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PubMed1998

Anemia after orchiectomy.

The decrease in testosterone production associated with bilateral orchiectomy may result in normocytic anemia in men. We sought to determine the effect of orchiectomy on hemoglobin concentration. Patients were evaluated at the Mayo Clinic in 1993 and 1994 and underwent bilateral orchiectomy for prostate carcinoma. All patients were seen by one of the staff urologists. Patients were included if they had a normal preoperative complete blood cell count and serum levels of creatinine, if they remained without disease progression (suppressed prostate-specific antigen level and no evidence of clinical progression on review), and if they had normal serum levels of creatinine and mean corpuscular volume during the follow-up period. The patients could have no other cause of anemia. The complete blood cell count, prostate-specific antigen level, and serum level of creatinine were determined preoperatively and at least once (>90 days) after orchiectomy. Sixty-four patients were included in the analysis (median age, 68 years). The median decrease in hemoglobin concentration was 1.2 g/dL after orchiectomy. There was a statistically significant difference in the hemoglobin concentration before orchiectomy compared with postoperative values at all the intervals studied, both by the paired group t-test and the Kruskal-Wallis test. There is a clinically and statistically significant decrease in hemoglobin concentration after orchiectomy. Knowledge of this phenomenon may prevent unnecessary diagnostic work-up in men with normocytic anemia after bilateral orchiectomy.

Aged↗

PubMed1988

Treatment of metastatic prostate cancer. Factors that influence treatment selection and methods to increase acceptance of orchiectomy.

Orchiectomy is the preferred method for treating patients with metastatic adenocarcinoma of the prostate (MAP) because it is safer and more reliable than estrogen therapy. Nonetheless, a survey of Northern California urologists showed that 57 percent of their patients with MAP were treated with diethylstilbestrol (DES) rather than orchiectomy. Factors which determined treatment selection include the physician's belief that estrogen therapy was either equally (35%) or more (22%) effective than orchiectomy and the patients' rejection of orchiectomy even if it were recommended to them (20-30%). The survey also showed that previous attempts to increase the acceptability of orchiectomy by performing a subcapsular procedure have failed because urologists do not believe the procedure is effective (45%), or that subcapsular orchiectomy provides a satisfactory cosmetic result (20%). Recent laboratory and clinical investigations have shown that complete and subcapsular orchiectomy were equally effective in reducing serum testosterone. Patient acceptance of subcapsular orchiectomy may be increased by utilizing the term testicular curettage, which does not imply castration, to describe the procedure and by implantation of intracapsular testicular prostheses to restore normal testicular anatomy after the testicles' hormone-producing tissue has been removed.

Adenocarcinoma↗

PubMed2001

Decline in bilateral orchiectomy for prostate cancer in Olmsted county, Minnesota, 1956-2000.

OBJECTIVE: To assess long-term secular trends in the utilization of bilateral compared with unilateral orchiectomy in the community. PATIENTS AND METHODS: This population-based descriptive study reviewed medical records of all Olmsted County, Minnesota, men undergoing orchiectomy between 1956 and 2000. RESULTS: Over the 45-year study period, 381 Olmsted County men had a first unilateral orchiectomy, while 431 underwent bilateral orchiectomy (including 8 with a second unilateral orchiectomy). There was no change over time in the age-adjusted utilization of unilateral orchiectomy, which was performed for a wide range of indications, mostly cryptorchidism and testicular malignancy. Most bilateral procedures, on the other hand, were in elderly men for castration, and trends over time generally paralleled those reported for prostate cancer in this community. CONCLUSION: The declining incidence of prostate cancer in recent years, combined with a shift to earlier stages and younger ages at diagnosis, and the development of pharmacological approaches to hormonal manipulation have led to a dramatic decline in the utilization of bilateral orchiectomy, while unilateral orchiectomy rates have remained unchanged.

Age Distribution↗

PubMed1997

Osteoporosis after orchiectomy for prostate cancer.

