Balancing efficacy and financial toxicity in the management of metastatic castration-sensitive prostate cancer

Sridhar, Srikala S.

doi:10.5489/cuaj.6346

Cited by 1 publication

(3 citation statements)

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“…In 2019, the Kidney Cancer Research Network of Canada met to develop a consensus statement on the role of renal mass biopsy for physicians and patients across Canada. 12 During this meeting, the unknown target for accuracy of renal mass biopsies for each centre was highlighted as a significant limitation in the available literature. Questions have also been raised about the centralization of renal mass biopsy to centres of excellence who are able to obtain high levels of sensitivity and specificity while minimizing complications.…”

Section: Discussionmentioning

confidence: 99%

“…In the development of the recent Kidney Cancer Research Network of Canada's (KCRNC) best practice report on biopsy for renal masses, there was a fair amount of discussion regarding the limitations of benchmarking the parameters for renal mass biopsies across Canada because the majority of the large studies had been done in centres of excellence. 12 This group of experts called for an assessment of the realistic benchmarks that small centres should aim for to ensure they are meeting standards of care. 12 Given the complexity of competing risks for these patients, utilities and disutilities of each disease state and characteristics of renal mass biopsy, decision analysis modeling allows for assessment of these questions and sensitivity analyses to compare ranges of probabilities for each variable.…”

Section: Introductionmentioning

confidence: 99%

“…12 This group of experts called for an assessment of the realistic benchmarks that small centres should aim for to ensure they are meeting standards of care. 12 Given the complexity of competing risks for these patients, utilities and disutilities of each disease state and characteristics of renal mass biopsy, decision analysis modeling allows for assessment of these questions and sensitivity analyses to compare ranges of probabilities for each variable.…”

Section: Introductionmentioning

confidence: 99%

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Optimizing the management of patients with small renal masses in a Canadian context: A Markov decision-analysis model

McAlpine¹,

Sud²,

Finelli³

et al. 2021

CUAJ

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Introduction: The management of patients with a small renal mass (SRM) varies significantly. The objective of this study was to determine which initial management strategy resulted in the greatest quality-adjusted life months (QALM) for an index patient with a SRM. Methods: A Markov decision analysis was used to determine the effect of 1) treating patients with a partial nephrectomy (PN); 2) active surveillance; and 3) renal mass biopsy on QALM over a 10-year horizon. All relevant health states were modelled. Biopsy sensitivity and specificity were modelled assuming an 80% prevalence of cancer using procedural pathology as the gold standard. Health state utilities were obtained from the Tufts Medical Centre Cost-Effective Analysis Registry. Deterministic sensitivity analyses were used to test key assumptions. Results: Over a 10-year time horizon for a 70-year-old male with a 2 cm SRM, the biopsy strategy resulted in 38.07 QALM, whereas treating all patients with PN resulted in 37.69 QALM and active surveillance in 36.25 QALM. The model was most sensitive to the probability that a patient would remain alive at baseline. Biopsy was the preferred strategy when sensitivity was greater than 77%. As the underlying probability of cancer increased, the threshold of renal mass biopsy sensitivity to still favor biopsy increased. Conclusions: Renal mass biopsy is the preferred initial management strategy for an index patient with a SRM to optimize QALM. When the probability of cancer is high, centers should aim for a sensitivity of at least 77% in order to consider a biopsy first strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%