The comeback of orchiectomy in advanced prostate cancer- is that feasible?

Background & objectives: Lifelong androgen deprivation therapy (ADT) is necessary for men with advanced prostate cancer (PCa). ADT via medical castration carries with it financial and physical toxicity. This feasibility trial evaluates the acceptance rate of surgical orchiectomy among men with metastatic PCa, assessing its viability as an alternative to ongoing medical castration.

Methods: We conducted a prospective trial of PCa patients from 3 academic medical centers, who had been on ADT for at least 1 year. The primary endpoint was the proportion of patients opting for surgical orchiectomy following an educational session regarding the procedure. Secondary endpoints included participation rates in the educational session, the correlation of orchiectomy acceptance with demographic factors, the impact on quality of life metrics (sexual satisfaction, body image perception) and decision regret scale.

Results: Of the 130 men approached, 101 (78%) consented to the educational session, and 58/101 (57%) consented for quality of life assessments. 27/101 (27%) consulted with a urologist about orchiectomy, and 14/101 (14%) ultimately underwent the procedure. Quality of life outcomes showed no difference between those who underwent orchiectomy and those who did not. Decision regret among orchiectomy patients was low with 93% indicating that orchiectomy was the right decision. Testicular atrophy was observed on pathology in 13 patients who underwent orchiectomy.

Conclusion: We found a limited acceptance rate of 14% for surgical orchiectomy among men with PCa on ADT for at least 1 year, who were educated on the procedure.