Orchidectomy prior to definitive radiotherapy for localized prostatic cancer.

PURPOSE: To identify potential survival benefits of cytoreductive orchidectomy performed prior to definitive radiation for localized prostate cancer. METHODS AND MATERIALS: Between 1977-1988, all patients with localized prostatic cancer from the Wellington Region received definitive radiotherapy (n = 200). One referring urologist Peter M. Meffen (P.M.M.) had commenced a program of prior orchidectomy followed by definitive radiation treatment (median time to radiation therapy was 5 months, n = 30). RESULTS: Five-year overall survival (OS) and relapse-free survival (RFS) for each stage were Stage A 82%, and 82%; Stage B 75%, and 61%; Stage C 57%, and 38%, respectively. Ten-year OS and RFS for each stage were Stage A 78%, and 72%; Stage B 51%, and 18%; Stage C 32% and 0%, respectively. Multivariate analysis identified prior orchidectomy treatment and histological grade as independently significant prognostic factors for OS and RFS. Factors influencing RFS were clinical stage, prior orchidectomy, and histological grade. Prior orchidectomy was associated with an increase in OS at 5 years when compared to those patients receiving radiotherapy alone, 86% vs. 69%, and maintained at 10 years, 82% vs. 46% (p < 0.05). The two groups were comparable by stage, histological grade, and age. There were no changes in the referral pattern during the study period. CONCLUSIONS: Our results suggest that prior cytoreduction by orchidectomy has a beneficial effect on OS and RFS for patients with localized prostate cancer. It is unclear whether survival benefits are due to the cytoreductive therapy, the adjuvant therapy, or a combination of both. Further study in this area is warranted, ideally in the form of randomized prospective clinical trials.

Orchiectomy and delayed radiotherapy as treatment for prostatic carcinoma. A 10-year survey.

One hundred and fifty patients with carcinoma of the prostate treated between 1967 and 1982 have been reviewed. Thirty-three patients were treated with stilboestrol alone, 36 by orchiectomy alone and in 81 cases radical radiotherapy was given to the prostate (and in 10 of the 81 cases to the regional and para-aortic lymph nodes) 5 or 6 months after orchiectomy. Although there was no significant difference between the results of those treated by stilboestrol alone and those treated by orchiectomy alone, in those patients receiving orchiectomy and delayed radiotherapy there was a significant improvement in survival. If patients with Stage D disease are excluded, this is a highly significant difference and indeed the survival in these patients does not differ significantly from the expected survival at this age. The 5-year survival rate of Stage D patients treated by this method was 35%.