PURPOSE: The possibility of increased osteoporosis and osteoporotic fractures following therapeutic orchiectomy in men with prostate cancer was investigated. MATERIALS AND METHODS: A total of 235 men with nonstage A prostate cancer diagnosed between 1983 and 1990 was analyzed for therapeutic orchiectomy, other osteoporotic risk factors and subsequent hospital treatment for osteoporotic fractures. The 17 castrated men alive in 1995 were interviewed, and femoral neck bone mineral density was compared to that of 23 controls of similar age. RESULTS: Risk factors for osteoporosis, including smoking, slender habitus and atrophic testes, were common among men treated with orchiectomy. Of the men in the study cohort 10 had osteoporotic fractures: 8 of 59 treated with and 2 of 176 without orchiectomy (13.6 versus 1.1%, p < 0.001). First fracture cumulative incidence rates 7 years after castration or diagnosis were 28 and 1%, respectively (p < 0.001). Osteoporotic fractures were much more common than pathological fractures or those due to major trauma (1 each). Bone mineral density averaged 0.91, 0.84, 0.79 and 0.66 gm./cm.2 in 9 controls without prostate cancer, 14 men with prostate cancer before orchiectomy, 9 men at 9 to 60 and 8 men at 60 to 115 months after orchiectomy, respectively. Of the 16 men surviving for longer than 60 months after orchiectomy 6 had osteoporotic fractures, as did 5 of 6 and 5 of 7 with a bone mineral density of less than 0.70 gm./cm.2 and less than 75% of normal for age, respectively. CONCLUSIONS: Orchiectomy for prostate cancer is frequently followed by severe osteoporosis, some of which had developed before castration. Appropriate therapy should be identified that does not diminish the antitumorigenic effectiveness of androgen ablation.

Aged↗

PubMed1989

Extended experience with surgical treatment of stage D1 adenocarcinoma of prostate. Significant influences of immediate adjuvant hormonal treatment (orchiectomy) on outcome.

Concepts regarding the surgical treatment of cancer of the prostate have changed significantly at the Mayo Clinic. Rather than emphasizing radical prostatectomy only for low-grade (grade less than or equal to 2) and low-stage (less than or equal to T1/B1) lesions--which may be equally well treated at less than ten years, in regard to crude survival, by radiotherapy--we believe that radical prostatectomy is particularly suitable for lesions of higher local stages, including those with regional node extension. This view is based on a large experience (less than 2,000 cases) with the radical surgical treatment of cancer of the prostate and on the realization that conservative single-modality treatment (hormonal or radiotherapy) for advanced local Stages (C and D1) provides poor cause-specific survival and nonprogression rates and may lead to high local morbidity. The treatment of Stage D1 prostate cancer was thought to be not amenable to surgical treatment, and many have recommended observation only. In 266 patients (mean age, 64 years) followed one to twenty-one years (mean, 4.7 years), immediate adjuvant orchiectomy at the time of radical prostatectomy performed in 162 patients (61%) resulted in a highly significant (P less than 0.0001) decrease in progression compared with no immediate orchiectomy in 104 patients (39%). The ten-year overall and local nonprogression rates for those undergoing immediate orchiectomy were 80 percent and 98 percent, respectively; median time to progression for the no-immediate-orchiectomy group was less than 4.5 years, and the local recurrence rate was 25 percent at ten years. Of all the pathologic variables, only DNA ploidy pattern had a significant influence on progression and cause-specific survival. Also, in patients with D1 disease and a nuclear DNA diploid pattern, immediate adjuvant orchiectomy resulted in a nonprogression rate of 100 percent at ten years compared with virtually 0 percent in those with a nondiploid tumor and no immediate orchiectomy. Because 42 percent of the patients with D1 disease in the Mayo Clinic experience have DNA diploid tumors, adjuvant orchiectomy in this group results in no progression or prostate cancer death. Patients with Stage D1 prostate cancer and DNA nondiploid pattern undergoing prostatectomy should be entered in prospective adjuvant innovative treatment protocols since these tumors do not seem to respond to early hormonal manipulation.

