Posted March 12, 2015
Julia Hayes, M.D., Dana-Farber Cancer Institute
About 70 percent of men in the Unites States have low-risk prostate cancer, and it is estimated that 60 percent of them are treated unnecessarily with radiation therapy or radical prostatectomy surgery. Many men with low-risk localized prostate cancers can safely choose active surveillance (AS) or watchful waiting (WW) instead of undergoing immediate treatment and have better quality of life while reducing health care costs. In AS, a typical surveillance schedule would include blood tests for prostate specific antigen (PSA) every three months, rectal examinations every six months, and a prostate gland biopsy at one year with follow up every three years. If the tests find the cancer is aggressive, the patients begin treatment aimed at curing the disease. A patient who chooses WW is observed without intensive monitoring and given palliative treatment when the cancer becomes symptomatic.
Dr. Julia Hayes, a medical oncologist at Dana-Farber Cancer Institute, received a PCRP FY08 Physician Research Training Award which supported her team's creation of a computer model of low-risk prostate cancer that can be used to analyze the most effective and least expensive way to screen for and treat prostate cancer. Their decision analytic model allowed them to synthesize trial and quality of life data from the medical literature to create a "mock clinical trial" that can be analyzed to assess length of life, quality of life, and cost. Their findings from this analysis were published in two papers 1,2 which demonstrated that observational approaches such as AS or WW are associated with better quality of life than any immediate treatment (brachytherapy, intensity-modulated radiation therapy, or radical prostatectomy). Because WW involves less active monitoring of the cancer, it could possess a higher risk of patient death; but despite this potential risk, Dr. Hayes' most recent publication showed WW was associated with better quality of life even than AS while also being less expensive. These studies support observation as a reasonable alternative to initial treatment for the men who face this decision. Understanding that personal preferences influence the election of treatments, the next step for Dr. Hayes includes planning an interface to use this model on an individual basis to assist men in selecting a surveillance regime that is both cost-effective and provides high quality of life. With additional support from the Prostate Cancer Foundation, Dr. Hayes also plans to continue this line of research by developing models for intermediate and high-risk disease, expanding the utility of this approach to more men diagnosed with prostate cancer.
Hayes JH, Ollendorf DA, Pearson SD, et al. Observation versus initial treatment for men with localized, low-risk prostate cancer: a cost-effectiveness analysis. Ann Intern Med. Jun 18 2013;158(12):853-860.