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Category: Volume 07 Issue 10 October 2019
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Title: A comparison of medical castration versus surgical castration for patients with advanced prostatic carcinoma

Authors: S K Bhat, Nisar Ahmed Ansari, P K Mishra, Maham A, C S Rawat, Nikhil Mehrotra, A K Roy

 DOI: https://dx.doi.org/10.18535/jmscr/v7i10.39

Abstract

  

Background: The introduction of androgen deprivation therapies in the treatment paradigm for advanced prostate cancer have shown excellent survival benefits .However there seems controversies revolving around with the optimal timing , duration and most importantly the serious side effects especially higher incidences of peripheral vascular diseases and diabetes. The present study tried to compare the survival benefits, recurrence free survival and side effects between the medical and surgical treatment in advanced carcinoma prostate.

Material and Methods: This is a hospital based retrospective study from January 2012 to January 2017 was conducted in medical college in north part of India. All patients diagnosed with advanced prostate carcinoma were included who received either GnRHa or orchiectomy as primary cancer therapy within 12 months of diagnosis. Associations between clinical outcomes and prognosis were compared between the two modalities; the impact on the prostate-specific antigen (PSA) normalization rate, the rebound rate and the disease-free survival rate were evaluated. The median follow-up was 22.3 months

Results: Despite similar results in normalization of the PSA score between two groups in initial time intervals beyond 18 months the response in the surgical group was higher as compared to medical group though not reaching statistical significance. At the end of the study, normalization was sustained in surgical group (20%) while in the medical group, sustained proportions was Nil (0%). Among the surgical group, recurrence free survival was higher especially in late time intervals indicating sustainable effect.

Conclusion: Advanced prostate carcinoma patients, surgical castration group do better in terms of better PSA rebound rates and overall survival in comparison to the medical treatment

Keywords: Advanced carcinoma prostate, medical castration, surgical castration, recurrence free survival.

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Corresponding Author

Dr Sanjay Kumar Bhat

Associate Professor, Department of General Surgery, RML institute of Medical Sciences, Lucknow, India