Academic Journal
Subcapsular versus total orchiectomy in advanced prostate cancer: A systematic review and meta-analysis of clinical and patient-reported outcomes.
| Title: | Subcapsular versus total orchiectomy in advanced prostate cancer: A systematic review and meta-analysis of clinical and patient-reported outcomes. |
|---|---|
| Authors: | Pratama ADM; Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia. Electronic address: anggadewa.md@gmail.com., Shenelo SA; Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia., Kamila RAF; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia., Pramudhito D; Department of Surgery, Universitas Sriwijaya and Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. |
| Source: | Urologic oncology [Urol Oncol] 2026 Sep; Vol. 44 (9), pp. 243-255. Date of Electronic Publication: 2026 Jun 27. |
| Publication Type: | Journal Article; Systematic Review; Meta-Analysis |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: United States NLM ID: 9805460 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2496 (Electronic) Linking ISSN: 10781439 NLM ISO Abbreviation: Urol Oncol Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2003- : Philadelphia, PA : Elsevier Original Publication: New York, NY : Elsevier Science |
| MeSH Terms: | Prostatic Neoplasms*/surgery , Prostatic Neoplasms*/pathology , Orchiectomy*/methods , Patient Reported Outcome Measures*, Humans ; Male ; Quality of Life |
| Abstract: | Background: Prostate cancer (CaP) is a leading malignancy in men, frequently diagnosed at advanced stages where androgen deprivation therapy remains the standard treatment. Surgical castration, either subcapsular or total orchiectomy, offers a definitive and cost-effective approach to androgen deprivation therapy. This study systematically compares clinical and patient-reported outcomes between subcapsular and total orchiectomy in patients with advanced CaP. Methods: A systematic search was conducted in PubMed, Scopus, and Cochrane Library through July 2025. Eligible studies included men with advanced CaP undergoing subcapsular or total orchiectomy. Risk of bias was assessed using RoB 2 for randomized trials and Newcastle-Ottawa Scale for nonrandomized studies. Data were analyzed using RevMan, and certainty of evidence was evaluated using GRADE approach. Results: Twelve studies involving 759 patients were included. Subcapsular orchiectomy was associated with significantly higher postoperative testosterone levels (mean difference = 4.03, 95% confidence intervals 2.78-5.28), higher prostate-specific antigen (PSA) levels (mean difference = 0.94; 95% CI 0.54-1.33), and greater treatment satisfaction (odds ratios = 3.78; 95% confidence intervals 1.98-7.19) compared to total orchiectomy. No significant differences were found in overall functional assessment of cancer therapy-prostate scores, including physical, social, emotional, and functional well-being domains, prostate cancer subscale, operative time, and luteinizing hormone levels. Conclusions: Subcapsular orchiectomy may provide less effective hormonal and PSA suppression but greater treatment satisfaction, with comparable quality of life outcomes and operative time compared with total orchiectomy, suggesting a trade-off between biochemical suppression and patient-centered benefits. (Copyright © 2026 Elsevier Inc. All rights reserved.) |
| Competing Interests: | Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Orchiectomy; Patient satisfaction; Prostatic neoplasms; Quality of life; Treatment outcome |
| Entry Date(s): | Date Created: 20260627 Date Completed: 20260819 Latest Revision: 20260825 |
| Update Code: | 20260826 |
| DOI: | 10.1016/j.urolonc.2026.05.030 |
| PMID: | 42364308 |
| Database: | MEDLINE |
Be the first to leave a comment!