Background: The introduction of androgen deprivation therapies in the treatment paradigm for advanced prostate cancer have shown excellent survival benefits .However there seems controversies revolving around with the optimal timing , duration and most importantly the serious side effects especially higher incidences of peripheral vascular diseases and diabetes. The present study tried to compare the survival benefits, recurrence free survival and side effects between the medical and surgical treatment in advanced carcinoma prostate.

Material and Methods: This is a hospital based retrospective study from January 2012 to January 2017 was conducted in medical college in north part of India. All patients diagnosed with advanced prostate carcinoma were included who received either GnRHa or orchiectomy as primary cancer therapy within 12 months of diagnosis. Associations between clinical outcomes and prognosis were compared between the two modalities; the impact on the prostate-specific antigen (PSA) normalization rate, the rebound rate and the disease-free survival rate were evaluated. The median follow-up was 22.3 months

Results: Despite similar results in normalization of the PSA score between two groups in initial time intervals beyond 18 months the response in the surgical group was higher as compared to medical group though not reaching statistical significance. At the end of the study, normalization was sustained in surgical group (20%) while in the medical group, sustained proportions was Nil (0%). Among the surgical group, recurrence free survival was higher especially in late time intervals indicating sustainable effect.

Conclusion: Advanced prostate carcinoma patients, surgical castration group do better in terms of better PSA rebound rates and overall survival in comparison to the medical treatment

Keywords: Advanced carcinoma prostate, medical castration, surgical castration, recurrence free survival.

1. Ferlay J, Shin H, Bray F, Forman D, Mathers C, Parkin DM: GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10 [Internet]. 2010, Lyon, France: International Agency for Research on Cancer
2. David A Bader, BS,1 Jasmina Z Cerne,D2 and Sean E Mc Guire Recent Developments in Androgen Deprivation Therapy for Locally Advanced Prostate Cancer,4 Oncology & Hematology Review, 2014;10(2):133–8
3. Heidenreich A, Bellmunt J, Bolla M, et al., EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localized disease, Eur Urol, 2011; 59:61–71.
4. Mohler JL, Kantoff PW, Armstrong AJ, et al., Prostate cancer, Version 1.2014, J Natl Compr Canc Netw, 2013; 11:1471–9.
5. Huggins C, Hodges CV. Studies on prostatic cancer: I. The effect of Castration, of estrogen and of androgen injection on serum phosphates in metastatic carcinoma of the prostate. Cancer Res 1941; 1: 293–7.
6. Anderson J, Abrahams son PA, Crawford D, Miller K, Tombal B.Manage ment of advanced prostate cancer: can we improve on Androgen deprivation therapy? BJU Int 2008; 101: 1497–501.
7. Saylor PJ, Smith MR. Metabolic complications of androgen deprivation therapy for prostate cancer. J Urol 2009; 181: 1998–2006.
8. Nguyen PL, Alibhai SM, Basaria S, et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol. 2015;67(5): 825-836.
9. Hu JC, Williams SB, O’Malley AJ, Smith MR, Nguyen PL, Keating NL. Androgen-deprivation therapy for non metastatic prostate cancer is associated with an increased risk of peripheral arterial disease and venous thrombo embolism. EurUrol. 2012; 61(6):1119-1128.
10. Keating NL, O’Malley AJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol.2006; 24(27):4448-4456.
11. Sun M, Choueiri TK, Hamnvik O-PR, et al. Comparison of gonadotropin-releasing hormone agonists and orchiectomy: effects of androgen-deprivation therapy [published online December 23, 2015]. JAMA Oncol. doi: 10.1001/jamaoncol.2015.4917.
12. Jespersen CG, Nørgaard M, Borre M.Androgen-deprivation therapy in treatment of prostate cancer and risk of myocardial infarction and stroke: a nationwide Danish population-based cohort study. Eur Urol. 2014; 65(4):704-709.
13. Bosco C, Crawley D, Adolfsson J, Rudman S, Van HemelrijckM. Quantifying the evidence for the risk of metabolic syndrome and its components following androgen deprivation therapy for prostate cancer: a meta-analysis. PLoS One. 2015; 10(3):e0117344.
14. Shawinigan VB, Kuo YF, Freeman JL, Goodwin JS. Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med. 2005; 352(2):154-164
15. Chuang CK, Chu SH, Chiang YJ, Chun-Te Wu M, Lin MH, Wei TY, etal. Tolerability assessment of maximal androgen blockade with 50 mg daily of bicalutamide and castration in patients with advanced Prostate cancer. Chang Gung Med J 2002; 25: 577–82.
16. Albertsen P. Androgen deprivation in prostate cancer–step by step. N Engl J Med 2009; 360: 2572–4.
17. Anderson J, Abrahamsson PA, Crawford D, Miller K, Tombal B. Manage ment of advanced prostate cancer: can we improve on androgen deprivation therapy? BJU Int 2008; 101: 1497–501.
18. Saylor PJ, Smith MR. Metabolic complications of androgen deprivation therapy for prostate cancer. J Urol 2009; 181: 1998–2006
19. Shahinian VB, Kuo YF, Freeman JL, Orihuela E, Goodwin JS. Increasing use of gonadotropin-releasing hormone agonists for the treatment of localized prostate carcinoma. Cancer 2005; 103: 1615–24.
20. Barry MJ, Delorenzo MA, Walker-Corkery ES, Lucas FL, Wennberg DC. The rising prevalence of androgen deprivation among older American men since the advent of prostate-specifi c antigen testing: a population-based cohort study. BJU Int 2006; 98: 973–8.
21. Messing EM, Manola J, Sarosdy M, Wilding G, Crawford ED,Trump D. Immediate hormonal therapy compared with observation after radical prostate-ctomy and pelvic lymphadenectomy in men with nodepositive prostate cancer. N Engl J Med 1999; 341: 1781–8.
22. Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G,et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and Goserelin. N Engl J Med 1997; 337: 295–300.
23. Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen dependent growth. Eur Urol 2009; 55: 310–20.
24. Oefelein MG, Cornum R. Failure to achieve castrate levels of testosterone during luteinizing hormone releasing hormone agonist Therapy: the case for monitoring serum testosterone and a treatment Decision algorithm. J Urol 2000; 164: 726–9.
25. Yri OE, Bjoro T, Fossa SD. Failure to achieve castration levels in Patients using Leuprolide acetate in locally advanced prostate cancer. Eur Urol 2006; 49: 54–8; discussion 58.

Dr Sanjay Kumar Bhat

Associate Professor, Department of General Surgery, RML institute of Medical Sciences, Lucknow, India