Comparison of Subcapsular and Total Orchiectomy in Patients with Prostate Cancer

Abstract

Ad dress for Cor res pon den ce: Taha Numan Yıkılmaz MD, University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Clinic of Urology, Ankara, Turkey Phone: +90 312 336 09 09 E-mail: numanyikilmaz@gmail.com ORCID-ID: orcid.org/0000-0001-8410-2474 Re cei ved: 02.10.2017 Ac cep ted: 13.12.2017 Objective: We aimed to compare the oncologic and functional outcomes of patients who underwent subcapsular or total orchiectomy for surgical castration in prostate cancer. Materials and Methods: We studied 65 patients who underwent total or subcapsular orchiectomy with a diagnosis of prostate cancer between April 2014 and May 2017. At postoperative 3-month follow-up, prostate specific antigen (PSA) and total testosterone levels were measured and patients were asked about their psychological status due to organ loss. Results were compared between the groups. Results: Sixty-five patients were evaluable: 23 had subcapsular and 42 had total orchiectomy. The mean age of the cases was 71.4 (60-83) years, the mean PSA level was 45.4 ng/dL (4-3800 ng/dL), and 41 cases had metastatic foci. There was no significant difference between the complication rates of the groups, but duration of the operation was significantly shorter in the subcapsular orchiectomy group. The two groups had similar mean PSA and testosterone levels at postoperative 3 months, but significantly more patients with total orchiectomy reported psychological problems due to organ loss. Conclusion: Subcapsular orchiectomy should be preferred for surgical castration because of the short duration of operation and the advantage of organ presence within the scrotal sac after surgery. In terms of oncologic outcomes, subcapsular orchiectomy shows no difference from total orchiectomy and is a safe alternative.