The German HTA Report: Orchiectomy versus LH-RH Analogues in the Treatment of Advanced Prostate Carcinoma: Are There Any Consequences For the Daily Health Service?

PURPOSE: This systematic review evaluates international data on the medical effectiveness of orchiectomy and medical therapy with LH-RH analogues in patients with advanced prostate cancer. These results are discussed in the context of primary, neoadjuvant, adjuvant and intermittent hormone deprivation. MATERIALS AND METHODS: A systematic, diversified literature analysis in the common medical and HTA databases and further media was conducted. RESULTS: All identified, randomised and controlled studies concerning the application of LH-RH analogues showed the same medical effectiveness for orchiectomy and for treatment with LH-RH analogues. Four different studies regarding the quality of life revealed no significant difference between the treatment with LH-RH analogues and the therapy with orchiectomy. CONCLUSION: According to available studies, there is clear evidence for the equivalent effectiveness of LH-RH analogues and orchiectomy in the treatment of advanced prostate cancer. A change back to orchiectomy - even though it is more cost-efficient - cannot be recommended when taking the extended indications for temporary hormone deprivation into consideration.