Bilateral orchiectomy versus total androgen blockade in the management of metastatic cancer prostate
Keywords:Bilateral orchiectomy, Total androgen blockade, Metastatic cancer prostate
Background:Advanced prostatic cancer in India is mainly managed by bilateral scrotal orchiectomy. Though combined androgen blockade is advocated, its doubtful efficacy and high cost promoted us to undertake this study in Indian patients comparing bilateral orchiectomy plus placebo versus bilateral orchiectomy plus flutamide in improving overall survival in metastatic prostate cancer.
Methods: This 18 months observational study was conducted in the patients coming to the urology unit of department of Surgery, SN Medical College & Hospital Agra, with the symptoms of prostate cancer after taking permission from the Institutional Ethical committee. Methods of Palliation used were bilateral orchiectomy and Anti-androgen flutamide. Statistical analysis was done using SPSS and a p value of <0.05 was considered ads statistically significant.
Results:A total of 12 previously untreated patients with osseous metastases confirmed by bone scan or skeletal survey, were entered into a double blind randomization placebo controlled trial of bilateral orchiectomy with or without total androgen blockade. The patients were followed up for eighteen months. One patient out of twelve in placebo group died due to early progressive disease. The mean percentage changes in placebo group was 68% and flutamide group was 73%, Showing no statistical difference in both groups (p-value>0.05). Over all response rate was 83.3% in both the groups. The adverse effect like hot flushes and diarrhoea was observed 33.3% in total androgen blockade in comparison to placebo controlled group having 16.6% only. Colonic origin of sepsis was associated with worse outcome probably due to presence of feculent exudates which was more commonly associated with colonic origin of sepsis. Female sex was associated with better outcome as compared to male sex. Our study differs from MPI in these 2 variables of adverse outcome.
Conclusions:It is evident that the addition of antiandrogen like flutamide to orchiectomy did not show any significant beneficial effect. The routine use of flutamide is not advisable due to its cost effectiveness.