Evaluating the trade-offs men with localised prostate cancer make between the risks and benefits of treatments: The COMPARE study


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Hashim U. Ahmed1,Verity Watson2,Neil McCartan3,Nicolas Krucien2,Victor Abu4,Divine Ikenwilo2,Mark Emberton3

1Imperial College London,2Health Economics Research Unit, University of Aberdeen,3Research Department of Urology, Division of Surgery and Interventional Science, Faculty of Medicine, University College London,4Health and Social Care, Adult Nursing, London South Bank University

Abstract

Background

Patient with localised prostate cancer have to choose between active surveillance or radical therapy. The COMPARE study investigated the extent to which patients make trade-offs and prioritise one aspect of treatment over another using a discrete choice experiment (DCE).

Method

COMPARE (COMparing treatment options for ProstAte cancer) underwent a 3-staged process to optimise a DCE with the intent of eliciting patient preferences for managing localised prostate cancer. The DCE included a number of attributes comprising a) type of treatment (radical therapy, active surveillance, focal therapy), b) return of day-to-day activities, c) sexual function, d) urinary function, e) further treatment and f) cancer-specific survival over 10-15 years. Patients with localised prostate cancer completed the questionnaire within one week of being diagnosed. Our primary outcome was men’s preferences for, and the trade-offs between, the attributes of different treatments.

Results

Four-hundred and sixty-eight  (74%) men had low/intermediate risk cancer and 166 (26%) high-risk. Mean age was 67.7 years old. Type of active treatment did not affect men’s preferences. Men with low/intermediate risk preferred active surveillance to radical therapy. The order of impact of attributes on patients’ choices is survival, no incontinence, not needing further treatment and maintaining an erection. The marginal rate of substitution showed patients were willing to make trade-offs between side-effects and survival. Overall, on average, patients were willing to trade 0.68%, 0.41% and 0.28% survival for 1% chance of improving urinary function, 1% chance requiring no further treatment and 1% chance of keeping erections, respectively.

Conclusion

Our study shows that patients with low/intermediate risk prostate cancer prefer active surveillance to radical therapy. Further, patients from all cancer risk groups were willing to trade-off detriments in survival if there were fewer further treatments following the initial therapy, a higher chance of maintaining urinary continence and a higher chance of maintaining erectile function.