Active surveillance or immediate surgery for low-risk prostate cancer ...

Posted on February 20, 2012 by Sitemaster

A new study has attempted to?calculate the impact of age, health status, and patient preference on?the relative outcomes (and merits)?of immediate surgery?as compared to active surveillance for the management of low-risk prostate cancer.

Liu et al. used highly structured mathematical modeling techniques the calculate the quality-adjusted life expectancies, the actual life expectancies, the prostate cancer-specific mortality rates, and the years of treatment side effects for 200,000 men diagnosed with low-risk prostate cancer and treated with either active surveillance or immediate radical prostatectomy.

They used model parameters derived from the available literature to simulate outcomes for men aged between 50 and 75 years with poor, average, or excellent health status.

The core results of this study suggest the following:

• For 65-year-old men with low-risk disease in average health, compared to active surveillance, immediate radical surgery resulted in
  • 0.3 additional years of life expectancy
  • 1.6 additional years of impotence or incontinence
  • A?4.9 percent?decrease in prostate cancer-specific mortality
  • A?net difference of 0.05 fewer quality-adjusted life years.
• Increased age and poorer baseline health status favored active surveillance.
• With greater than 95% probability, active surveillance resulted in net benefits compared to immediate radical surgery
  • For?men older than 74 years in excellent health
  • For men older than 67 years in average health
  • For men older than?54 years?in poor health.
• Patient preferences toward life under surveillance, biochemical recurrence of disease, treatment side effects, and future discount rate affected optimal management choice.

The authors conclude (based on this purely mathematical model) that, ?Older men and men in poor health are likely to have better quality adjusted life expectancy with active surveillance.? However, they go on (helpfully in our opinion) to emphasize the obvious, which is that ?specific individual preferences impact optimal choices and should be a primary consideration in shared decision making.?

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Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk Tagged: | active surveillance, life, low, outcome, quality, risk, surgery

Source: http://prostatecancerinfolink.net/2012/02/20/active-surveillance-or-immediate-surgery-for-low-risk-prostate-cancer-lets-look-at-the-math/

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