OBJECTIVES: Estimate the cost-effectiveness of four treatment strategies used in advanced prostate cancer. The strategies were monotherapy using leuprolide or goserelin, combination therapy, (goserelin plus bicalutamide), and orchiectomy. METHODS: Using a Markov model, cost-effectiveness analysis was conducted for four strategies from a societal perspective. The model states obtained from Bayoumi (2001). The time horizon was 20 years and the base case was assumed to be 65 years old with a recurrence of cancer with local metastasis. Life Years, Quality-Adjusted Life Years (QALY), Incremental Cost-Effectiveness Ratios, and Net Montarey Benefit (NMB) were the outcomes that were measured. We conducted one-way sensitivity analyses and probabilistic sensitivity analysis. RESULTS: Orchiectomy showed overall survival of 6.78 years, leuprolide 6.78 years, combination therapy 6.74 years, , and goserelin 6.56 years. Orchiectomy had the highest quality-adjusted life years at 5.09 QALY, with a total cost estimated at ($ 51,753). Combination therapy resulted in 5.00 QALY, with a total cost estimated at ($ 131, 283). Leuprolide had 4.96 QALY, with a total cost estimated at ($ 84,015), and goserelin had 4.96 QALY, with total cost estimated at ($ 92,537). Orchiectomy is seen to dominate the other therapies in terms of costs per QALY. Given the dominating position of orchiectomy, its NMB will always be the maximum at any WTP. If these results may be thought applicable to patients who refuse to undergo orchiectomy, so that alternative is not available, then goserelin is dominated by leuprolide and the only relevant ICER of combination therapy vs. leuprolide is in excess of $ one million, making leuprolide the optimal choice. CONCLUSIONS: Orchiectomy is the most cost-effective androgen deprivation strategy for patients with advanced prostate cancer of alternatives included in this study. If these results hold for patients refusing orchiectomy, leuprolide is the cost-effective choice.