Bicalutamide

Advanced Prostate Cancer

Orchiectomy is the simplest and most cost-effective therapy in advanced prostate cancer, based on a metaanalysis by Dr. Ahmed M. Bayoumi of the University of Toronto and his associates.

Various methods of androgen suppression yield similar survival rates, but orchiectomy is cheaper and spares patients repeated hospital visits and drug-related side effects. But orchiectomy is unacceptable to many men, and the patient's preference should drive the selection of antiandrogen therapy, they said.

Compared with no antiandrogen therapy, orchiectomy would increase the average survival of a 65-year-old man with advanced prostate cancer by 7.6 years. Treatment with a luteinizing hormone-releasing hormone agonist or with combined androgen blockade would add 7.5 years. Nonsteroidal antiandrogen therapy would increase survival by 7.4 years, and diethylstilbestrol would increase survival by 6.9 years.

The analysis was based on a prototypical 65-year-old man who has a history of prostate cancer and presents with clinically evident, localized cancer recurrence and no distant metastases (J. Natl. Cancer Inst. 92[21]:1731-39, 2000). Orchiectomy cost was based on Medicare charges; other costs were based on, comprehensive cost studies. (See chart.)

Quality of life estimates were based on a review of the literature on prostate cancer-related quality of life; the investigators in the current study assumed that men did not experience much of a decrease in quality of life until distant metastases developed.

In their sensitivity analysis, when orchiectomy was assigned a quality of life value of 0.88 or greater, the cost-effectiveness of other strategies exceeded $100,000 per quality-adjusted life year. When the procedure was assigned a quality of life weight of less than 0.83, the cost-effectiveness of luteinizing hormone-releasing hormone was less than $50,000 per quality-adjusted life year.

When orchiectomy was excluded, diethylstilbestrol was the least expensive option, but it was less effective than orchiectomy. Combined androgen block ade treatment of nonsteroidal antiandrogen and luteinizing hormone--releasing hormone was more expensive but was as effective as orchiectomy.

COPYRIGHT 2001 International Medical News Group
COPYRIGHT 2001 Gale Group