Parenteral @entity172 versus total XXXX ablation in the treatment of @entity263 : effects on overall survival and cardiovascular mortality. The Scandinavian @entity263 Group (SPCG)-5 Trial Study.

@entity2796 @entity1 @entity172 @entity7955 @entity263 @entity19040 @entity12194 @entity342 @entity65 @entity21367
OBJECTIVES: To compare the effect on overall survival of total @entity342 ablation ( @entity2796 ) with that of parenteral @entity172 and to pay special attention to cardiovascular mortality. @entity2796 (orchiectomy or a luteinizing hormone-releasing hormone analogue combined with an antiandrogen) has been proposed as superior to other endocrine treatments for @entity1 with @entity263 . Recently, the use of parenteral @entity172 has been suggested to reduce or even negate the well-known cardiovascular side effects of oral @entity172 . METHODS: Nine hundred fifteen @entity1 were randomized to intramuscular injections of 240 mg @entity21367 ( @entity7955 ) every second week for the first 8 weeks (5 doses) followed by a maintenance dose of 240 mg every month (n = 458) or to bilateral orchiectomy or triptorelin 3.75 mg every month combined with the antiandrogen @entity12194 250 mg three times daily. The choice between orchiectomy and triptorelin was at the discretion of the clinician and @entity1 . @entity1 were stratified according to performance status, presence of @entity65 , and alkaline phosphatase level. An observer totally unaware of the treatment given classified all deceased @entity1 . RESULTS: At a median follow-up of 18.5 months, no signs of a difference in overall survival were found between @entity2796 and @entity7955 (P <0.001). Of 458 @entity1 , 266 (58.1%) had died in the @entity7955 group compared with 269 (58.9%) of 457 @entity1 in the @entity2796 group. Within the @entity2796 group, no difference in overall survival existed between @entity1 who had undergone orchiectomy or who were given @entity19040 . Furthermore, no differences in cardiovascular mortality were found (3.5% in the @entity7955 group and 3.1% in the @entity2796 group). CONCLUSIONS: The current parenteral @entity172 regimen seems to be of comparable efficacy and cardiovascular safety as @entity2796 in terms of overall survival. @entity7955 has by far the lowest drug cost and also the lowest cumulative direct costs and thus has the highest cost-effectiveness. We suggest that parenteral @entity172 be included as a therapeutic option in the endocrine management of @entity263 .
