title: Prescription practice for LH-RH analogs and androgen receptor antagonists in the treatment of advanced prostate cancer in Germany (1993-2003).
abstract: BACKGROUND
  Nearly 80% of the patients suffering from advanced stages of prostate cancer in Germany are treated currently with luteinizing hormone-releasing hormone (LH-RH) analogs alone or in combination with androgen receptor antagonists. The aim of this study was to assess whether the prescription practice for LH-RH analogs and direct antiandrogens between 1993 and 2003 parallels the rise in the incidence rates for prostate cancer associated with the proportional rise in daily doses.
  
  
  METHODS
  Between 1993 and 2000 a yearly randomly selected number of receipts has been evaluated from official pharmacies in Germany which have been billed to public health insurance companies. Data concerning drug use, number of daily doses, and total cost of the respective drugs have been calculated by the Research Institute of the AOK (Wissenschaftliches Institut der AOK, WIdO). These prescription data have been related to incidence and mortality rates of patients with prostate cancer.
  
  
  RESULTS
  Between 1993 and 2003 the age-standardized incidence rate of carcinomas of the prostate has risen by 180%, while the disease-specific mortality practically has remained nearly at the same level. The daily prescribed doses of LH-RH analogs have risen by a factor of 8.5 from 3.9 to 33.5 million daily doses during this time. In contrast, the daily doses of androgen receptor antagonists have remained unchanged between 1997 and 2001, followed by a rise of 50% between 2001 and 2003.
  
  
  CONCLUSIONS
  The first analysis of the prescription practice of antiandrogens in the treatment of prostate cancer with respect to the incidence rates in Germany could only be facilitated by the fact that these medications are in exclusive use for this indication in Germany. The rise in prescriptions may be explained by the therapy shift from surgery to LH-RH application until the year 2000; the reasons for a further rise since 2000 remain speculative. In conclusion, only prevalence data would allow the exact calculation of medication needs among prostate cancer patients.
authors.affiliation: Department of Urology and Pediatric Urology, Justus Liebig University Giessen, Giessen, Germany. vrohde@gmx.de
authors.forename: Volker
authors.initials: V
authors.lastname: Rohde
authors.forename: Thorsten
authors.initials: T
authors.lastname: Diemer
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Hauck
authors.forename: Beate
authors.initials: B
authors.lastname: Bestmann
authors.forename: Jörg
authors.initials: J
authors.lastname: Miller
authors.forename: Helmut
authors.initials: H
authors.lastname: Schröder
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weidner
authors.forename: Alexander
authors.initials: A
authors.lastname: Katalinic
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D059002:Androgen Receptor Antagonists; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000639:trends; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000726:Androgen Antagonists; D059002:Androgen Receptor Antagonists; D007987:Gonadotropin-Releasing Hormone