Der Deutsche HTA-Report: Orchiektomie versus LH-RH-Analoga in der Therapie des fortgeschrittenen Prostatakarzinoms: Ergeben sich Konsequenzen für den Versorgungsalltag?

Zusammenfassung

Fragestellung: In dieser systematischem Übersichtsarbeit wird die internationale Datenlage zur Effektivität der Hormondeprivation durch LH-RH-Analoga und der Orchiektomie zur Behandlung des fortgeschrittenen Prostatakarzinoms bewertet und im Kontext der primären, neoadjuvanten, adjuvanten und intermittierenden Hormondeprivation diskutiert. Material und Methoden: Zur Erschließung des Datenmaterials für dieses Health Technology Assessment wurde eine systematische, breit angelegte Literaturrecherche in den gängigen medizinischen und HTA-Datenbanken und weiteren Medien durchgeführt und die extrahierten Daten differenziert ausgewertet. Ergebnisse: In allen identifizierten, randomisierten, kontrollierten Studien zeigten RH-Analoga und Formen der Orchiektomie die gleiche medizinische Wirksamkeit. Hinsichtlich der Lebensqualität konnte in vier Studien unterschiedlichen Studiendesigns kein signifikanter Unterschied zwischen einer Behandlung mit LH-RH-Analoga und einer Therapie mit Orchiektomie gezeigt werden. Schlussfolgerung: Nach der gegenwärtig vorliegenden Studienlage gibt es klare Belege für die äquivalente Wirksamkeit von LH-RH-Analoga und einer Orchiektomie zur Therapie eines fortgeschrittenen Prostatakarzinoms. Eine Umkehr zur irreversiblen Orchiektomie, wenn auch gesundheitsökonomisch kostengünstiger, ist insbesondere unter der Berücksichtigung der erweiterten Indikationen zur temporären Hormondeprivation abschließend nicht empfehlenswert.

Abstract

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.

Schlüsselwörter

Prostatakarzinom - Versorgungsalltag - Hormondeprivation - Effektivität

Key words

Prostate carcinoma - daily health service - hormondeprivation - effectiveness

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