First published in Pharmacoeconomics, Volume 14, pages 27-48, 1998.

For this report, the Technology Evaluation Center, an AHCPR Evidence-based Practice Center of the Blue Cross and Blue Shield Association, conducted a systematic review of the evidence from randomized controlled trials on the relative effectiveness of alternative strategies for androgen suppression as treatment of advanced prostate cancer.

Prostate cancer is a disease of older men, and is second only to lung cancer in cancer mortality for men. For 1998, it was estimated that 184,500 new cases of prostate cancer would be diagnosed, and 39,200 men would die of prostate cancer that year.

In 1994, the total Medicare expenditure for treatment of prostate cancer was $1,411,687,900. Of the total, $477,851,000 was for androgen suppression therapy using luteinizing hormone-releasing hormone (LHRH) agonists. The prevalence of prostate cancer, and the expenditures for its treatment, are likely to increase with the aging of the population and the trend to earlier detection of the disease.

Three key issues are addressed in the report:

Two supplementary analyses were also conducted for each key question:

Exercise Testing, whether it is convention exercise electrocardiography or exercise imaging with perfusion scintigraphy or echocardiography, has many purposes. Its best-know application is to diagnose coronary artery disease, and in this role it serves as a model for reasoning about diagnostic tests. Among the other uses of exercise testing, including measuring exercise capacity, evaluating the efficacy of therapy, establishing an exercise prescription, and reassuring the patient about the safety of exercise, assessing prognosis is one of the most important, but it has been overshadowed by the emphasis on diagnosis.