Subepididymal orchiectomy in patients with advanced prostatic carcinoma.

Aims and Objectives: The high cost of LH-RH analogues for patients with advanced prostatic carcinoma raises the need to consider highly cost-effective one-time surgical castration. This study was done to compare the effectiveness of bilateral subepididymal orchiectomy, bilateral total orchiectomy and bilateral subcapsular orchiectomy in terms of androgen ablation (serum testosterone), control of disease progression (serum PSA) and esthetic superiority (patient satisfaction). Materials and Methods: 114 patients of advanced prostatic carcinoma (T3, T4 or any T with bony metastasis) in the age group of 55-92 years were divided in 3 groups- Group A: bilateral total orchiectomy (38 patients), Group B: bilateral subcapsular orchiectomy (38 patients), and Group C: bilateral subepididymal orchiectomy with epididymoplasty (38 patients). Serum PSA and serum testosterone values were done preoperatively and at 3 months follow-up. Patients' esthetic satisfaction was scored on a quality of life scale of 1-5. Results: In Groups A, B and C, at 3 months the post-operative mean serum testosterone values were 33.4, 38.8 and 36.7 ng/ml; and mean serum PSA values were 4.2, 3.9 and 3.4 ng/ml respectively, the difference not being statistically significant in both groups. On satisfaction scale the average scores were 1.81, 2.76 and 4 respectively ( P<0.05), the difference being highly significant. Conclusion: All three procedures are equally effective in reducing the serum testosterone values to post-castration levels (<50 ng/ml) and controlling the disease in terms of reduction in serum PSA values. Bilateral sub-epididymal orchiectomy clearly stands out in terms of highest patient satisfaction score. Bilateral sub-epididymal orchiectomy may be considered procedure of choice to achieve surgical castration in advanced prostatic carcinoma. [ABSTRACT FROM AUTHOR]