Journal of Andrology, Vol. 25, No. 3, May/June 2004
Copyright © American Society of Andrology
Autologous Tunica Vaginalis and Subcapsular Orchiectomy: A Hormonal Therapy for Prostate Cancer
MARTYN A. VICKERS, JR*,
,
DONALD P. LAMONTAGNE*,
KHURSHID A. GURU
,
RAMGOPAL K. SATYANARAYANA,
KRISTIN E. VICKERS
AND
MANI MENON
From the * Department of Surgery, the Togus VA
Medical Center, Togus, Maine; the Division of
Urology, the University of Massachusetts Medical School, Worcester,
Massachusetts; the Department of Urology, the
Henry Ford Hospital, Detroit, Michigan; and the
Department of Psychology, Harvard University,
Cambridge, Massachusetts.
|
Correspondence to: Dr Martyn A. Vickers Jr, Department of Veterans Affairs, 1
VA Center, Togus, ME 04330
(e-mail:martyn.vickers{at}med.va.gov). |
Two novel surgical procedures that combine an autologous tunica vaginalis
pedicle graft (TVG) with a subcapsular orchiectomy (SCOT) were evaluated in
asymptomatic patients with rising prostate-specific antigen (PSA) values
following radiation therapy, a radical retropubic prostatectomy, or a newly
diagnosed prostatic cancer with bony metastasis. In the SCOT I procedure, the
TVG was secured to the inner wall of the tunica albuginea. In the SCOT II
procedure, the TVG was folded and secured to the external wall of the tunica
albuginea. Between December 1, 1999, and July 1, 2000, 26 patients were
offered hormonal therapy. Twelve patients selected the SCOT I procedure, 12
selected a luteinizing hormone-releasing hormone (LHRH) agonist, and 2
selected a bilateral total orchiectomy (BTO). Because the cosmetic outcome of
the SCOT I procedure was less than ideal, this procedure was modified in
December 2001. Between December 1, 2001, and July 1, 2002, 28 hormonal
candidates were evaluated. Twelve patients selected the SCOT II procedure, 11
selected an LHRH agonist, and 5 selected a BTO. Preoperative measurements of
the testicular area and PSA were obtained. During postoperative visits, the
total testosterone, PSA, and testicular area were determined, and the
Fugl-Meyer questionnaire (FMQ) and SCOT-specific questionnaire (SSQ) were
completed. Between March 1, 2000, and December 1, 2002, 10 patients underwent
a BTO. This group was the control for the postoperative SCOT total
testosterone values. Sixty-three percent of the mean preoperative testicular
area was preserved in the SCOT II group vs 43% in the SCOT I group at the 9-
to 12-month visit (P < .01). The mean postoperative total testosterone
values for the SCOT I, SCOT II, and BTO groups were in the castrate range. No
statistically significant difference was noted between the preoperative and
postoperative FMQ scores among the SCOT I and SCOT II groups. Eighty-three
percent of the SCOT II patients experienced no change in masculine identity,
and 58% noted no change in testicular size. One hundred percent of the SCOT I
patients experienced no change in masculine identity and noted no change in
testicular size. The SCOT II procedure preserved a greater testicular area
than the SCOT I. Both SCOT procedures achieved castrate levels of total
testosterone and maintained masculine identity in 83%–100% of
patients.
Key words: Castration, body image
Related articles in Journal of Andrology:
- 10th Summit Meeting Consensus: Recommendations for Regulatory Approval for Hormonal Male Contraception
- Pertti Aaltonen, John K. Amory, Richard A. Anderson, Hermann M. Behre, Gabriel Bialy, Diana Blithe, Wilhelm Bone, William J. Bremner, Doug Colvard, Trevor G. Cooper, Jörg Elliesen, Henry L Gabelnick, Yi-Qun Gu, David J. Handelsman, Elof A. B. Johansson, Wendy Kersemaekers, Peter Liu, Trent MacKay, Stephen Matlin, Michael Mbizvo, Robert I. McLachlan, Maria Cristina Meriggiola, Stephan Mletzko, Ellen Mommers, Hilde Muermans, Eberhard Nieschlag, Viveca Odlind, Stephanie T. Page, Albert Radlmaier, Regine Sitruk-Ware, Ronald Swerdloff, Christina Wang, Frederick Wu, and Michael Zitzmann
Journal of Andrology 2007 28: 362-363.
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Copyright © 2004 by The American Society of Andrology.
