Decision analysis using individual patient preferences to determine optimal treatment for localized prostate cancer.

BACKGROUND: Selecting treatment for clinically localized prostate cancer remains an ongoing challenge. Previous decision analyses focused on a hypothetical patient with average preferences, but preferences differ for clinically similar patients, implying that their optimal therapies may also differ.

METHODS: A decision model was constructed comparing 4 treatments for localized prostate cancer: 1) radical prostatectomy (RP); 2) external beam radiation (EB); 3) brachytherapy (BT); and 4) watchful waiting (WW). Published data were used regarding treatment success, side effects, and noncancer survival, and 156 men with prostate cancer were surveyed to elicit preferences in quality-adjusted life years (QALYs). The clinical scenarios were determined (age, tumor grade, and prostate-specific antigen [PSA]) for which variations in patient preferences led to different optimal treatments and those for which the optimal treatment was unaffected by preferences.

RESULTS: Patient preferences were critical in determining treatment for low-risk cancers (Gleason score
CONCLUSIONS: The optimal treatment for prostate cancer depends on both the clinical scenario (patient age and tumor aggressiveness) and the patient's preferences. Decision analyses taking individualized preferences into account may be a useful adjunct in clinical decision-making.