Adenocarcinoma↗

PubMed2001

Delayed orchiectomy after chemotherapy in patients with advanced testicular cancer.

INTRODUCTION: The therapeutic procedures in the management of testicular cancer are determined by histological findings in the removed testis and by the extent of the disease at the time of diagnosis. However, all advanced tumors could be treated by primary chemotherapy regardless of the histological findings. The current imaging techniques (ultrasound of the testis, abdominal and chest CT examination) and laboratory tests (determination of serum tumor markers AFP and hCG) provide sufficient evidence for the presence of cancer. When the diagnosis of advanced tumor is evident, it is possible to start the treatment without orchiectomy. The aim of this study was to evaluate the advantages of neo-adjuvant chemotherapy with delayed orchiectomy in the management of advanced testicular cancer. MATERIAL AND METHODS: A total of 36 patients with advanced germ cell testicular cancer underwent primary PVB or BEP chemotherapy without previous orchiectomy. Mean age of patients was 32 years. Detailed medical, surgical and urological examination showed pulmonary metastases and/or extensive abdominal tumorous masses imitating acute abdominal crisis and impaired drainage of the kidney due to ureteral obstruction. Searching for the origin, testicular tumor was detected. Eleven patients had a bulky disease in the retroperitoneum (Stage IIC), two had enlarged retroperitoneal lymph nodes (Stage IIB), two had enlarged mediastinal lymph nodes (Stage III) and other 16 patients had also pulmonary metastases, and 5 pts had pulmonary metastases only. The patients were treated with cisplatin-containing combination chemotherapy. Following completion of chemotherapy, orchiectomy was performed alone or simultaneously with retroperitoneal lymph node dissection (RPLND) and/or lung metastasectomy in cases with persistent residual mass. Following orchiectomy the patients were regularly checked and in cases with viable malignant tumor found in the testis sequential chemotherapy was administered. Similarly when the relapse of the disease was detected, the patients were treated with sequential chemotherapy. RESULTS: Complete disappearance of metastases was observed in 12 patients following chemotherapy alone. The residual mass persisted in 24 patients (in 22 out of them in the retroperitoneum and in two patients also in the lungs) and was removed surgically. The viable tumor in the removed tissue was found in one patient. Delayed orchiectomy was performed simultaneously with surgical removal of residual mass in the retroperitoneum in 24 patients and as a separate procedure in 12 patients who have been considered to be complete responders following chemotherapy alone. Residual viable tumor in testicular specimen was found in three patients, necrotic or fibrotic tissue in 18, and mature teratoma in 15 patients. Overall survival of the patients was 26/36 (72.7%) at mean of 56.9 months (range 7-145 months, median 50 months) since the start of the treatment. CONCLUSIONS: In patients with advanced germ cell testicular cancer preference must be given to the early beginning of intensive chemotherapy without the need of tissue diagnosis of primary tumor that should be obtained by orchiectomy. Benefit of this therapeutic approach is the timely management of acute abdominal and/or pulmonary symptoms of life-threatening distant metastases.

Adult↗

PubMed2004

Hip fractures in men with prostate cancer treated with orchiectomy.

PURPOSE: Androgen deprivation therapy increases the risk of osteoporosis related fractures. This issue is of increasing importance in men with prostate cancer as increasingly more undergo androgen deprivation therapy and therapy is administered sooner following diagnosis. Data directly addressing the long-term fracture risk in men diagnosed with prostate cancer are limited. MATERIALS AND METHODS: Using population based registries in Sweden we studied the incidence of hip fractures in 17,731 men diagnosed with prostate cancer from 1964 to 1996 who were treated with bilateral orchiectomy within 6 months of diagnosis. The fracture incidence was compared to the incidence in 43,230 men diagnosed with prostate cancer but not treated with orchiectomy and in 362,354 of similar age who were randomly selected from the general population. RESULTS: Men treated with orchiectomy were at increased risk for hip fracture. The estimated relative risk comparing men who underwent orchiectomy to population controls was 2.11 (95% CI 1.94 to 2.29) for femoral neck fractures and 2.16 (95% CI 1.97 to 2.36) for intertrochanter fractures. An increased risk of hip fracture was observed as early as 6 months after orchiectomy and the relative risk remained fairly constant up to 15 years following orchiectomy. CONCLUSIONS: Hip fracture risk increases almost immediately following orchiectomy and the excess risk persists for at least 15 years. This side effect should be considered when assessing the merits of androgen deprivation therapy, particularly in symptom-free men diagnosed with localized prostate cancer. Measures to prevent osteoporosis should be considered in men undergoing androgen deprivation therapy.

