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    PCa castration study fuels surgery vs. GnRHA debate

    While the use of orchiectomy for androgen deprivation therapy (ADT) has been almost entirely replaced by medical castration with a gonadotropin-releasing hormone agonist (GnRHA), guidelines continue to recommend orchiectomy as a first-line treatment for men with metastatic prostate cancer.

    Now, results of a recently published, population-based study examining the safety of the two approaches (JAMA Oncol epub ahead of print, Dec. 23, 2015: 1-8) support stronger consideration for orchiectomy, according to its authors.

    Also see: Can Gleason 7 cancer be low-risk disease?

    The investigation, using the Surveillance, Epidemiology, and End Results Medicare-linked database, identified 3,295 men aged 66 years and older who were treated from 1995 to 2009 with ADT as primary cancer therapy within 12 months of metastatic prostate cancer diagnosis.

    Results of analyses using competing risk regression models and adjusting for all-cause mortality showed the surgical castration group (429 patients) had significantly lower risks of any fractures (–23%), peripheral arterial disease (–36%), and cardiac-related complications (–26%) when compared to their counterparts receiving GnRHA treatment (2,866 patients).

    Additional analyses showed orchiectomy was associated with a significantly higher 3-year overall survival rate versus GnRHa treatment (46% vs. 39%) and similar total expenditures at 1 year after prostate cancer diagnosis in an analysis adjusting for treatment propensity scores.

    Next: Orchiectomy "a perfectly reasonable, cost-effective treatment"

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