Comparison of Biochemical Efficacy of Bilateral Orchidectomy and Medical Castration (Goserelin) in Patients with Advanced Prostate Cancer at Lagos State University Teaching Hospital, Lagos.

Abstract

Background: 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 in Nigerian hospitals present with advanced disease and this requires 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. Aim: The study compared the biochemical efficacy of medical castration (Goserelin) with bilateral orchidectomy in reducing serum testosterone and serum PSA in patients with advanced PCa. Design and setting of the study: 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 who met the inclusion criteria were recruited consecutively into two groups; surgical and medical castration groups after obtaining written informed consent. 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 and the percentage drop in median serum testosterone for the medical castration(Goserelin) group at 1,3 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 and for medical castration(Goserelin) 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 goserelin group. All patients in both groups had hot flushes, reduced libido and weak erection as systemic side-effects. Conclusion: Medical castration (Goserelin) and surgical castration(Orchidectomy) are both equally efficacious in the short term,in the treatment of advanced prostate cancer.