Comparison of Metabolic and Cardiovascular Impact between Gonadotropin-Releasing Hormone Agonists and Orchidectomy for Androgen Deprivation Therapy in Metastatic Carcinoma Prostate

Abstract

Background: Metastatic prostate cancer is a global health challenge and requires a balanced approach to preserve the quality of life and extend survival. Current treatment is to offer monotherapy either orchidectomy or GnRH agonists or antagonists to hormone-sensitive metastatic prostate cancer patients. Androgen deprivation therapy increases the risk of obesity, diabetes, dyslipidemia and osteoporosis. Objectives: This study was done to compare the metabolic and cardiovascular impact of GnRH agonist and orchidectomy for androgendeprivation therapy in metastatic carcinoma prostate. Methods: This Quasi-experimental study was conducted at the Department of Urology, Dhaka Medical College Hospital, Dhaka during the period from July 2019 to December 2020. A total of 28 patients diagnosed with metastatic prostate cancer were included in the study as per inclusion and exclusion criteria. After counselling, patients were allocated to orchidectomy (Group- A) or GnRH agonist (group-B) as per the patient’s choice. After undergoing orchidectomy or receiving GnRH agonists, patients were advised to follow up at 1, 3 and 6 months. Two patients were lost to follow-up. Result: The mean age of patients in group-A was 66.55(range 58-74) years and in group B was67.8 (62-73) years. There was a significant increase in RBS, triglyceride and a decrease in HDL and bone mineral density at 6 months of group B compared to Group-A. After 6 months, 9.09% of patients in group-A compared to 26.6% of patients in group B had RBS above 11.1 mmol/L. In group-A, 45.45% of patients had triglyceride levels>150 mg/dL compared to 80% in group B. HDL level decreased <40 mg/dL in 45.45% of patients in group-A but 60% in group B. Bone mineral density decreased below -2.5 in 9.09% of patients in group- A compared to 46.66% in group B. Mean S.PSA was around 2 ng/ml in both groups during the follow-up period. The cardiovascular and metabolic impact of orchidectomy was less compared to GnRH agonists. .......