Aged↗

PubMed1984

Orchiectomy does not selectively increase adrenal androgen concentrations.

Prostatic carcinoma is androgen dependent and, therefore, treated by orchiectomy. However, adrenal androgen secretion remains intact after orchiectomy, and several investigators even reported an increase in serum adrenal androgen concentrations after orchiectomy. Such an increase in androgen secretion theoretically could promote tumor recurrence. To investigate this question, we obtained multiple blood samples from 10 men before, within 1 week after, and up to 6 months after orchiectomy for prostatic carcinoma. Serum testosterone concentrations became unmeasurable (less than 40 ng/dl) after orchiectomy. Three of the 10 patients had transient increases of at least 50% in both serum dehydroepiandrosterone (DHA) and cortisol after orchiectomy, presumably due to surgical stress, but mean serum DHA and DHA sulfate (DHAS) did not increase in the group as a whole. Subsequently, serum DHA and DHAS concentrations were similar to preoperative values in all patients. Therefore, we find no evidence to support the hypothesis that adrenal androgen concentrations increase after orchiectomy.

Adrenal Glands↗

PubMed1983

Some effects of orchiectomy, oestrogen treatment and radiation therapy in patients with prostatic carcinoma.

In patients treated for prostatic carcinoma with oestrogen, orchiectomy or external radiation, serum concentrations of testosterone, LH, FSH, prolactin, TeBG and oestradiol-17 beta as well as changes in sexual behaviour and mental mood were studied. Oestrogen treatment as well as orchiectomy reduced serum testosterone concentration to similar values. Neither totally nor subcapsularly orchiectomized patients responded to HCG stimulation. The free testosterone was 68% lower in oestrogen treated than in orchiectomized patients, probably due to a high TeBG concentration induced by oestrogens. patients oestrogen treated for less than 3 years and in whom the treatment had been withdrawn had normal serum testosterone and LH at follow-up. In contrast, low serum testosterone concentration and normal LH were found after oestrogen cessation in patients oestrogen treated for more than 3 years indicating reduced Leydig cell, and/or hypothalamic-hypophyseal function. In patients oestrogen treated for more than 3 years the serum testosterone concentration neither increased after oestrogen cessation nor decreased after orchiectomy. Absorbed testes doses during radiation treatment were measured from a few to more than 10 Gy but were reduced by about 50% if the gonads were protected by lead shields during anterior and posterior treatment sessions. Radiation may affect gonadal function as decreased serum testosterone concentration and increased LH, FSH were found after treatment. Sexual function was altered after oestrogen, orchiectomy and radiation treatment. Sexual activity and capability were distinctly better maintained after radiation than after orchiectomy or oestrogen treatment. Sixty-seven percent of the patients had coitus or masturbated after radiation treatment, all experiencing orgasm. Patients on oestrogen treatment or after orchiectomy had coitus/masturbation less often (17% in both groups). They also experienced orgasm less often (8% and 17% respectively). The group of patients on oestrogen treatment had a higher average score for depression than those treated with orchiectomy or radiation treatment.

Adenocarcinoma↗

PubMed2005

Testicular torsion and risk factors for orchiectomy.

