title: Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer.
abstract: BACKGROUND
  Men diagnosed with localised prostate cancer (LPC) face difficult choices between treatment options that can cause persistent problems with sexual, urinary and bowel function. Controlled trial evidence about the survival benefits of the full range of treatment alternatives is limited, and patients' views on the survival gains that might justify these problems have not been quantified.
  
  
  METHODS
  A discrete choice experiment (DCE) was administered in a random subsample (n=357, stratified by treatment) of a population-based sample (n=1381) of men, recurrence-free 3 years after diagnosis of LPC, and 65 age-matched controls (without prostate cancer). Survival gains needed to justify persistent problems were estimated by substituting side effect and survival parameters from the DCE into an equation for compensating variation (adapted from welfare economics).
  
  
  RESULTS
  Median (2.5, 97.5 centiles) survival benefits needed to justify severe erectile dysfunction and severe loss of libido were 4.0 (3.4, 4.6) and 5.0 (4.9, 5.2) months. These problems were common, particularly after androgen deprivation therapy (ADT): 40 and 41% overall (n=1381) and 88 and 78% in the ADT group (n=33). Urinary leakage (most prevalent after radical prostatectomy (n=839, mild 41%, severe 18%)) needed 4.2 (4.1, 4.3) and 27.7 (26.9, 28.5) months survival benefit, respectively. Mild bowel problems (most prevalent (30%) after external beam radiotherapy (n=106)) needed 6.2 (6.1, 6.4) months survival benefit.
  
  
  CONCLUSIONS
  Emerging evidence about survival benefits can be assessed against these patient-based benchmarks. Considerable variation in trade-offs among individuals underlines the need to inform patients of long-term consequences and incorporate patient preferences into treatment decisions.
authors.affiliation: Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Room 148, Transient Building (F12), Sydney, NSW 2006, Australia. madeleine.king@sydney.edu.au
authors.forename: M T
authors.initials: MT
authors.lastname: King
authors.forename: R
authors.initials: R
authors.lastname: Viney
authors.forename: D P
authors.initials: DP
authors.lastname: Smith
authors.forename: I
authors.initials: I
authors.lastname: Hossain
authors.forename: D
authors.initials: D
authors.lastname: Street
authors.forename: E
authors.initials: E
authors.lastname: Savage
authors.forename: S
authors.initials: S
authors.lastname: Fowler
authors.forename: M P
authors.initials: MP
authors.lastname: Berry
authors.forename: M
authors.initials: M
authors.lastname: Stockler
authors.forename: P
authors.initials: P
authors.lastname: Cozzi
authors.forename: P
authors.initials: P
authors.lastname: Stricker
authors.forename: J
authors.initials: J
authors.lastname: Ward
authors.forename: B K
authors.initials: BK
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects; D018572:Disease-Free Survival; D007172:Erectile Dysfunction / Q000453:epidemiology; D006801:Humans; D007410:Intestinal Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D014570:Urologic Diseases / Q000453:epidemiology
chemical_list: D000726:Androgen Antagonists