Subcapsular orchiectomy versus total orchiectomy and LHRH analogue in the treatment of hormone-sensitive metastatic prostate cancer: a different perspective in evaluation of the psychosocial effects

Abstract

Purpose We aimed to compare total orchiectomy, subcapsular orchiectomy, and luteinizing hormone-releasing hormone (LHRH) analogue treatment in patients with hormone-sensitive metastatic prostate cancer in terms of efficacy of androgen deprivation treatment (ADT), patient satisfaction, health-related quality of life (HRQoL), development of phantom testis syndrome (PTS), and post-traumatic stress disorder (PTSD). Method Among 272 patients treated between July 2015 and January 2019, 189 patients were enrolled in this prospective, cohort study and the patients were divided into three groups: group I, bilateral total orchiectomy (n66); group II, bilateral subcapsular orchiectomy (n63); and group III, LHRH analogue treatment (n60). The adequacy of ADT was routinely monitored every 3 months and clinical parameters were evaluated. After 6 to 36 months following ADT, questionnaires were used to evaluate PTS, PTSD, and HRQoL during outpatient visits. The patient satisfaction was questioned as yes/no. Results Adequate castration was provided with all three treatments, while the presence and frequency of PTS and severity of PTSD were lower, and patient satisfaction related to ADT and all components of HRQoL were better in patients undergoing subcapsular orchiectomy than those undergoing total orchiectomy. All findings except for PTS were similar in patients undergoing subcapsular orchiectomy and LHRH analogue treatment. In analysis of all patients, total incidence of PTS was 43.4% and PTSD was reported to be 48.7%. A strong relationship was found between PTSD and phantom testis pain (r0.621,p < 0.001). Conclusions Subcapsular orchiectomy has less psychosocial side effects than total orchiectomy and is similar to LHRH analogue treatment. It can be a reliable, cheaper, and fast-acting alternative to LHRH analogue treatment.