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Press Release Date: January 12, 1999
Men with advanced prostate cancer who are given one of several different testosterone-suppressing drugs known as "luteinizing hormone-releasing hormone (LHRH) agonists" survive roughly the same length of time and experience roughly the same side effects, regardless of which drug they use. A technology assessment report released today shows that despite the substantial differences in costs among the different LHRH agonists, they all produce equivalent health outcomes.
The report, which was prepared for the U.S. Agency for Health Care Policy and Research (AHCPR) by the Blue Cross and Blue Shield Association (BCBSA) Technology Evaluation Center in its capacity as an AHCPR Evidence-based Practice Center (EPC), also found that a more aggressive form of therapy called "combined androgen blockade" may be of little added clinical benefit. The report found that the more aggressive therapy only marginally increases survival, but also causes more severe side effects. Furthermore, while it has been hypothesized that subpopulations of patients who have a good prognosis may benefit more from such aggressive treatment, the evidence does not support this hypothesis.
LHRH agonists are used to suppress the production of testosterone, the main androgen (male hormone). Produced primarily in the testicles, testosterone can promote the growth of prostate cancer cells. Combined androgen blockade uses either an LHRH agonist or surgical removal of the testicles, plus a second drug called a non-steroidal anti-androgen, to block the action of testosterone. All LHRH agonists are as effective as surgical removal of the testicles, which was once considered the standard treatment for prostate cancer.
Naomi Aronson, Ph.D., director of the Technology Evaluation Center EPC, said, "More aggressive treatments for advanced prostate cancer are now available. Before men choose a therapy that starts earlier or is more intensive, they need solid information based on scientific evidence about whether such treatments result in longer survival or enhanced quality of life."
"This report provides the first comprehensive analysis of all the available evidence on first-line treatment of this disease," said John M. Eisenberg, M.D., AHCPR's administrator. "It will help clarify the difficult choices that face men with advanced prostate cancer, their families, and their physicians."
The technology assessment also examined whether treating men early with testosterone suppression results in better outcomes than treating them later in the course of their disease. There was insufficient evidence to determine whether survival is improved by starting testosterone suppression as soon as advanced prostate cancer is detected. The alternative—waiting until symptoms develop—may spare the patient years of living with the serious side effects of treatment, one of which is impotence.
Prostate cancer, the second leading cause of cancer deaths in American men, is primarily a disease of older men, and in 20 years the elderly population of the United States is expected to increase significantly. This expansion, coupled with increased prostate cancer detection and the trend toward earlier diagnosis, makes it very important to understand the relative effectiveness and cost-effectiveness of alternative treatment strategies for prostate cancer. Currently, approximately 185,000 new cases of prostate cancer are diagnosed annually, and 39,000 men die of the disease each year.
The cost of treating prostate cancer is a major national expenditure. The direct hospital charges alone for prostate cancer treatment cost Medicare more than $1.4 billion in 1994. Federal agencies that provide medical care to beneficiaries, such as the U.S. Department of Veterans Affairs and the U.S. Department of Health and Human Services' Indian Health Service, as well as private health insurers, also incur expenses for prostate cancer treatment.
The findings are based on a systematic assessment of evidence from randomized controlled trials. A Technical Advisory group of prostate cancer experts provided ongoing guidance on all phases of this project. In addition, the report was reviewed by 10 other experts on prostate cancer, an expert on cost-effectiveness analysis, an expert on systematic review and meta-analysis, and two patient representatives. Pharmaceutical companies whose products are included in the report were asked to review the findings as was the federal government's Health Care Financing Administration, which nominated this topic for assessment by AHCPR's Evidence-based Practice Center program.
Select to access an online summary of Relative Effectiveness and Cost-Effectiveness of Methods of Androgen Suppression in the Treatment of Advanced Prostatic Cancer (AHCPR 99-E011). Print copies are available free of charge from the AHCPR Publications Clearinghouse (P.O. Box 8547 Silver Spring, MD 20907; 1-800-358-9295 within the United States and 703-437-2078 from outside the country).
The full report (AHCPR 99 E012) will be in posted on the National Library of Medicine's HSTAT database. At the same time, printed copies of the full report will become available from the AHCPR Publications Clearinghouse.
Forthcoming EPC evidence reports and technology assessments examine clinical issues such as treating depression treatment with new drugs, diagnosis and treatment of acute sinusitis, management of stable angina, diagnosis and treatment of dysphagia/swallowing in elderly patients, evaluation and treatment of new onset of atrial fibrillation in the elderly and the prevention and management of urinary tract infections in paralyzed persons.
Note to Editors: For further details about the study, call: Laura Ryan, BCBSA, (312) 297-6161.
For additional information, contact AHCPR Public Affairs: Karen Migdail, (301) 427-1855 (KMigdail@ahrq.gov).