OBJECTIVE: To determine risk factors for testicular loss due to testicular torsion. DESIGN AND PARTICIPANTS: Medical records of patients aged 1 to 25 years with a principal diagnosis of testicular torsion were extracted from the 1998 Nationwide Inpatient Sample. Population-based rates of testicular torsion and orchiectomy were determined. Logistic regression was used to create a predictive model for orchiectomy. For comparison, medical records of patients aged 1 to 25 years with a principal diagnosis of testicular neoplasm were extracted. RESULTS: The sample comprised 436 participants. The estimated incidence of testicular torsion for males aged 1 to 25 years in the United States is 4.5 cases per 100,000 male subjects per year, and the estimated incidence of benign and malignant testicular tumors is 1.2 cases per 100,000. Of the estimated 2248 males diagnosed nationally in 1998 with testicular torsion, 762 (34%) had an orchiectomy. In the final multivariate model estimating the probability of orchiectomy, only age was significant. CONCLUSIONS: For males aged 1 to 25 years, testicular torsion is more common than testicular tumors, and increasing age is the sole identifiable risk factor for orchiectomy. We suggest that health care professionals educate prepubertal male patients about testicular torsion and the necessity of seeking timely care to reduce the risk of orchiectomy and of possible subsequent reduced fertility.

Adolescent↗

PubMed1998

A worse prognosis for men with testicular atrophy at therapeutic orchiectomy for prostate carcinoma.

BACKGROUND: The significance of testicular atrophy at the time of therapeutic orchiectomy for prostate carcinoma has not been examined even though pretreatment hypogonadism has been associated with poor prognosis during chemical androgen ablation for these tumors. METHODS: Survival after therapeutic orchiectomy was determined for 78 men with prostate carcinoma and related to the histologic severity of testicular atrophy. Included in analysis were the presence or absence of prior radiation therapy, tumor grade and stage at diagnosis, host age, obesity, and smoking habits. RESULTS: Among 35 men who underwent therapeutic orchiectomy for progressive disease after primary radiation therapy to the prostate bed, the 25 men with testicular atrophy had worse 5-year, tumor specific, postorchiectomy survival than the 10 men without testicular atrophy (30% vs. 89%) (P=0.02). These 25 men had tumors of more advanced stage and greater undifferentiation at the time of diagnosis an average of 45 months before orchiectomy, but neither characteristic was related to postorchiectomy survival. Among 25 men with Stage D2 disease (American Urologic Association staging system) with orchiectomy as the primary treatment, the 7 men with testicular atrophy more often had undifferentiated tumors and had lower 2-year tumor specific survival than the 18 men without atrophy (43% vs. 72% ) (P > 0.10). CONCLUSIONS: Testicular atrophy at the time of therapeutic orchiectomy for prostate carcinoma is associated with poor postorchiectomy prognosis in men with prior prostate bed radiation therapy and perhaps in men without prior radiation. The association may reflect a high frequency of inherently more aggressive tumors (often relatively nonandrogen-dependent) among those tumors that are progressing in hypogonadal men.

Aged↗

PubMed1996

The flare in serum alkaline phosphatase activity after orchiectomy: a valuable negative prognostic index for progression-free survival in prostatic carcinoma.

PURPOSE: We determined whether an early flare in serum alkaline phosphatase activity after orchiectomy was of prognostic value for progression-free survival in patients with advanced prostatic carcinoma. MATERIALS AND METHODS: A retrospective analysis of a data base from a Dutch multicenter study on prostatic carcinoma was done to determine the prognostic value of a flare in alkaline phosphatase activity after orchiectomy in 112 patients with metastatic (75%) or locally advanced (25%) disease. Cox's proportional hazards models and Kaplan-Meier survival curves were used. RESULTS: Of the patients 50% had initially increased alkaline phosphatase levels and a flare in activity was demonstrated in 87% 2 to 4 weeks after orchiectomy. The prostate specific antigen nadir (cutoff 4 ng./ml.) 6 months after orchiectomy was of significant prognostic value for progression-free survival. A flare in alkaline phosphatase activity after orchiectomy demonstrated an early significant prognostic value for progression-free survival, independent of the serum alkaline phosphatase activity. CONCLUSIONS: The simplicity, ready availability and cost-effectiveness of serum alkaline phosphatase activity as a prognostic index render it attractive to the clinician, particularly early in the course of prostatic carcinoma. Measuring the flare in alkaline phosphatase activity within 1 month of orchiectomy may permit early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from aggressive treatment.

