Abstract
Introduction Orchidectomy is the most cost-effective means of hormonal therapy for locally advanced or metastatic prostate cancer (LAMP). However, cost-effectiveness should not detract from health-related quality of life (HRQoL) considerations. Bilateral simple orchidectomy (BSO) has been linked to negative psychometric deficits from an empty scrotum. This study compared the HRQoL, therapeutic efficacy, and cosmetic appeal of BSO with endogenous pseudotesticular techniques of bilateral subcapsular orchidectomy (BSCO) and bilateral-epididymal-sparing orchidectomy (BESO). Research Design. Nigerian patients with LAMP were randomised into three surgical arms: BSO, BSCO, and BESO. Expanded Prostate Cancer Index Composite-26 HRQoL and sociodemographic questionnaires were administered before and three months after orchidectomy. Serum testosterone and PSA were measured at 0, 1, 2, and 3 hours; 7 days; and 3 months postoperatively. Pseudotesticular volumes and cosmetic appeal were assessed at 3 months. Result Sixty-three patients were recruited (24 BSO, 21 BSCO, 18 BESO), 73% of whom were low-income earners. There was no significant difference in the procedure cost nor the PSA or testosterone nadirs achieved over the three-month follow-up period (11.3, 12.6, 15.2 ng/ml (p=0.667) and 0.44, 0.64, 0.79 nmol/l (p=0.603) respectively). Those with pseudotesticles (BSCO, BESO) felt less emasculated (p=0.010). BSCO produced the least sexual bother, highest sexual function, and largest pseudotesticular volumes. The cosmetic appeal scores were similar between groups (77.9 ± 22.8, 81 ± 13.9, and 81.9 ± 22.5, respectively, p=0.858). Conclusion Endogenous pseudotesticular techniques, when compared with BSO, reduce the negative psychological impact experienced by patients without increasing costs. BSCO produced the best pseudotesticular volumes and postoperative sexual function. This study is registered with the ClinicalTrials.gov of the National Institute of Health U.S. National Library of Medicine as TEPSO study, NCT03744494: Comparison of the Therapeutic Efficacy and Patient Satisfaction of Three Techniques of Bilateral Orchidectomy in Prostate Cancer Patients of a Nigerian Sub-population. Registration completed on 16th of November, 2018 (registered retrospectively) NCT03744494.
Highlights
Orchidectomy is the most cost-effective means of hormonal therapy for locally advanced or metastatic prostate cancer (LAMP)
The patronage of medical options of castration in Nigeria is on the rise, bilateral orchidectomy is still the most common option of androgen deprivation used by Nigerian patients with advanced Prostate cancer (PCa) due to the cheaper cost [2, 4, 5, 13]
Is study aimed at comparing Bilateral simple orchidectomy (BSO), the practice at our centre, with two pseudotesticular techniques of orchidectomy (BSCO, practiced in some other centres in the country, and bilateral-epididymal-sparing orchidectomy (BESO)) and evaluating the cosmetic appeal as perceived by the patient as well as the health-related quality of life (HRQoL)
Summary
Prostate cancer (PCa) is the most prevalent cancer affecting Nigerian males [1]. Nigerian men with PCa commonly present late and require androgen deprivation therapy (ADT) [2, 3]. BESO was the technique with the best cosmetic appeal It was uncertain if the outcome would be similar among Nigerian men as race affects the size of the testis and its appendages [22]. Is study aimed at comparing BSO, the practice at our centre, with two pseudotesticular techniques of orchidectomy (BSCO, practiced in some other centres in the country, and BESO) and evaluating the cosmetic appeal as perceived by the patient as well as the health-related quality of life (HRQoL). Variation in serum testosterone and PSA, sociodemographic and technical parameters, pre- and postoperative testicular volumes, cosmetic appeal, and HRQoL parameters were compared between the three groups and analysed using univariate analyses of variance (ANOVA) and multivariate analyses of variance, Student’s t-test for the continuous, and Wilcoxon rank-sum test for the nonparametric measures. Were dichotomised into those with and without pseudotesticles, and the associations were reevaluated
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
