Epididymal Sparing Bilateral Simple Orchiectomy: Cost-Effectiveness and Aesthetic Preservation for Men with Metastatic Prostate Cancer.

INTRODUCTION: In the last 2 decades medical androgen deprivation therapy has replaced surgical castration for the treatment of metastatic prostate cancer. We assessed costs and patient satisfaction associated with epididymal sparing bilateral simple orchiectomy in an underinsured, immigrant population. METHODS: We performed epididymal sparing bilateral simple orchiectomy in patients with metastatic prostate cancer between January 2003 and September 2014 at our institution. Procedures were performed in the operating room with the patient under general anesthesia and later under conscious sedation. Associated material and facility costs were calculated and compared to costs of androgen deprivation therapy with leuprolide or degarelix. Medication costs were calculated using wholesale acquisition costs. Patient satisfaction and body image perception were evaluated using a survey questionnaire. RESULTS: A total of 108 orchiectomies were performed in the operating room and 12 in the outpatient unit. The total cost of bilateral simple orchiectomy in the operating room was $4,118. By performing orchiectomy in the outpatient unit we reduced the cost to $2,101. The cost of orchiectomy in the operating room is the equivalent of 4 months of leuprolide and 7.8 months of degarelix. When performed in the outpatient clinic the cost of bilateral simple orchiectomy is equivalent to 2.1 months of leuprolide and 4 months of degarelix. Overall 95% of participants surveyed were pleased with the surgical results. CONCLUSIONS: The average life expectancy of men with metastatic prostate cancer is 30 months and, thus, a onetime surgical cost offers significant cost savings. Further cost reductions are achieved by performing bilateral simple orchiectomy in the outpatient setting. By sparing the epididymis, patients are left with a sense of testicular preservation. Epididymal sparing bilateral simple orchiectomy is a cost-effective and cosmetically acceptable method of androgen deprivation therapy for patients with metastatic prostate cancer.