Aged↗

PubMed2002

Teratoma in the orchiectomy specimen and volume of metastasis are predictors of retroperitoneal teratoma in post-chemotherapy nonseminomatous testis cancer.

PURPOSE: Patients who require post-chemotherapy retroperitoneal lymph node dissection after induction chemotherapy for metastatic testis cancer derive therapeutic benefit from resection of teratoma but resection of necrosis is not beneficial. We determine if the absence of teratoma in the orchiectomy specimen is a reliable predictor of the absence of teratoma in the retroperitoneum at post-chemotherapy retroperitoneal lymph node dissection. MATERIALS AND METHODS: A retrospective review of the Indiana University testis cancer data base was performed. A total of 644 patients who underwent retroperitoneal lymph node dissection after induction chemotherapy only were selected for study. The presence or absence of teratoma in the orchiectomy specimen and volume of retroperitoneal tumor were analyzed as predictors of retroperitoneal teratoma at post-chemotherapy retroperitoneal lymph node dissection. RESULTS: Of the patients with teratoma in the orchiectomy specimen 85.6% had an element of teratoma in the retroperitoneum, and of those without teratomatous elements in the orchiectomy specimen 48% had teratoma in the retroperitoneum (p <0.00001). Increasing volumes of retroperitoneal tumor were associated with a higher probability of discovering teratoma at post-chemotherapy retroperitoneal lymph node dissection. CONCLUSIONS: The absence of teratoma in the orchiectomy specimen does not reliably predict the absence of teratoma in the surgical specimen at post-chemotherapy retroperitoneal lymph node dissection. Post-chemotherapy surgery is indicated if retroperitoneal tumor remains after chemotherapy irrespective of the presence or absence of teratoma in the orchiectomy specimen.

Chemotherapy, Adjuvant↗

PubMed1996

Comparison of subcapsular and total orchiectomy for treatment of metastatic prostate cancer.

OBJECTIVES: To determine whether subcapsular orchiectomy provides suboptimal treatment of metastatic prostate cancer when used to avoid the psychologic consequences of the empty scrotum that results from total orchiectomy. METHODS: We compared testosterone and prostate-specific antigen levels and survival of 37 patients who underwent total orchiectomy and 37 patients who underwent subcapsular orchiectomy for metastatic prostate cancer. RESULTS: The two groups of 37 patients were similar by clinical parameters. Postoperatively, testosterone levels were 21 +/- 11 ng/dL for subcapsular versus 21 +/- 9 ng/dL for total orchiectomy patients. Tumor response was similar in the two groups when assessed by prostate-specific antigen measured 3 weeks, 6 months, and 1, 2, and 3 years postoperatively. Survival was similar when assessed using Kaplan-Meier analysis (P = 0.76). CONCLUSIONS: Subcapsular orchiectomy is a viable option for treatment of metastatic prostate cancer.

Aged↗

PubMed2005

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.

Aged↗

PubMed1999

Use of orchiectomy and testosterone replacement to explore meal number-to-meal size relationship in male rats.

Because food intake is a function of meal number and meal size and because gender-related hormones are involved in feeding regulation, we explored effects of orchiectomy and testosterone replacement on the relationship between meal number and size and changes in resulting feeding patterns in adult male rats, randomized into orchiectomy and sham-operation groups. A rat eater meter measured feeding indexes for 1 wk before and 2 wk after castration and during 8 days of testosterone replacement. Orchiectomy leads to an immediate change in the meal number-to-size relationship, resulting in 1) change in pattern of feeding; 2) a significant decrease in dark-phase meal number; 3) a significant increase in dark-phase meal size, but insufficient to offset decrease in meal number, so total food intake significantly decreased during dark phase; 4) no significant change in light-phase meal number; and 5) an increase in meal size leading to an increased food intake during light phase, which offset decreased food intake in dark cycle and resulted in no net significant change in food intake after orchiectomy. Testosterone replacement acutely reversed effects of orchiectomy on meal number-to-meal size relationship, restoring feeding pattern. Data suggest that androgens immediately influence the meal number-to-meal size relationship. The speed of onset seen after orchiectomy suggests that the influence of testosterone on food intake may also occur partially via a nongenomic effect.

