Comparison of Biochemical Efficacy of Bilateralorchidectomy and Medical castration (IHRH analogue, zoladex®) in patients with advanced Prostate Cancer at Lagos State University Teaching Hospital, Lagos.

Abstract

Introduction: Prostate cancer (PCa) is a leading cause of cancer –related deaths among men and it is the most commonly diagnosed cancer among Nigerian men. Most of the patients with PCa cases in Nigerian hospitals usually present with advanced disease and this requires androgen deprivation therapy (ADT) which can be in form of surgical or medical castration. This study was designed to determine which of the two options is more efficacious. Objectives: The study compared the biochemical efficacy of medical castration (Zoladex®) with bilateral orchidectomy in reducing serum testosterone and serum PSA in patients with advanced PCa. Methods: A prospective, hospital based, non-randomized clinical study was conducted over one-year period from November 2016 - October 2017.Each patient was followed up for six months. Patients that met the inclusion criteria were recruited consecutively into two groups; surgical and medical castration groups. Serum testosterone and PSA were measured before prostate biopsy was done using chemiluminescent immunoassay. Serum testosterone and PSA were repeated at 1, 3- and 6-months following commencement of treatment in the two groups. Data were analyzed using the Statistical Package for Social Sciences (SPSS IBM) version 20.0. Results: Fifty patients were studied, twenty- five patients in each group. The percentage drop in median serum testosterone at 1,3 and 6 months for the orchidectomy group was 85.40%, 91.30%, 91.90% respectively while the percentage drop in median serum testosterone for the medical castration group at1,3 and 6 months was 87.30%, 93.80%, 94.00% respectively. The percentage drop in median serum PSA at 1,3 and 6 months for orchidectomy treatment group was 69.40%, 97.50% and 99.20% respectively while for medical castration group, the percentage drop in median serum PSA at 1,3 and 6 months was 68.40%, 96.80%, 98.20% respectively. Local complications associated with orchidectomy were scrotal hematoma (20%) and surgical site infection (28%). Injection site reaction (8%) was recorded in medical castration group. All patients in both groups had hot flushes, reduced libido and weak erection as systemic complications. Conclusion: ADT still remains the mainstay of management of advanced PCa. Medical castration ( Zoladex®) and surgical castration (Orchidectomy) are both equally efficacious in the short term. Early response to PSA control is found to be slightly better with surgical than medical castration.