Abstract
Objective
To determine the attitudes and education regarding surgical castration in men receiving
androgen deprivation therapy (ADT) for metastatic prostate cancer (mCaP).
Methods
We identified 142 patients receiving ADT for mCaP at our institution without prior
orchiectomy who were then sent 2 surveys via mail: (1) A questionnaire to assess knowledge
and understanding of ADT treatment alternatives and (2) the functional assessment
of cancer therapy – prostate (FACT-P) questionnaire which determines health-related
quality of life (HRQOL). Two cohorts were created based on the answer to “would you
be interested in surgical orchiectomy?” and demographic, CaP and HRQOL were compared
between the surgical castration yes (SC+) and surgical castration no (SC-) cohorts.
A second analysis identified predictors of worse HRQOL.
Results
Of 68 (47.9%) patients that responded to the survey, only 39 (59.1%) recalled a discussion
regarding treatment alternatives to ADT and only 22 (33.3%) recalled a discussion
regarding orchiectomy. There were 24 (40.0%) patients that stated interest in undergoing
orchiectomy (SC+) as an alternative to ADT with the only independent risk factor being
“…bother from the number of clinical appointments required for ADT…” Patients most
bothered by side effects and cosmetic changes associated with ADT reported lower HRQOL
scores on the FACT-P.
Conclusions
Few men on ADT knew about surgical alternatives, implying that educational deficits
may be a significant factor in the decline in the utilization of orchiectomy. Changes
in healthcare economics, utilization and delivery brought on by a global pandemic
should warrant a fresh look at the use of surgical castration.
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References
- Cancer statistics, 2019.CA Cancer J Clin. 2019; 69: 7
Wood A. J. J., Catalona W. J. Management of cancer of the prostate. 331:996, 1994
- Quality-of-life outcomes after primary androgen deprivation therapy: results from the prostate cancer outcomes study.J Clin Oncol. 2001; 19: 3750
- Hormonal treatment and quality of life of prostate cancer patients: new evidence.Minerva Urol Nefrol. 2018; 70: 144
- Meaningful differences and validity for the NCCN/FACT-P symptom index: an analysis of the ALSYMPCA data.Cancer. 2019; 125: 1877
- Measuring quality of life in men with prostate cancer using the functional assessment of cancer therapy-prostate instrument.Urology. 1997; 50: 920
- Relative effectiveness and cost-effectiveness of methods of androgen suppression in the treatment of advanced prostate cancer.Evid Rep Technol Assess (Summ). 1999; i
- Studies on prostatic cancer. I. The effect of castration, of estrogen and androgen injection on serum phosphatases in metastatic carcinoma of the prostate.CA Cancer J Clin. 1972; 22: 232
Hwang T. I. S., Lin Y.-C., Lee M. C.-C. et al. The effects of medical castration on testes in patients with advanced prostate cancer. 21:169, 2010
- The fate of the medically castrated testis: expectation versus reality.J Urol. 2004; 172: 1042
- Androgen deprivation therapy in prostate cancer: are rising concerns leading to falling use?.BJU Int. 2011; 108: 1588
- Utilization and outcomes of surgical castration in comparison to medical castration in metastatic prostate cancer.Clin Genitourin Cancer. 2020; 18: e157
- Surgical versus medical castration for metastatic prostate cancer: use and overall survival in a national cohort.J Urol. 2020; 203: 933
- Reimbursement cuts and changes in urologist use of androgen deprivation therapy for prostate cancer.BMC Urol. 2015; 15 (PMID: 25885745; PMCID: PMC4399221): 25https://doi.org/10.1186/s12894-015-0020-y
- Association of reimbursement policy and urologists' characteristics with the use of medical androgen deprivation therapy for clinically localized prostate cancer.Urol Oncol. 2014; 32: 748
- Patients' choice of treatment in stage D prostate cancer.Urology. 1989; 33: 57
- Physician referral patterns among men with advanced prostate cancer.J Clin Oncol. 2014; 32
- Comparison of gonadotropin-releasing hormone agonists and orchiectomy: effects of androgen-deprivation therapy.JAMA Oncol. 2016; 2: 500
- Reassessment of the definition of castrate levels of testosterone: implications for clinical decision making.Urology. 2000; 56: 1021
- The efficacy and safety of degarelix: a 12-month, comparative, randomized, open-label, parallel-group phase III study in patients with prostate cancer.BJU Int. 2008; 102: 1531
- A comparison of the quality of life of patients with metastatic prostate cancer who received or did not receive hormonal therapy.Cancer. 1993; 71: 1143
- Quality of life of asymptomatic men with nonmetastatic prostate cancer on androgen deprivation therapy.J Urol. 2000; 163: 1743
- Quality of life in advanced prostate cancer: results of a randomized therapeutic trial.J Natl Cancer Inst. 1998; 90: 1537
- Metabolic consequences of gonadotropin-releasing hormone agonists vs orchiectomy: a randomized clinical study.BJU Int. 2019; 123: 602
- Trends in the use of telehealth during the emergence of the COVID-19 pandemic - United States, January-March 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 1595-1599
- Cost-effectiveness of androgen suppression therapies in advanced prostate cancer.J Natl Cancer Inst. 2000; 92: 1731
- Goserelin (Zoladex) or orchiectomy in metastatic prostate cancer? A quality of life and cost-effectiveness analysis.Anticancer Res. 2001; 21: 781
- Good practice in the conduct and reporting of survey research.Int J Qual Health Care. 2003; 15: 261
- Comparing response rates in e-mail and paper surveys: a meta-analysis.Educ Res Rev. 2009; 4: 26
- Racial or ethnic and socioeconomic disparities in prostate cancer survivors' prostate-specific quality of life.Urology. 2018; 112: 132
Article info
Publication history
Published online: May 07, 2021
Accepted:
April 19,
2021
Received:
November 30,
2020
Identification
Copyright
Published by Elsevier Inc.