Animals↗

PubMed1996

Effects of orchiectomy on the rat parotid gland--an ultrastructural and stereological study.

The relation of the tests/testosterone with the structure and function of the mammalian parotid gland has so far been poorly investigated. The present study deals with the morphology of the rat parotid gland and its changes after orchiectomy and testosterone substitution. The glands of control and experimental animals (orchiectomized and orchiectomized with testosterone substitution) were analyzed by electron microscopy and stereology. In orchiectomized animals 30-60 days after castration, a significant reduction of the volume of the acini and the duct system as well as a significant increase of the connective tissue volume per cubic millimeter of the gland were noted. The volume and length of the intercalated and the striated ducts per cubic millimeter of parotid tissue are significantly reduced 45-60 days after orchiectomy. Excretory ducts seem to be unaffected by orchiectomy. The structure of the rat parotid acini is also changed by castration, indicating a reduction of acinar-cell activity. In controls, the volume of acinar cells with wide cisternae of rough endoplasmic reticulum is 3 times larger than the volume of acinar cells with regular and narrow cisternae of rough endoplasmic reticulum. After orchiectomy, the volume of acinar cells with wide cisternae of rough endoplasmic reticulum is significantly decreased, while the volume of acinar cells with regular and narrow cisternae of rough endoplasmic reticulum is significantly increased. Exogenously given testosterone can prevent or alleviate the mentioned effects of orchiectomy on the gland. It is concluded that orchiectomy affects the rat parotid gland, demonstrating the existence of an interaction between the testis and the mammalian parotid gland.

Animals↗

PubMed1994

Orchiectomy alone for clinical stage I nonseminomatous germ cell tumors of the testis (NSGCTT): a minimum follow-up period of 5 years.

AIMS AND BACKGROUND: Surveillance after orchiectomy alone has gained great popularity in the management of stage I NSGCTT. Preliminary results were enthusiastic, but critical voices have been raised against general use of this option as routine management. In an effort to identify patients at high risk of relapse, there has been a search for adverse prognostic factors of stage I nonseminomatous germ cell testicular tumors (NSGCTT). The aim of the study was to identify those patients in whom a surveillance policy is less likely to be successful. METHODS: Eighty patients with stage I NSGCTT were followed for at least 5 years. They were assigned to their respective clinical stage on the basis of physical examination, chest X-ray, CT of the retroperitoneum and post-orchiectomy tumor markers. The criteria for inclusion in clinical stage I were normal results of these examinations. The policy of surveillance consisted of regular follow-up with tumor markers, chest X-ray and CT of the retroperitoneum. Patients who relapsed were treated with cisplatin-containing chemotherapy. In all patients, diagnostic delay, pre-orchiectomy tumor markers, T staging category, size, histopathology and vascular invasion in the primary tumor, and semen analysis were recorded. RESULTS: Follow-up revealed that 51 of the 80 patients (63.7%) were free of disease 61-110 months (mean, 83.1) after orchiectomy. Relapse was detected in 29 patients (36.3%) 3-58 months (mean, 13) after orchiectomy. The overall survival rate was 95%. The main risk factors of relapse were: vascular invasion, a major embryonal carcinoma and a minor teratoma component in the primary tumor, and low sperm count before orchiectomy. CONCLUSIONS: The authors recommend the following risk-adapted treatment procedures: retroperitoneal lymph node dissection in patients with vascular invasion and a major teratoma component, adjuvant chemotherapy in patients with vascular invasion and a major embryonal carcinoma component, and surveillance policy in patients without vascular invasion.

Adolescent↗