Evaluating the Trade-offs Men with Localised Prostate Cancer Make Between the Risks and Benefits of Treatments: The COMPARE Study
Adult Urology | Journal of Urology
the trade-offs patients make between different aspects of active surveillance and
definitive therapy.
different treatment characteristics in 34 urology departments. Patients with localised
prostate cancer completed the DCE within one week of being diagnosed and before they
made treatment decisions. The DCE was pre-tested (N=5) and piloted (n=106) with patients.
Patients chose their preferred treatment profile based on six characteristics:
treatment type (active surveillance, focal therapy, radical therapy),
return to normal activities,
erectile function,
urinary function,
not needing more cancer treatment and
10-15 year cancer-specific survival. Different tools were designed for low-intermediate (n=468) and high-risk (n=166)
patients. An error-components conditional logit model was used to estimate preferences
and trade-offs between treatment characteristics.
to have active surveillance over definitive therapy. They were willing to trade 0.75%,
0.46% and 0.19% absolute decrease in survival for a one-month reduction in time-to-return
to normal activities, and 1% absolute improvements in urinary and sexual function,
respectively. High-risk patients were willing to trade 3.10%, 1.04% and 0.41% absolute
decrease in survival for a one-month reduction in time-to-return to normal activities
and 1% absolute improvements in urinary and sexual function, respectively.
to definitive therapy. Patients of all risks were willing to trade-off cancer-specific
survival for improved quality-of-life.
© 2020 by American Urological Association Education and Research, Inc.
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Evaluating the Trade-offs Men with
Evaluating the Trade-offs Men with
Localised Prostate Cancer Make Between the Risks and Benefits of
Treatments: The COMPARE Study
Hashim U. Ahmed
Abstract
Purpose:
COMPARE (COMparing treatment options for ProstAte cancer) aimed to evaluate and quantifythe trade-offs patients make between different aspects of active surveillance and
definitive therapy.
Methods:
A Discrete Choice Experiment (DCE) tool was used to elicit patients’ preferences fordifferent treatment characteristics in 34 urology departments. Patients with localised
prostate cancer completed the DCE within one week of being diagnosed and before they
made treatment decisions. The DCE was pre-tested (N=5) and piloted (n=106) with patients.
Patients chose their preferred treatment profile based on six characteristics:
treatment type (active surveillance, focal therapy, radical therapy),
return to normal activities,
erectile function,
urinary function,
not needing more cancer treatment and
10-15 year cancer-specific survival. Different tools were designed for low-intermediate (n=468) and high-risk (n=166)
patients. An error-components conditional logit model was used to estimate preferences
and trade-offs between treatment characteristics.
Results:
Low-intermediate risk patients were willing to trade 6.99% absolute decrease in survivalto have active surveillance over definitive therapy. They were willing to trade 0.75%,
0.46% and 0.19% absolute decrease in survival for a one-month reduction in time-to-return
to normal activities, and 1% absolute improvements in urinary and sexual function,
respectively. High-risk patients were willing to trade 3.10%, 1.04% and 0.41% absolute
decrease in survival for a one-month reduction in time-to-return to normal activities
and 1% absolute improvements in urinary and sexual function, respectively.
Conclusions:
Patients with low-intermediate risk prostate cancer preferred active surveillanceto definitive therapy. Patients of all risks were willing to trade-off cancer-specific
survival for improved quality-of-life.
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