Should medicare provide reimbursement for prostate-specific antigen testing for early detection of prostate cancer? part I: Framing the debate

Barry, Michael J.; Fleming, Craig; Coley, Christopher M.; Wasson, John H.; Fahs, Marianne C.; Öesterling, Joseph E.

doi:10.1016/s0090-4295(99)80151-4

Cited by 38 publications

(28 citation statements)

References 106 publications

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“…Previous decision analyses have modeled the impact of treatment based on capsular penetration. 11,12,14 Capsular penetration, however, cannot be determined in the WW patient. Rather, we have chosen to model treatment efficacy using actual treatment data, pooled and analyzed in the same manner as the WW data.…”

Section: Decision Analysis Modelmentioning

confidence: 99%

A Decision Analysis for Treatment of Clinically Localized Prostate Cancer

1997

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OBJECTIVE:To determine the preferred treatment of clinically localized prostate cancer. DESIGN:Cancer grade, patient age, and comorbidities are considered in a Markov model with Monte Carlo sensitivity analyses. Large and recent pooled analyses and patient-derived utilities are included. RESULTS:Principal findings suggest benefit for radical prostatectomy relative to watchful waiting for men under 70 years of age with low to moderate comorbidity. Men older than 70 with high comorbidity and disease of low to moderate grade do better with watchful waiting. CONCLUSIONS:Cohort-level sensitivity analyses suggest a quality-adjusted treatment benefit for radical prostatectomy for younger men and treatment harm for older men. Tailored patient and clinician decisions remain necessary, especially for men older than 70 in good health but with aggressive cancers. radical prostatectomy (RP) would help resolve the debate. The results of such a trial, however, are at least a decade away. In the meantime, we must rely on rational comparisons of the risks and benefits with either choice.The purpose of this study is to compare WW and RP in a decision analysis in which the risks of adverse events and patients' feelings about those events are quantified. Our perspective is that of society; we analyzed the data to determine the preferred treatment for a hypothetical cohort of men with localized prostate cancer. Although costeffectiveness is important, it is not included in this report. Our outcomes of interest are life expectancy, with and without adjustments for quality of life, for WW and RP patients who are between the ages of 60 and 75.Two large pooled analyses of metastasis-free survival have recently been conducted: one on WW patients, 4 and one on RP patients. 5,6 In addition, a recent analysis by Albertsen et al. has illustrated the increased risk of death due to noncancerous chronic illnesses in the prostate cancer population. 7 Recent studies have also examined treatment and complication impacts on quality of life 8,9 and patient utilities. 10 Our analysis incorporates all of these recent developments in an attempt to provide a comprehensive and current evaluation of the choice between RP and WW for localized prostate cancer. METHODS Decision Analysis ModelWe build on a model of prostate cancer previously published by the Prostate Patient Outcomes Research Team (PORT). 11 We analyzed this model previously, 12 and we found it reasonably approximated the natural history of prostate cancers. In our Markov model (depicted in Fig. 1), all patients begin with localized prostate cancer with no evidence of metastases and are treated by WW or RP. Each 6 months, a fraction of the patients progress to hormonally controlled metastatic disease. In subsequent 6-month periods, a fraction of these patients progress to hormone-refractory metastatic disease and eventual death from prostate cancer. At every 6-month period, a fraction of the patients die from causes other than prostate cancer. The arrows in Figure 1 illustrate the permissibl...

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Section: Decision Analysis Modelmentioning

confidence: 99%

A Decision Analysis for Treatment of Clinically Localized Prostate Cancer

1997

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“…Preoperative characteristics provide important information for predicting the outcome after RRP [1, 9, 10, 11, 12, 13], but few data are available on the application of multivariate calculations for judging simultaneous effects of these characteristics [14, 15, 16, 17, 18, 19]. Of potential value are the qualitative and quantitative data obtained from preoperative systematic sextant biopsies of the prostate; a classification scheme based on these data combined with other preoperative characteristics might enhance the predictive power for a PSA relapse.…”

Section: Introductionmentioning

confidence: 99%

Early Prostate-Specific Antigen Relapse after Radical Retropubic Prostatectomy:Prediction on the Basis of Preoperative andPostoperative Tumor Characteristics

Graefen¹,

Noldus²,

Pichlmeier

et al. 1999

European Urology

100

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“…At Stanford the double-line technique has therefore been adopted to place the biopsies lateral of the parasagittal plane in order to better predict the volume of the tumor, which tends to be located in a more lateral position [16]. In contrast, the fan-shaped biopsy technique offers better evaluation of the lateral regions of the prostate.…”

Section: Discussionmentioning

confidence: 99%