Androgen-deprivation therapy (ADT), which is achieved through surgical or medical castration, has been a cornerstone in the management of metastatic prostate cancer (PCa) for the past 50 years. But the use of bilateral orchiectomy has been nearly eliminated in the U.S. because of cosmetic and psychological concerns.
Quoc-Dien Trinh, M.D., of Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, and coauthors compared adverse effects of GnRHa and bilateral orchiectomy in 3,295 men with metastatic PCa (66 or older) between 1995 and 2009. The authors analyzed six major adverse effects, which were picked based on their effect on a patient's quality of life, the potential for increased health care costs, and on a previously described association with ADT use. The six adverse effects were: any fractures, peripheral artery disease, venous thromboembolism, cardiac-related complications, diabetes and cognitive disorders.