OBJECTIVES: Prostatic cancer is the second most frequent cancer and the third highest cause of cancer-related deaths in Italy. Age is the principal risk factor and given the ageing Italian population, it seems that the related health care expenditure is bound to increase, causing the need for pharmacoeconomic evaluation of the therapies available. METHODS: We performed a cost/utility analysis using a Markov model of hormonal therapies in patients with advanced prostate cancer who underwent radical prostatectomy, from biochemical recurrence to death. Nine androgen suppression therapies were considered: orchiectomy, two nonsteroidal antiandrogens (NSAA), four luteinising hormone-releasing hormone (LHRH) agonists, cyproterone acetate and the maximal androgen blockade (MAB) obtained with the association of a NSAA and a LHRH. In the simulation, the androgen suppression therapies were started at PSA recurrence and continued until death. The model used the Italian NHS prospective and a patient’s lifetime simulation horizon. Drug costs were calculated for each therapy, considering the less costly brand. RESULTS: All therapies produced a life expectancy (LE) of about 12 life years (LYs) with a small variability ranging from 12.3 LYs for MAB to 11.37 LYs for NSAA-flutamide. Quality adjusted life expectancy ranged from 9.98 QALYs for MAB to 9.28 QALYs for NSAA-flutamide. The cost per patient presented more variability, from €12,538 for orchiectomy to €59,496 for NSAA-bicalutamide. Orchiectomy provided the most cost/effective alternative with €1300/QALY. In the LHRH-agonists class leuprorelin was the most cost/effective at about €2200/QALY. CONCLUSIONS: MAB was identified as the most effective and the most costly therapy. Orchiectomy was less effective but involved the lowest cost and, thus, represented the most cost/effective strategy. Nonetheless, its application in actual clinical practice is difficult and it is almost always refused by patients. Among the class of LHRH-agonists, leuprorelin (22.5 mg – 7.5 mg) dominated the alternatives and provided an excellent therapeutic strategy.