A decision analysis of alternative treatment strategies for clinically localized prostate cancer. Prostate Patient Outcomes Research Team

摘要: OBJECTIVE To model the impact of initial therapy on outcomes for men with localized (clinical stage A or B) prostatic carcinoma. DESIGN decision analysis modeling three strategies: radical prostatectomy, external-beam radiation therapy, and watchful waiting, delayed hormonal if metastatic disease develops. We modeled main benefit treatment as a reduction in chance death disutility from disease. These benefits were offset by risks treatment-related morbidity mortality. The was used to analyze expected tumor grade (well, moderately, poorly differentiated) 60 75 years age. DATA Probabilities rates important clinical events, obtained through review literature carcinoma Medicare claims data. MAIN RESULTS Several patterns emerged within range uncertainty about In patients well-differentiated grades, based staging, at best offers limited terms quality-adjusted life expectancy may result harm patient. Among moderately differentiated tumors, we use most optimistic assumptions efficacy, then aged 65 would either prostatectomy compared waiting. However, other cases, less than 1-year improvement decreases Invasive generally appears be harmful older 70 years. CONCLUSIONS Radical selected groups prostate cancer, particularly younger higher-grade tumors. our shows that cases potential are small enough choice is sensitive patient's preferences various discounting. waiting reasonable alternative invasive many