Background. The therapeutic impact of palliative androgen deprivation in metastatic prostate cancer is indisputable. Bilateral orchiectomy represents the traditional method of AD but was reduced during the last years in favor for treatment with LHRH analogues. Due to limited economic resources of the health care system, the economically priced definite surgical castration might experience a renaissance. Methods. In this single-center retrospective study, 83 consecutive patients with osseous metastasized prostate cancer were evaluated, who had primarily been treated by subcapsular bilateral orchiectomy. Response to therapy, time until therapy failure, overall survival time, psychological disorders due to loss of organ, and disease-associated and postoperative surgical complications were recorded. The median followup was 35 months (IQR: 26–46). Results. Patients' mean age at surgery was 72.1 (54–91) years. Six patients (7.2%) displayed immediate tumor progression after orchiectomy. Median time of tumor remission and overall survival time were 29 and 36 months, respectively. 14% of the study group showed minor postoperative complications. No psychological problems occurred following bilateral orchiectomy. Conclusion. Due to an effective and persistent oncological effectiveness, less morbidity, and absence of psychological implications, bilateral subcapsular orchiectomy seems to be a practicable and advisable alternative in the first-line therapy of metastasized PCa. 1. Introduction In the pre-PSA era, one third of men with prostate cancer (PCa) presented with distant metastasis at time of diagnosis, and currently, it is about 5%–10% [1]. Despite these changes, PCa still represents the second most frequent tumor-associated cause of death. In 2006, 12000 men died from PCa in Germany [1]. Suppression of endocrine testicular function still represents the gold standard in palliative treatment in advanced stage or metastasized PCa. Already in 1941, Huggins and Hodges demonstrated control of PCa growth rate by androgens and showed that there is no better way to achieve temporary control of PCa growth than androgen deprivation (AD) [2]. Basically, AD treatment is able to induce a remission in 90% of PCa patients; the median progression-free survival ranges from 18 to 34 months [3]. The earliest method of AD is represented by the bilateral orchiectomy, which means a definitive therapy for the patient. Treatment with Diethylstilbestrol (DES) was described as to the first method of reversible castration. At present, medicinal castration is achieved either by LHRH
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