Slow zoledronic acid releasing testis prostheses in the treatment of prostate cancer patients with bone metastases Ege Can Serefoglu * , M. Derya Balbay Ataturk Training and Research Hospital, Department of Urology, Ankara, Cinnah Caddesi No: 47, Cankaya, Ankara, Turkey article info Article history: Received 22 January 2009 Accepted 26 January 2009 summary Surgical castration is still considered the ‘gold standard’ for androgen deprivation therapy which have become the mainstay for the management of advanced prostate cancer. The main drawback of this safe operation is that it may have a negative psychological effect, thus, in recent years, a decline in the utili- zation of bilateral orchiectomy which is the most cost-effective form of androgen deprivation therapy can be witnessed. Testicular prostheses have been shown to reduce the psychological impact resulting from loss or absence of a testicle in those patients. Besides, patients with advanced prostate cancer are at risk of skeletal complications and bisphosphonates are used in treatment. Zoledronic acid is the only bis- phosphonate agent demonstrated to effectively reduce skeletal related events in patients with advanced prostate cancer metastatic to bone. Therefore, zoledronic acid releasing testicular prostheses can be used in the treatment of prostate cancer patients with bone metastases after bilateral orchiectomy. This tech- nology has the potential to become the preferred clinical management tool for prostate cancer patients with bone metasthases after bilateral orchiectomy. Ó 2009 Elsevier Ltd. All rights reserved. Introduction Bilateral orchiectomy in advanced prostate cancer and testicular prostheses Prostate cancer has been the most common visceral malignant neoplasm in US men since 1984, now accounting for one third of all such cancers [1]. Prostate cancer is rarely diagnosed in men younger than 50 years, accounting for less than 0.1% of all patients. Peak incidence occurs between the ages of 70 and 74 years, with 85% diagnosed after the age of 65 years [2]. Since Huggins and Hodges evaluated the positive effect of sur- gical castration and oestrogen administration on the progression of metastatic prostate cancer and demonstrated the responsive- ness of this malignancy to androgen deprivation for the first time [3,4], androgen-suppressing strategies have become the mainstay for the management of advanced prostate cancer. Surgical castra- tion is still considered the ‘gold standard’ for androgen deprivation therapy (ADT) against which all other treatments such as oestro- gens, Luteinizing hormone-releasing hormone (LHRH) agonists, LHRH antagonists, antiandrogens are rated [5]. The main drawback of orchiectomy is that it may have a negative psychological effect; some men consider it to be an unacceptable assault on their man- hood [5]. Therefore, a decline in the utilization of bilateral orchiec- tomy can be witnessed recently which can be related to the development of equally effective pharmacological agents of castra- tion, as well as the effects of stage migration towards earlier dis- ease [6]. However it has been recently demonstrated that, bilateral orchiectomy is the most cost-effective form of ADT pro- viding a higher quality-adjusted survival for men who can accept it [7]. While orchiectomy is a very safe and inexpensive procedure, patients are increasingly not willing to undergo this simple sur- gery, given the medical alternatives available. Testicular prostheses have been shown to reduce the psycho- logical impact resulting from loss or absence of a testicle in those patients [8,9]. The Western Section of the American Urological Association reported the indications for implantation of a testicular prosthesis over a 10-year period in 1986, demonstrating that nearly a fifth of patients undergoing insertion of a testicular pros- thesis were in men undergoing bilateral orchiectomy for advanced prostate cancer [10]. However, the usage of surgical castration in the management of metastatic prostate cancer has fallen dramati- cally in the early 1990s, after the introduction of medical castration with LHRH analogues; thus, this indication for implantation has fallen considerably [11]. Skeletal complications of prostate cancer and zoledronic acid Many prostate cancer patients with bone metastases are treated with androgen deprivation therapy which represents the standard of care for metastatic disease [12]. Furthermore, patients with prostate cancer receiving androgen deprivation therapy are at risk of skeletal complications, regardless of disease stage [13]. Older 0306-9877/$ - see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.mehy.2009.01.054 * Corresponding author. Tel.: +90 505 407 6332; fax: +90 312 438 2792. E-mail address: egecanserefoglu@hotmail.com (E.C. Serefoglu). Medical Hypotheses 73 (2009) 387–388 Contents lists available at ScienceDirect Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy