Surgical Versus Medical Castration.

[pjoshea13]

New study below [1].

The subject has come up occasionally.

I imagine that most men are a little squeamish about parting with their equipment.

Surgical castration "decreased from 8.5% in 2004 to 3.5% in 2016", in the U.S.

"Men with potentially limited health care access receive more surgery, perhaps reflective of a provider bias towards the perceived benefit of permanent castration."

Exclude those who opted for surgery for financial reasons, & it seems that orchiectomy is extremely unpopular.

I wonder how physician bias plays into this?

Note that prosthetics can restore one to youthful grandeur - & they will not shrink!

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/317...

J Urol. 2019 Nov 20:101097JU0000000000000684. doi: 10.1097/JU.0000000000000684. [Epub ahead of print]

Surgical Versus Medical Castration for Metastatic Prostate Cancer: Use and Overall Survival in a National Cohort.

Weiner AB1, Cohen JE1, DeLancey JO1, Schaeffer EM1, Auffenberg GB1.

Author information

1

Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Abstract

PURPOSE:

Surgical castration for metastatic prostate cancer is used less frequently than medical castration, yet costs less, requires less follow-up, and may be associated with fewer adverse effects. We sought to evaluate temporal trends and factors associated with the use of surgical castration.

MATERIALS AND METHODS:

This retrospective cohort study sampled 24,805 men with newly diagnosed (de novo) metastatic prostate cancer from a national cancer registry in the United States (2004-2016). Multivariable logistic regression assessed the association between sociodemographics and surgery. Multivariable Cox regression evaluated the association between castration type and overall survival.

RESULTS:

Overall, 5.4% of men received surgical castration. This decreased from 8.5% in 2004 to 3.5% in 2016 (Per year later: OR 0.89, 95% CI 0.87-0.91,p<0.001). Compared to Medicare, private insurance was associated with less surgery (OR 0.73, 95% CI 0.61-0.87, p<0.001) while Medicaid or no insurance was associated with more surgery (OR 1.68, 95% CI 1.34-2.11, <0.001 and OR 2.12, 95% CI 1.58-2.85, p<0.001, respectively). Regional median income >$63,000 was associated with less surgery (vs <$38,000: OR 0.61, 95% CI 0.43-0.85, p=0.004). After a median follow-up of 30 months, castration type was not associated with differences in survival (Surgical vs medical: HR 1.02, 95% CI 0.95-1.09, p=0.6).

CONCLUSION:

In a contemporary, real-world cohort, use of surgical castration is low and decreasing despite its potential advantages and similar survival compared to medical castration. Men with potentially limited health care access receive more surgery, perhaps reflective of a provider bias towards the perceived benefit of permanent castration.

KEYWORDS:

United States; castration; epidemiology; orchiectomy; prostatic neoplasms

PMID: 31746656 DOI: 10.1097/JU.0000000000000684

[dadzone43]

It would be my choice if I were faced with that choice. Happily (so far) I am not.

[larry_dammit]

Would not go to the knife but have the medical castration now. Poor boys are peanuts compared to what they were 😢😢😢. But that’s part of it including no hair under my arms or nose. Hating the monster 🙏😡

[Union98]

I suspect part of the reason that most doctor's don't push the procedure is that if using ADT there is always the chance that the patient can take a "holiday" while with the procedure that isn't a possibility.

[GeorgesCalvez]

If there is a hope of a cure or long periods of remission and the period of castration is short then medical castration is better as it can be stopped or paused. Hopefully the patient's testosterone will return giving benefits in terms of quality of life and also improved cardiovascular health, etc.

One could argue that surgical castration is better in older patients or patients where it is very unlikely or impossible that there will be remission but maybe doctors do not want to be perceived by the patient as putting them in the palliative care pile?

I think if my PCa moved from being in the IIIb possible remission pile to the IV with metastases and some form of castration for life then I might opt for a matching pair neuticles!

[Muffin2019]

I would not hesitate the surgery than to take many meds with side effects, considering my age who cares. Not going to have kids, would not shower at health clubs due to things you could catch in showers. If denutting is a good option then why not, cheaper also if your meds are going to break the bank.

[GeorgesCalvez]

Most of the side effects of medical and surgical castration are the same with exceptions being the local inflammation at the injection sites, etc that are particular to Eligard / Lupron and Firmagon.

The overwhelming majority of effects such as hot flashes, sweating, hair loss, etc are common to both so you do not gain a lot.

As a side note I have lost most of my body hair but my beard is as luxuriant as ever and I have grown more hair on my head and it is noticeably darker.

[Jimhoy in reply to GeorgesCalvez]

George

If you are speaking as a brother PC patient and are referring to your own experiences or this is your opinion, please be sure to include that as a caveat!!

If you are a professional, I would love to see some simple statistics / facts.

Many aPC brothers would strongly disagree with your statement to the extent that yes, the typical andropause symptoms should be similar but many have extended side effects that could be / seem to be contributed to by the chemicals!! Including me!!

I have talked with a lot of guys and shamefully, did not save my results. They overwhelmingly favor their decision to snip. Some of which have made the comparison of having been on chemical castration regiments verses surgical and (relative to adverse side effects) have preferred the later of the two forms of ADT.

Maybe some of those guys will see this post and comment!! I don’t recall the names!!!

Jc

[GeorgesCalvez]

Hi there,

I have been through nineteen months of Firmagon as part of my treatment and some of my side effects could be put down to simple androgen deprivation but others obviously were not.

One of the problems that doctors struggle with is that side effects are diverse.

My doctor told me that I would put on weight, not true, my weight has remained roughly constant throughout the treatment.

He said that I would not be able to get an erection while on Firmagon, he had forgotten at this point that I had undergone a non nerve sparing prostatectomy so erections were already a non starter for me, but I would not care as my libido would have disappeared.

Not true, my mental libido has kept on going throughout, now I have stopped the Firmagon my body seems to be resexualising after only a month and a half.

I have tried to generalise out the effects of cutting testosterone and the generalities fit a group of men but there are plenty of exceptions, me included to some extent.

Physical castration affects men in different ways as well, some find it quite problem free while others find it difficult.

Best wishes,

Georges

[j-o-h-n]

Just think of this.... you can always shellac them and hang them on your Christmas tree.....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 11/22/2019 7:40 PM EST - JFK assassination 1963

[Shooter1 in reply to j-o-h-n]

Tried that approach, but Surgeon and hospital refused to release then to me in secimen jar to display on mantel as conversation starter.

[j-o-h-n in reply to Shooter1]

Sort of goes like this:

Hello doctor how's your snipping going lately? OMG whose balls are those in that jar on your mantel? You mean to tell me they're Shooter1's? Naw, can't be doc, cause you told me his were blue....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/23/2019 1:34 PM EST

[Zetabow]

Started on combined Chemo and ADT for 12 months, PSA went from 1386 to 0.028. My Oncologist said I'm that advanced with my bone Mets I will never get a ADT holiday, he talked me into surgery, I had it on Thursday, only issue was bladder became blocked and needed a Catheter, it came out the following morning with some drugs to get me flowing again, I guess I'll be sore for a couple more days. Up side is having a 25y old nurse changing bandages and washing my balls. I'll take the memory to the grave with a smile on my face. I got to keep my balls the just snipped the lines.