate cancer, which can be achieved either by surgical or medical castration. In this study, we evaluated the trends of utilization of surgical castration and also assess the survival differences of patients who underwent surgical castration when compared with those who underwent medical castration. Materials and Methods: The National Cancer Database was used to identify patients with metastatic prostate cancer from 2004 to 2014. Cochran-Armitage tests were used to assess temporal trends in the proportion of patients receiving surgical castration relative to medical castration. Logistic and Cox regression models were utilized to estimate the odds of utilization of surgical castration and the effect of castration on overall survival (OS). Results: A total of 33,585 patients with metastatic prostate cancer were identified; 31,600 (94.1%) had medical castration, and 1985 (5.9%) underwent surgical castration. There was significant decline in the trend of utilization of surgical castration from 8.6% in 2004 to 3.1% in 2014. On multivariable analysis, being of a non-Caucasian race, having lower median income levels, having non-private insurance, and earlier years of diagnosis were found to be associated with increased odds of choosing surgical castration over medical castration. Notably, the odds of surgical castration were lower at academic centers. On univariable analysis, a survival difference between castration modality was evidenced (P < .01); 5-year OS for medical castration and surgical castration were 24.3% and 18.2%, respectively. However, on multivariable analysis, there was no OS difference between surgical castration and medical castration (P ¼ .13). Conclusions: In this large contemporary analysis, the utilization of surgical castration has declined over time, with no OS difference when compared with medical castration. Increasing the utilization of surgical castration could help reduce health care expenditures. With rising health care costs, patients and physicians need to be aware of treatment options and their financial implications.

Development and Evaluation of a PSMA-Targeted Nanosystem Co-Packaging Docetaxel and Androgen Receptor siRNA for Castration-Resistant Prostate Cancer Treatment

“…Although a series of treatments for PC, including surgical castration, androgen deprivation therapy (ADT), and chemotherapy and radiation therapy [ 2 ], have been significantly refined and improved in recent years, the 5-year relative survival rates for PC by stage at diagnosis and race have reached 98% among the selected cancer types [ 1 ]. Repeated use of single therapeutic agents may lead to undesirable and severe adverse effects; for example, most patients have difficulty accepting surgical castration therapy [ 3 , 4 ]. Worse still, with the development of the disease, ADT causes almost all patients to become less sensitive to androgens and progress to castration-resistant prostate cancer (CRPC) [ 5 ].…”

Prostate cancer management in the era of COVID‐19: Recommendations from the Hong Kong Urological Association and Hong Kong Society of Uro‐oncology

“…The panel recommended medical over surgical castration during the epidemic, because they are associated with similar survival rates, 22 but medical castration is noninvasive and provided on an outpatient basis (R4.1). The use of longer‐acting medical castration agents may help to reduce the number of required hospital visits.…”

Androgen Deprivation Therapy in High-Risk Localized and Locally Advanced Prostate Cancer

“…Studies have reported the efficacy and tolerability of GnRH agonists as a first-line treatment for advanced PC and concluded that the survival rate, disease progression, and time to treatment failure are comparable between GnRH agonist therapy and orchiectomy [ 20 , 21 , 22 , 23 ]. Surgical castration is a simple and cost-effective outpatient procedure, while the advantage of medical castration is the avoidance of surgery [ 20 , 21 , 22 , 23 , 24 ]. In recent years, the rate of surgical castration has been reported to be less than 9% [ 24 ].…”

“…Surgical castration is a simple and cost-effective outpatient procedure, while the advantage of medical castration is the avoidance of surgery [ 20 , 21 , 22 , 23 , 24 ]. In recent years, the rate of surgical castration has been reported to be less than 9% [ 24 ]. Although castration reduces serum testosterone levels by approximately 90%, 20–40% of dihydrotestosterone (DHT) remains in human PC tissue [ 25 , 26 , 27 ].…”