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Active Surveillance Versus Surgery for Low Risk Prostate Cancer: A Clinical Decision Analysis

2012; Lippincott Williams & Wilkins; Volume: 187; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2011.12.015

1527-3792

David Liu, Harold P. Lehmann, Kevin D. Frick, H. Ballentine Carter,

Bladder and Urothelial Cancer Treatments

No AccessJournal of UrologyAdult Urology1 Apr 2012Active Surveillance Versus Surgery for Low Risk Prostate Cancer: A Clinical Decision Analysis David Liu, Harold P. Lehmann, Kevin D. Frick, and H. Ballentine Carter David LiuDavid Liu Johns Hopkins University School of Medicine, Baltimore, Maryland , Harold P. LehmannHarold P. Lehmann Johns Hopkins University School of Medicine, Baltimore, Maryland Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland , Kevin D. FrickKevin D. Frick Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland , and H. Ballentine CarterH. Ballentine Carter Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Urology, the James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland View All Author Informationhttps://doi.org/10.1016/j.juro.2011.12.015AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed the effect of age, health status and patient preferences on outcomes of surgery vs active surveillance for low risk prostate cancer. Materials and Methods: We used Monte Carlo simulation of Markov models of the life courses of 200,000 men diagnosed with low risk prostate cancer and treated with surveillance or radical prostatectomy to calculate quality adjusted life expectancy, life expectancy, prostate cancer specific mortality and years of treatment side effects, with model parameters derived from the literature. We simulated outcomes for men 50 to 75 years old with poor, average or excellent health status (50%, 100% and 150% of average life expectancy, respectively). Sensitivity of outcomes to uncertainties in model parameters was tested. Results: For 65-year-old men in average health, surgery resulted in 0.3 additional years of life expectancy, 1.6 additional years of impotence or incontinence and a 4.9% decrease in prostate cancer specific mortality compared to surveillance, for a net difference of 0.05 fewer quality adjusted life years. Increased age and poorer baseline health status favored surveillance. With greater than 95% probability, surveillance resulted in net benefits compared to surgery for age older than 74, 67 and 54 years for men in excellent, average and poor health, respectively. Patient preferences toward life under surveillance, biochemical recurrence of disease, treatment side effects and future discount rate affected optimal management choice. Conclusions: Older men and men in poor health are likely to have better quality adjusted life expectancy with active surveillance. However, specific individual preferences impact optimal choices and should be a primary consideration in shared decision making. References 1 : Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol2010; 28: 1117. Google Scholar 2 : Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst2008; 100: 1144. Google Scholar 3 : A decision analysis of alternative treatment strategies for clinically localized prostate cancer: Prostate Patient Outcomes Research Team. JAMA1993; 269: 2650. Google Scholar 4 : A critique of the decision analysis for clinically localized prostate cancer. J Urol1994; 152: 1894. Link, Google Scholar 5 : A decision analysis for treatment of clinically localized prostate cancer. J Gen Intern Med1997; 12: 299. Crossref, Medline, Google Scholar 6 : Do older men benefit from curative therapy of localized prostate cancer?. J Clin Oncol2003; 21: 3318. Google Scholar 7 : Decision analysis using individual patient preferences to determine optimal treatment for localized prostate cancer. Cancer2007; 110: 2210. Google Scholar 8 : Active surveillance compared with initial treatment for men with low-risk prostate cancer: a decision analysis. JAMA2010; 304: 2373. Google Scholar 9 : New technology and health care costs–the case of robot-assisted surgery. N Engl J Med2010; 363: 701. Google Scholar 10 : Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. Google Scholar 11 : NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. : 2011. www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed March 11, 2011. Google Scholar 12 : Active surveillance and radical prostatectomy for clinically localized, low-risk prostate cancer: Institute for Clinical and Economic Review. www.icer-review.org/index.php/as-rp.html. Accessed May 5, 2010. Google Scholar 13 : Probabilistic sensitivity analysis using Monte Carlo simulation: A practical approach. Med Decis Making1985; 5: 157. Google Scholar 14 : Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ1994; 3: 95. Google Scholar 15 : Handling uncertainty in cost-effectiveness models. Pharmacoeconomics2000; 17: 479. Google Scholar 16 : Outcomes of localized prostate cancer following conservative management. JAMA2009; 302: 1202. Google Scholar 17 : Prevalence of lower urinary tract symptoms in men aged 45–79 years: a population-based study of 40 000 Swedish men. BJU Int2004; 94: 327. Google Scholar 18 : Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med2003; 139: 161. Google Scholar 19 : Final outcomes of patients with low-risk prostate cancer suitable for active surveillance but treated surgically. BJU Int2009; 104: 1501. Google Scholar 20 : Pathological features after radical prostatectomy in potential candidates for active monitoring. J Urol2007; 178: 860. Link, Google Scholar 21 : Follow-up prostate cancer treatments after radical prostatectomy: a population-based study. J Natl Cancer Inst1996; 88: 166. Google Scholar 22 : Use of second treatment following definitive local therapy for prostate cancer: data from the CaPSURE database. J Urol1998; 160: 1398. Link, Google Scholar 23 : Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy. J Urol2004; 171: 1141. Link, Google Scholar 24 : Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA2008; 299: 2760. Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTaneja S (2019) Re: Radical Prostatectomy or Watchful Waiting in Prostate Cancer—29-Year Follow-upJournal of Urology, VOL. 202, NO. 2, (210-211), Online publication date: 1-Aug-2019.van Stam M, Pieterse A, van der Poel H, Bosch J, Tillier C, Horenblas S and Aaronson N (2018) Shared Decision Making in Prostate Cancer Care—Encouraging Every Patient to be Actively Involved in Decision Making or Ensuring the Patient Preferred Level of Involvement?Journal of Urology, VOL. 200, NO. 3, (582-589), Online publication date: 1-Sep-2018.Penson D (2013) Re: Active Surveillance for Prostate Cancer Compared with Immediate Treatment: An Economic AnalysisJournal of Urology, VOL. 189, NO. 6, (2109-2110), Online publication date: 1-Jun-2013. Volume 187Issue 4April 2012Page: 1241-1246Supplementary Materials Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordsquality-adjusted life yearsdecision support techniquesprostatectomyprostatic neoplasmswatchful waitingMetricsAuthor Information David Liu Johns Hopkins University School of Medicine, Baltimore, Maryland Nothing to disclose. More articles by this author Harold P. Lehmann Johns Hopkins University School of Medicine, Baltimore, Maryland Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Nothing to disclose. More articles by this author Kevin D. Frick Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Financial interest and/or other relationship with ITA Partners. More articles by this author H. Ballentine Carter Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Urology, the James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland Nothing to disclose. More articles by this author Expand All Advertisement PDF downloadLoading ...