Relative Effectiveness and Cost-Effectiveness of Methods of Androgen Suppression211 in the Treatment of Advanced Prostate Cancer. Evidence Report/Technology 211 Assessment Number 4

摘要

With 184,500 new cases and 39,200 deaths anticipated in 1998, prostate cancer is211u001esecond only to lung cancer mortality for men. This report is a systematic review 211u001eof the evidence from randomized controlled trials on the relative effectiveness 211u001eof the alternative strategies for androgen suppression as treatment of advanced 211u001eprostate cancer. Three key issues are addressed: (1) the relative effectiveness 211u001eof the available methods for monotherapy (orchiectomy, lutenizing hormone-211u001ereleasing hormone (LHRH) agonists, and antiandrogens), (2) the effectiveenss of 211u001ecombined androgen blockade compared to monotherapy, and (3) the effectiveness of 211u001eimmediate androgen suppresson compared to androgen suppression deferred until 211u001eclinical regression. Outcomes of interest are overall, cancer-specific, and 211u001eprogression-free survival; time to treatment failure; adverse effects; and 211u001equality of life. Two supplementary analyses were conducted for each key question: 211u001e(1) metal-analysis of overall survival at 2 years (questions 1 and 2) and 5 years 211u001e(questions 2 and 3), and (2) cost-effectiveness analysis.