Are there substantive medical differences between androgen deprivation achieved with LHRH agonist drugs and surgical castration?

This is a perennial question: Does it make much difference for advanced prostate cancer patients on ADT whether androgen suppression is achieved by surgical or chemical castration? In terms of cancer control, there does not appear to be a difference. However, what about side effects? 


This is small study that randomized advanced prostate cancer patients to either surgical castration (an orchiectomy; N =28) or the LHRH agonist drug, triptorelin (marketed as Trelstar in North America; N= 29). Both ADT regimes caused the metabolic side effects commonly associated with ADT. However “orchiectomy resulted in an additional weight increase with a substantial increase in fat mass” compared with the LHRH agonist and that increase in total fat mass was followed by “increased insulin resistance” indicative of an increased risk of diabetes. The patients were followed for 48 weeks and these changes were already showing up at 12 and 24 weeks.


Often patients believe that LHRH drugs are better than surgical castration because they are reversible. But even for advanced patients who will be on ADT for the remainder of their lives, the drug route may be a bit better because it causes less severe changes in body composition and diabetic risk.


To read the abstract for this article, please follow the link below.


Ostergren, P. B., Kistorp, C., Fode, M., Bennedbaek, F. N., Faber, J., & Sonksen, J. (2018). Metabolic consequences of gonadotropin-releasing hormone agonists versus orchiectomy: A randomized clinical study. BJU International [Epub ahead of print]. doi: 10.1111/bju.14609