Surgical versus medical castration following radical prostatectomy in patients with very high-risk prostate cancer
10.3969/j.issn.1009-8291.2025.09.005
- VernacularTitle:手术去势与药物去势在极高危前列腺癌根治术后应用效果的比较
- Author:
Yifan CHANG
1
;
Chaozhao LIANG
1
;
Zongyao HAO
1
;
Shuiping YIN
1
;
Li ZHANG
1
;
Lingfan XU
1
;
Junyue TAO
1
;
Changhao SONG
1
;
Jun ZHOU
1
Author Information
1. 安徽医科大学第一附属医院泌尿外科,安徽医科大学泌尿外科研究所,泌尿男科疾病研究与医学转化安徽省重点实验室,安徽 合肥 230022
- Publication Type:Journal Article
- Keywords:
prostate cancer;
very high-risk prostate cancer;
radical prostatectomy;
surgical castration;
medical castration
- From:
Journal of Modern Urology
2025;30(9):748-754
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the efficacy,economic burden,psychological impact,and quality of life between surgical and medical castration following radical prostatectomy(RP)in patients with very high-risk prostate cancer(VHR PCa).Methods Clinical data of 167 patients with VHR PCa who underwent RP in the Department of Urology,the First Affiliated Hospital of Anhui Medical University during Jul.2019 and Mar.2024 were retrospectively collected.Patients were divided into two groups:the surgical castration group(n=44)and medical castration group(n=123).The effects of different castration methods on the biochemical recurrence(BCR)were analyzed with Cox proportional hazards models.The survival curves of BCR-free and progress to castration-resistant prostate cancer(CRPC)were plotted with the Kaplan-Meier method.The differences in functional assessment of cancer therapy-prostate(FACT-P)and hospital anxiety and depression scale(HADS)between the two groups were evaluated with linear regression model.Results The total costs were significantly lower in the surgical castration group than in the medical castration group[(47 422.0±3 998.3)yuan vs.(59 017.2±8 014.1)yuan,P＜0.001].One month postoperatively,the surgical castration group had significantly lower prostate-specific antigen(PSA)level[0.028(0.010,0.159)ng/mL vs.0.100(0.029,0.895)ng/mL,P=0.002].However,no significant differences were observed in the PSA level between the two groups at 3,6,and 12 months postoperatively,or in PSA nadir and time to nadir(P＞0.05).Cox regression analysis suggested a potentially higher risk of BCR in the medical castration group(HR=2.23),but the difference was not statistically significant(P=0.112).The 1-and 3-year BCR-free survival rates were higher in the surgical castration group(90.9％vs.85.4％;86.4％vs.70.7％,respectively),whereas 1-and 3-year progression-free survival rates were comparable between the two groups(97.7％vs.97.6％;95.5％vs.91.9％),with no significant differences(P＞0.05).No significant differences were found in FACT-P[(57.3±10.2)vs.(57.3±7.6)]or HADS[(12.6±5.1)vs.(11.3±4.8)]scores between the two groups(P＞0.05).Conclusion In VHR PCa patients,surgical castration performed following RP is not inferior to drug castration in terms of PSA control,and potential delay of BCR.It had a lower cost and does not significantly increase the psychological burden.As an underutilized strategy,surgical castration can become an optional option for individualized treatment.
