QoL better with surveillance for low-risk prostate cancer versus active treatment
MedWire News: Active surveillance offers a quality-of-life (QoL) advantage to low-risk prostate cancer patients compared with initial treatment, show the results of a study that calculated patients' quality-adjusted life expectancy (QALE).
Analysis of a simulated model including 65-year-old low-risk prostate cancer patients revealed that the optimal treatment strategy should be sensitive to patient preferences for a particular health state.
"Models that incorporate individual patient utilities should be developed to assist patients and their caregivers to estimate the risks and potential benefits of active surveillance before making this decision," suggest Julia Hayes (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) and colleagues.
The benefit of active surveillance "reflects the deferred and substantially lower incidence of adverse effects of treatment" they add in JAMA.
Using estimates from a systematic literature review, the researchers calculated the QoL benefits of active surveillance as well as its related risk for prostate cancer-specific death, compared with brachytherapy, intensity-modulated radiotherapy (IMRT), or radical prostatectomy.
Patients' preferred health states were also calculated, with scores ranging between 0 (death) and 1 (perfect health). These scores provided the basis for patients' quality-adjusted life-years (QALYs), denoting years of life in the desired health state during active surveillance/after active treatment.
The most effective treatment strategy - defined as the strategy with the highest QALE - was active surveillance followed by IMRT for cancer progression. This combination resulted in 11.07 QALYs compared with 10.57 and 10.51 QALYs for immediate treatment with brachytherapy and IMRT, respectively.
This equates to an additional 6 months of QALE with active surveillance compared with immediate brachytherapy, which was the most effective initial treatment, note Hayes et al.
An immediate prostatectomy was the least effective strategy, giving a QALY of 10.23.
The researchers add that 15% of men on surveillance would have to die from prostate cancer compared with 9% on initial treatment for the two approaches to have equal QALE, translating to "a lifetime relative risk for death of 0.6 for initial treatment versus surveillance."
The team concludes: "Even if choosing active surveillance places men at a substantially higher risk for dying from prostate cancer or the risk for progressive disease… active surveillance is associated with higher QALE."
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By Sarah Guy