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Gesundheitsökonomie & Qualitätsmanagement 2005; 10(6): 370-375
DOI: 10.1055/s-2005-858457
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Die Orchiektomie in der Primärtherapie des metastasierten Prostatakarzinoms - ein anachronistischer Eingriff?

The Orchiectomy in the Primary Therapy of Metastatic Carcinoma of the Prostate - an Anachronistic Intervention?M. May1 , R. Kheyri1 , M. Seehafer1 , B. Hoschke1 , P. G. Fabricius2
  • 1Urologische Klinik des Carl-Thiem-Klinikums Cottbus (Chefarzt: Dr. med. B. Hoschke)
  • 2Klinik für Urologie des Vivantes-Klinikums Berlin-Neukölln (Direktor: Prof. Dr. med. P. G. Fabricius)
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Publication History

Publication Date:
30 November 2005 (online)

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Zusammenfassung

Hintergrund: Der Stellenwert der palliativen Hormonbehandlung des metastasierten Prostatakarzinoms ist unumstritten. Die bilaterale Orchiektomie stellt hierbei das traditionelle Verfahren zur Androgendeprivation dar, wurde jedoch in den letzten Jahren weitgehend zugunsten der LHRH-Analoga-Therapie aufgegeben. Aufgrund der eingeschränkten ökonomischen Ressourcen des Gesundheitssystems rückt die Bewertung der Therapiekosten aktuell wieder verstärkt in den Focus des allgemeinen Interesses. Material und Methode: Insgesamt 83 Patienten mit einem metastasierten Prostatakarzinom wurden zwischen Januar 1990 und Dezember 2000 in Form der subkapsulären bilateralen Orchiektomie androgendepriviert. In einer retrospektiven Untersuchung wurden die Patienten hinsichtlich der Tumorremissionszeit, Überlebenszeit, krankheitsassoziierten und postoperativ-chirurgischen Komplikationen sowie des Kostenfaktors analysiert und mit den aktuellen Daten zur medikamentösen Kastration verglichen. Ergebnisse: Das mittlere Patientenalter betrug 72,1 Jahre und der Allgemeinzustand entsprach im Median einem ECOG-Performance-Status von 0. Bei einem durchschnittlichen Follow-up von 35 Monaten waren die mediane Tumorremissionszeit und Überlebenszeit 29 Monate respektive 36 Monate. In 14 % wurden postoperative Komplikationen nachgewiesen, die in der Mehrzahl konservativ therapiert wurden. Psychologische Probleme ließen sich aufgrund des Organverlustes nicht eruieren. Gemäß dem DRG-System kann von einem Krankenhaus mit einem durchschnittlichen Case-Mix-Index der Eingriff mit einem Entgelt von 2160 € berechnet werden. Unter Berücksichtigung einer identischen durchschnittlichen Überlebenszeit und dem aktuellen Arzneimittelpreis der LHRH-Analoga (Zoladex® 3,6 mg) ist die Orchiektomie um den Faktor 3,2 preiswerter als die medikamentöse Kastration. Schlussfolgerung: Bei äquivalentem onkologischen Outcome zur LHRH-Analoga-Therapie und geringer Morbidität stellt die subkapsuläre bilaterale Orchiektomie aufgrund ihrer hohen Compliance und der niedrigen Kosten eine sinnvolle Alternative in der Primärtherapie des metastasierten Prostatakarzinoms dar.

Abstract

Background: The significance of palliative hormonal treatment of the metastatic prostate carcinoma is indisputable. The bilateral orchiectomy hereby represents the traditional procedure of androgen deprivation therapy, but in recent years it was given up to a large extent in favour of the LHRH analogue therapy. Due to limited economic resources of the public health system the evaluation of therapy costs becomes relevant again and has moved in the centre of public interest. Materials and methods: Between January 1990 and December 2000 in a total of 83 patients with metastatic prostate carcinoma were androgen-deprived undergoing a subcapsular bilateral orchiectomy. In a retrospective study the patients were analysed with regard to tumour remission time, survival time, disease-associated and postoperative surgical complications as well as cost factors and the results were then compared to the current data of medical castration. Results: The average age of patients was 72.1 years and the general condition met in median an ECOG performance status of 0. A median follow-up of 35 months showed an median tumour remission time and survival time of 29 months and 36 months, respectively. In 14 % of cases postoperative complications were proved, which had been conservatively treated in the majority. Psychological problems due to the loss of the organ were not found out. Under the DRG system a hospital with an average Case Mix Index can charge a fee of 2,160 € for this surgery. Taking an identical survival time and the current drug price for the LHRH analoque (Zoladex® 3.6 mg) under consideration, the orchiectomy is by the factor 3.2 less expensive than the medical castration. Conclusion: With an equivalent oncological outcome compared to the LHRH analogue therapy and a less morbidity the subcaspular bilateral orchiectomy represents a reasonable alternative in the primary therapy of the metastatic prostate carcinoma due to its high compliance and lower costs.

Schlüsselwörter

Prostatakarzinom - Metastasen - chirurgische Kastration - Überleben - Nebenwirkungen - Kostenanalyse

Key words

Prostate carcinoma - metastases - surgical castration - survival - side effects - cost analysis

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Dr. med. Matthias May

Oberarzt der Urologischen Klinik, Carl-Thiem-Klinikum Cottbus, Lehrkrankenhaus der Universitätsklinik Charité zu Berlin

Thiemstraße 111

03048 Cottbus

Email: M.May@ctk.de

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