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Abstract
Rise in incidence and variable natural history of prostatic carcinoma, presents a challenge to professionals involved in its management. Cases that come for evaluation and treatment in developing countries like ours are elderly and usually present in the late stages of the disease. Perhaps the best option remain at this stage is palliative in the form of channel TURP to improve the urine flow and suppress the cancer growth by androgen deprivation treatment (ADT). Further improvement of quality of life is achieved by supportive measures like good nutrition, vitamins and calcium supplementation to prevent demineralisation of bones and analgesic for pain relief. Bilateral Orchidectomy remains the most effective and permanent solution for ADT as it brings down serum testosterone level very rapidly to castration level of 20%. Epididymis functions only as the carrier of sperms and help in maturation during the passage. In no way it is involved in spermatogenesis or production of testosterone. Epididymal sparing bilateral orchidectomy with epididymoplasty achieves androgen deprivation to that of castration level. Left over epididymal bubbins in the scrotal sacs maintains the shape of scrotum and gives the patient a feel of scrotal sac not being empty.
Highlights
Prostate cancer is predominantly a disease of aging population
Suspected cancer prostate and/or elevated prostate specific antigen (PSA) presenting with LUTS are subjected to channel TURP and initial specimen sent for frozen section biopsy
On confirmation of cancer prostate, bilateral orchidectomy is done at the end of TURP
Summary
Improvement in socioeconomic condition and availability of better health care facilities has lead to increase in longevity and a larger number of aging populations with rise in incidence of prostate cancer. To further add to the problem, is the variable nature and clinical presentation of the disease which leads to a formidable challenge to all the professionals involved in its management [1,2]. The clinical and scientific understanding of the disease process is ever improving leading to a rapid change in its management options. Stage of the disease (localised prostate cancer) is very difficult to pick up due to silent nature of its clinical presentation. Though the detection of early prostate cancer is increasing in recent years due to easy availability of prostate specific antigen (PSA) estimation [3], the treatment option recommended is widely variable.
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