A decision analysis for treatment of clinically localized prostate cancer.
OBJECTIVE
To determine the preferred treatment of clinically localized prostate cancer.


METHODS
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-based 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.
Kattan
M W
MW
Matsunaga-Conte Prostate Cancer Research Center, Baylor College of Medicine, Houston, TX 77030, USA.
Cowen
M E
ME
Miles
B J
BJ
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D003661:Decision Support Techniques; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D009010:Monte Carlo Method; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D016019:Survival Analysis