Orchidectomy following Failure of Antiandrogen Monotherapy in Patients with Metastatic Prostate Cancer

Abstract

Objective: Patients with metastatic prostate cancer who are initially treated by oral antiandrogens and then have progressive disease may be offered surgical castration as a second–line treatment. Twenty–eight such patients were reviewed to determine the outcome in terms of secondary PSA response, symptomatic relief and disease–specific survival. Materials and Methods: Retrospective chart–based review of patients undergoing bilateral scrotal orchidectomy after failure of antiandrogen monotherapy. Results: Patients who had a >50% reduction in PSA at 12 weeks’ postorchidectomy had significantly greater duration of PSA response and disease–specific survival. 64% of patients who had bone pain prior to orchidectomy had some relief of symptoms postoperatively. No prognostic indicators of improved survival were identified. Conclusion: Orchidectomy as a secondary hormonal treatment following relapse on antiandrogens does produce a response in terms of PSA level and symptoms in some patients.