Surgical Versus Medical Castration for Metastatic Prostate Cancer: Use and Overall Survival in a National Cohort.

Surgical castration for metastatic prostate cancer is used less frequently than medical castration, yet costs less, requires less follow-up, and may be associated with fewer adverse effects. We sought to evaluate temporal trends and factors associated with the use of surgical castration.

This retrospective cohort study sampled 24,805 men with newly diagnosed (de novo) metastatic prostate cancer from a national cancer registry in the United States (2004-2016). Multivariable logistic regression assessed the association between sociodemographics and surgery. Multivariable Cox regression evaluated the association between castration type and overall survival.

Overall, 5.4% of men received surgical castration. This decreased from 8.5% in 2004 to 3.5% in 2016 (Per year later: OR 0.89, 95% CI 0.87-0.91,p<0.001). Compared to Medicare, private insurance was associated with less surgery (OR 0.73, 95% CI 0.61-0.87, p<0.001) while Medicaid or no insurance was associated with more surgery (OR 1.68, 95% CI 1.34-2.11, <0.001 and OR 2.12, 95% CI 1.58-2.85, p<0.001, respectively). Regional median income >$63,000 was associated with less surgery (vs <$38,000: OR 0.61, 95% CI 0.43-0.85, p=0.004). After a median follow-up of 30 months, castration type was not associated with differences in survival (Surgical vs medical: HR 1.02, 95% CI 0.95-1.09, p=0.6).

In a contemporary, real-world cohort, use of surgical castration is low and decreasing despite its potential advantages and similar survival compared to medical castration. Men with potentially limited health care access receive more surgery, perhaps reflective of a provider bias towards the perceived benefit of permanent castration.

The Journal of urology. 2019 Nov 20 [Epub ahead of print]

Adam B Weiner, Jason E Cohen, John O DeLancey, Edward M Schaeffer, Gregory B Auffenberg

Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Go Beyond the Abstract and Read a Commentary by the Authors