Authors' objectives:

This report examines the costs and benefits of goserelin in first line palliative treatment of advanced prostate carcinoma, where it may be used as an alternative to orchidectomy.

Authors' results and conclusions: All three RCTs reached similar conclusions: in terms of subjective and objective response rates, laboratory markers, time to progression and median survival, no significant differences have been demonstrated. Few studies include quality of life measurements. One small study suggested that improvement in function and mood may be greater in patients who chose goserelin treatment over orchidectomy. A small RCT on triptorelin vs orchidectomy, also presents data which suggests greater psychological benefit on GnRH analogues, though the differences were not statistically significant.

Authors' recommendations: Orchidectomy is more cost effective than goserelin (unless survival is predicted to be less than about 6 months). The use of intermittent goserelin therapy may be effective and would reduce costs and side effects. At present there is minimal robust evidence supporting this mode of practice. There is some evidence to suggest that given a choice around 70% of patients with advanced carcinoma would chose monthly injections rather than orchidectomy. Local experience suggests that appropriate counselling can result in a high acceptance of orchidectomy (90%) in patients with hormone responsive disease. The authors therefore strongly recommend orchidectomy or goserelin for treatment of advanced prostatic cancer, but say that goserelin is considerably more expensive and has little to recommend it over orchidectomy.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.wihrd.soton.ac.uk

Year Published: 1996

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: Wessex Institute for Health Research and Development

Contact Address: Pauline King. Wessex Institute for Health Research and Development, Boldrewood Medical School, Bassett Crescent East, Highfield, Southampton. SO16 7PX Tel. +44 1703 595661 Fax +44 1703 595662

Copyright: Wessex Institute for Health Research and Development (WIHRD)