Feasibility of surgical orchiectomy in prostate cancer patients on long term luteinizing hormone-releasing hormone (LHRH) agonist therapy.

Abstract

265 Background: Androgen deprivation, achieved through surgical or medical castration, is central to metastatic prostate cancer (PCa) treatment. Life-long castration is thought to be critical to the management of patients with metastatic disease. Orchiectomy offers an alternative, more convenient, and cheaper alternative for permanent castration, but is under-utilized, in part due to patient reluctance. We hypothesized that patients on long term medical castration therapy would be willing to accept surgical castration as an alternative to repeated LHRH agonist injections. Methods: Men ≥18 years with metastatic PCa, on LHRH agonists for ≥1 year and ≤2 prior systemic therapies, were eligible. Participants first provided consent for an educational session on orchiectomy, followed by the collection of demographic and disease characteristics. Those providing further consent completed the PROMIS sexual function and satisfaction measures v2.0 and the Hopwood body image surveys, with a urology consult offered. At 6 months, patients completed the same surveys, and those undergoing orchiectomy also completed the decision regret scale. 100 patients agreeing to the educational session were required to provide a 10% confidence interval on an estimated 30-50% of patients undergoing an orchiectomy. Results: Of the 130 patients approached, 101 signed the first consent form (education), 58 signed the second (surveys), and 27 agreed to meet with the urology team. Patients agreeing to the educational session had a median age of 71 years (IQR 65-75), 46% were Black and 48% White, 48% completed college or an advanced degree, 36% had annual income > $80K, 58% were married and 64% received systemic therapy other than LHRH agonists. Fourteen patients underwent bilateral orchiectomy (one subcapsular). No association was found between orchiectomy and race, education, annual income, or marital status. While ~75% of all patients were dissatisfied with their sexual life, the vast majority had no body image concerns. Decision regret was low, with 13/14 patients satisfied with their choice of orchiectomy. Pathology revealed testicular atrophy in all cases. Conclusions: Only 11% of patients approached, and 14% of patients who participated in an educational session on orchiectomy proceeded with the procedure, suggesting limited feasibility for surgical castration in patients on long-term LHRH agonists. Testicular atrophy suggests that discontinuing medical castration may be an alternative cost-effective strategy to maintain castration in prostate cancer patients with metastatic disease. Clinical trial information: NCT04705038 .