title: Predictors of utilities for health states in early stage prostate cancer.
abstract: OBJECTIVE
  When faced with treatment choices for early stage prostate cancer, patients must balance the survival benefit of a treatment with its morbidity. Little is known about how patients balance these trade-offs. To further our understanding of patient decision making we assessed patient utilities for prostate cancer treatment related morbidities. We determined whether patient utilities were predicted by sociodemographic characteristics or baseline genitourinary function.
  
  
  METHODS
  We evaluated 401 men undergoing prostate needle biopsy for suspicion of prostate cancer at university, Veterans Affairs and public hospitals. Study design included a prospective cross-sectional cohort with correlation and multivariate analysis. Subjects were studied with 2 established health related quality of life instruments. Patient utilities were assessed with an interactive software application.
  
  
  RESULTS
  On multivariate analysis utility for current general health was a significant predictor of utilities for treatment related morbidities. Surprisingly baseline urinary, sexual and bowel function scores did not correlate well with respective utilities for potential incontinence, impotence or radiation proctitis. In other words, men with good and imperfect baseline function were equally willing to risk impairment to preserve life.
  
  
  CONCLUSIONS
  Men who perceived that general health was better appear to place higher value on quantity of life, while those who already are suffering from poor general health place higher value on quality of life. Ethnicity appears to modify some effects of other variables on patient preference. Utility assessment provides a quantitative tool to aid physicians in counseling patients when making treatment decisions for localized prostate cancer.
authors.affiliation: Department of Urology, University of California-Los Angeles, Los Angeles, CA 90095-1738, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Saigal
authors.forename: J
authors.initials: J
authors.lastname: Gornbein
authors.forename: R
authors.initials: R
authors.lastname: Nease
authors.forename: M S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000150:complications / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D011788:Quality of Life; D012720:Severity of Illness Index; D013812:Therapeutics / Q000009:adverse effects