Comparison of subcapsular and total orchiectomy for treatment of metastatic prostate cancer

Objectives. To determine whether subcapsular orchiectomy provides suboptimal treatment of metastatic prostate cancer when used to avoid the psychologic consequences of the empty scrotum that results from total orchiectomy. Methods. We compared testosterone and prostate specific antigen levels and survival of 37 patients who underwent total orchiectomy and 37 patients who underwent subcapsular orchiectomy for metastatic prostate cancer. Results. The two groups of 37 patients were similar by clinical parameters. Postoperatively, testosterone levels were 21 ± 11 ng/dL for subcapsular versus 21 ± 9 ng/dL for total orchiectomy patients. Tumor response was similar in the two groups when assessed by prostate-specific antigen measured 3 weeks, 6 months, and 1, 2, and 3 years postoperatively. Survival was similar when assessed using Kaplan-Meier analysis (P = 0.76). Conclusions. Subcapsular orchiectomy is a viable option for treatment of metastatic prostate cancer.