[Treatment of hormonal refractory metastatic prostate cancer]. / Behandling af hormonrefraktaer metastatisk prostatacancer.

Hormonal refractory metastatic prostate cancer is a fatal disease with a poor prognosis. Treatment options are palliative with second line anti-hormonal, estrogens and prednisolon. When palliation is the goal, the side effects have to be carefully considered. Local radiotherapy has an effective pain relieving effect, and can be repeated. Chemotherapy with docetaxel and prednisolon is indicated in patients with symptomatic metastatic disease. Newer options with immunotherapy and designed molecules have not yet proven effective. Pain and anemia are significant symptoms and should be treated in a multidisciplinary setting.

Subcapsular versus total orchiectomy in the treatment of advanced prostate cancer: a randomized trial.

OBJECTIVE: To compare subcapsular and total orchiectomy in patients with advanced prostate cancer. MATERIAL AND METHODS: Two urological centers participated in a prospective, randomized study comparing complication rates and patient satisfaction. A total of 89 patients were randomized to either total or subcapsular orchiectomy. After the operation the patients were scheduled for a 3-month follow-up visit and subsequently followed the routine of the clinic. Three men dropped out of the study and thus 86 were evaluated. RESULTS: The number of postoperative complications differed significantly between the two groups: 14/46 in the total and 5/40 in the subcapsular orchiectomy patients. Complications were defined as reoperation or a postoperative complication causing additional ambulatory visits during the first 3 months postoperatively. Eight patients were reoperated on: 6/46 in the total and 2/40 in the subcapsular orchiectomy group, and this difference was not statistically significant. There was no significant difference in complication rates among trained urologists and trainees or among patients who received local or general anesthesia. CONCLUSION: Subcapsular orchiectomy is associated with significantly fewer postoperative complications than total orchiectomy.