A Real-world Study Comparing The Efficacy And Associated Side Effects Of Surgical And Medical Castration In Patients With Prostate Cancer

Objective:To retrospectively analyze the effects of surgical castration and medical castration on the curative effect and related side effects of prostate cancer patients in the real world,so as to provide realistic guidance for the selection of endocrine therapy for prostate cancer patients.Materials:The data of prostate cancer patients who underwent surgical castration(n=130)and medical castration(n=114)in our hospital from January 2014 to January 2019 were collected,including pre-treatment BMI,FBG,TC,TG,UA,HDL,LDL,PSA,testosterone,Gleason score and other test indicators,and use IPSS and QLQ-PR25 quality of life score to score related scores,take the operation day or the first injection of LHRHa as the starting point for follow-up,and collect them respectively.After 3 months,6 months,and 12 months after treatment,the test indexes and the related scores on the day of follow-up were collected.At the same time,the lowest testosterone value after treatment,the lowest PSA value after treatment,and the time to reach the lowest value were collected.Methods:SPSS 23.0 statistical analysis software was used for analysis.In the measurement data,K-S test was used to test normality,and Levene test was used to test the homogeneity of variance.Normal distribution was expressed as mean ± standard deviation(x±s),and non-normal distribution was expressed as median(range).The independent samples T test was used for the comparison between groups with normal distribution,the paired samples T test was used for the comparison before and after treatment,and the repeated measures analysis of variance was used for the comparison within the group.Non-normally distributed between-group comparisons were performed using the Wilcoxon rank-sum test for independent samples in a rank-based nonparametric test.The test level was α=0.05,and P<0.05 was considered statistically significant.Results:A total of 244 patients were included in this study,including 130 in the surgical castration group and 114 in the medical castration group.There were no significant differences in age,BMI,fasting blood glucose,cholesterol,triglyceride,uric acid,HDL,LDL,PSA,IPSS and QLQ-PR25 scores between the two groups.(1)Treatment effect:The PSA level and IPSS score of the two groups of patients decreased to varying degrees after 3 months,6 months and 12 months of treatment,and there was no statistical difference in the level of PSA decrease and IPSS score between the two groups(P=0.448,0.429,0.064;0.196,0.101,0.667).There was no statistical difference between the two groups in the levels of PSAn,the lowest testosterone level and the time to PSAn,but there was a significant difference in the time to the lowest testosterone between the two groups.There was no significant difference in the effects of different methods of surgical castration and different drugs for medical castration on PSA and testosterone levels.(2)Side effects:In the surgical castration group,cholesterol,triglyceride and LDL showed a gradual upward trend after treatment,and HDL decreased in 3 months after treatment,and there was no significant difference between 3 months after treatment and 6 months after treatment(P=0.532),but there was a statistical difference at 12 months after treatment,BMI increased significantly at 6 months and 12 months after treatment,and fasting blood glucose showed a statistical difference at 12 months after treatment.Cholesterol,triglyceride,LDL and HDL in the drug castration group showed differences in different time periods after treatment,BMI increased at 6 months after treatment,and fasting blood glucose showed statistical difference at 3 months after treatment.There were statistically significant differences in cholesterol,triglyceride and LDL between the two groups at 12 months after treatment,among which there was a significant difference in LDL,but there was no statistical difference in uric acid levels before and after treatment.(3)Impact on quality of life:QLQ-PR25 showed that the two groups of patients showed a significant decrease in sexual function,and drug castration showed different degrees of improvement in sexual function 12 months after treatment,while surgical castration caused permanent loss of function.Conclusion:Both drug castration and surgical castration are effective in the treatment of prostate cancer patients.Both castration treatments can increase FBG,TC,TG,LDL,reduce HDL,and affect lipid metabolism.Compared with surgical castration,medical castration has a greater effect on blood lipid levels after long-term treatment.Both castration treatments reduced quality of life in some prostate cancer patients,but the effect of medical castration on sexual function attenuated with treatment duration.