A DECISION-ANALYSIS FOR TREATMENT OF CLINICALLY LOCALIZED PROSTATE-CANCER

OBJECTIVE: To determine the preferred treatment of clinically localize d prostate cancer. DESIGN: Cancer grade, patient age, and comorbiditie s are considered in a Markov model with Monte Carlo sensitivity analys es, Large and recent pooled analyses and patient-derived utilities are included. RESULTS: Principal findings suggest benefit for radical pro statectomy relative to watchful waiting for men under 70 years of age with low to moderate comorbidity. Men older than 70 with high comorbid ity and disease of low to moderate grade do better with watchful waiti ng. CONCLUSIONS: Cohort-level sensitivity analyses suggest a quality-a djusted treatment benefit for radical prostatectomy for younger men an d treatment harm for older men. Tailored patient and clinician decisio ns remain necessary, especially for men older than 70 in good health b ut with aggressive cancers.