Predictors of utilities for health states in early stage prostate cancer

Purpose: When faced with treatment choices for early stage prostate cancer, patients must balance the survival benefit of a treatment with its morbidi ty. 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 p atient utilities were predicted by sociodemographic characteristics or base line genitourinary function. Materials and Methods: We evaluated 401 men undergoing prostate needle biop sy for suspicion of prostate cancer at university, Veterans Affairs and pub lic hospitals. Study design included a prospective cross-sectional cohort w ith correlation and multivariate analysis. Subjects were studied with 2 est ablished 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. Surpr isingly baseline urinary, sexual and bowel function scores did not correlat e well with respective utilities for potential incontinence, impotence or r adiation proctitis. In other words, men with good and imperfect baseline fu nction were equally willing to risk impairment to preserve life. Conclusions: Men who perceived that general health was better appear to pla ce higher value on quantity of life, while those who already are suffering from poor general health place higher value on quality of life. Ethnicity a ppears to modify some effects of other variables on patient preference. Uti lity assessment provides a quantitative tool to aid physicians in counselin g patients when making treatment decisions for localized prostate cancer.