Active surveillance versus surgery for low risk prostate cancer: A clinical decision analysis

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1241-1246
Number of pages6
JournalJournal of Urology
Volume187
Issue number4
DOIs
StatePublished - Apr 2012

Fingerprint

Decision Support Techniques
Life Expectancy
Prostatic Neoplasms
Health Status
Patient Preference
Health
Quality of Life
Quality-Adjusted Life Years
Mortality
Erectile Dysfunction
Prostatectomy
Uncertainty
Decision Making
Recurrence
Therapeutics

Keywords

  • decision support techniques
  • prostatectomy
  • prostatic neoplasms
  • quality-adjusted life years
  • watchful waiting

ASJC Scopus subject areas

  • Urology

Cite this

Active surveillance versus surgery for low risk prostate cancer : A clinical decision analysis. / Liu, David; Lehmann, Harold P; Frick, Kevin; Carter, H Ballentine.

In: Journal of Urology, Vol. 187, No. 4, 04.2012, p. 1241-1246.

Research output: Contribution to journalArticle

@article{c043768fcf45439ba225b50e11c1ff1f,
title = "Active surveillance versus surgery for low risk prostate cancer: A clinical decision analysis",
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.",
keywords = "decision support techniques, prostatectomy, prostatic neoplasms, quality-adjusted life years, watchful waiting",
author = "David Liu and Lehmann, {Harold P} and Kevin Frick and Carter, {H Ballentine}",
year = "2012",
month = "4",
doi = "10.1016/j.juro.2011.12.015",
language = "English (US)",
volume = "187",
pages = "1241--1246",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Active surveillance versus surgery for low risk prostate cancer

T2 - A clinical decision analysis

AU - Liu, David

AU - Lehmann, Harold P

AU - Frick, Kevin

AU - Carter, H Ballentine

PY - 2012/4

Y1 - 2012/4

N2 - 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.

AB - 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.

KW - decision support techniques

KW - prostatectomy

KW - prostatic neoplasms

KW - quality-adjusted life years

KW - watchful waiting

UR - http://www.scopus.com/inward/record.url?scp=84862832081&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862832081&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2011.12.015

DO - 10.1016/j.juro.2011.12.015

M3 - Article

C2 - 22335873

AN - SCOPUS:84862832081

VL - 187

SP - 1241

EP - 1246

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 4

ER -