Open AccessA Decision Analysis for Treatment of Clinically Localized Prostate Cancer
Author(s) -
Kattan Michael W.,
Cowen Mark E.,
Miles Brian J.
Publication year - 1997
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1046/j.1525-1497.1997.012005299.x
Subject(s) - medicine , watchful waiting , prostatectomy , comorbidity , prostate cancer , cohort , cancer , prostate
OBJECTIVE: To determine the preferred treatment of clinically localized prostate cancer. DESIGN: Cancer grade, patient age, and comorbidities are considered in a Markov model with Monte Carlo sensitivity analyses. Large and recent pooled analyses and patient‐derived utilities are included. RESULTS: Principal findings suggest benefit for radical prostatectomy relative to watchful waiting for men under 70 years of age with low to moderate comorbidity. Men older than 70 with high comorbidity and disease of low to moderate grade do better with watchful waiting. CONCLUSIONS: Cohort‐level sensitivity analyses suggest a quality‐adjusted treatment benefit for radical prostatectomy for younger men and treatment harm for older men. Tailored patient and clinician decisions remain necessary, especially for men older than 70 in good health but with aggressive cancers. KEY WORDS: decision analysis; prostate cancer; watchful waiting; patient‐derived utilities; radical prostatectomy.