Decision tool for prostate cancer patients helps men customize treatment in anxious time

Jun 15, 2009

An online decision tool created in part by a graduate student at the University of California Irvine helps men diagnosed with prostate cancer sort through an intimidating flurry of possible treatments and customize treatment plans of their own, according to a study in the current issue of Interfaces, a journal of the Institute for Operations Research and the Management Sciences.

"Decision Making with Prostate Cancer: A Multiple-Objective Model with Uncertainty" is by Jay Simon, who received his doctorate this spring and is scheduled to join the faculty of the Naval Postgraduate School. The study appears in a special issue of Interfaces containing applications of operations research models to healthcare problems.

His research, says Simon, "gives a patient the opportunity to see all the available information in one place and personalize it, tailor it, and incorporate his own preferences."

The tool allows men to enter their own data, compare it with available research, score different options, and derive a "life score" that guides their decision.

Making decisions about prostate cancer treatment is unique, the author writes. Patients diagnosed with other diseases often face restricted options. By contrast, because prostate cancer in many cases progresses slowly, men with the disease choose from a variety of possible cares. These can be evaluated using multiattribute utility theory, which is used by operations researches and decision scientists to evaluate trade-offs.

"Two main factors are critical in making the treatment decision," the author writes.

"First, it is necessary to quantify as probabilities the uncertainties involving death and side effects over time. A decision analyst accomplishes this mainly by collecting and analyzing historical data reported in medical journals. Second, the decision analyst must elicit the patient's individual preferences and incorporate them into the analysis. Because the outcomes involve multiple attributes (e.g., length of life and side effects), it is necessary to know the relative importance that the patient places on each attribute."

The model considers five treatment options:

  1. surgery
  2. external radiation
  3. seed radiation
  4. dual radiation
  5. no treatment

The model's tasks are specifying and evaluating the uncertainties, and evoking patient preferences. Among the uncertainties considered are patients' expected life span in the absence of cancer and probability of death following each of the treatment options.

Information considered is data from the Social Security Administration, actuarial data, and cure rates reported in medical journals.

The model uses a cancer score to examine measures of prostate cancer severity.

The model considers not only the probability of death from surgery and other procedures, but also the likelihood of enduring side effects. The model expresses the possibility of each side effect's occurrence as comparable to a specific reduction in life span. A "multiobjective" model is then used to determine patients' own preferences, allowing patients to combine their concerns about life expectancy and side effects into scores rating each potential procedure. With scores derived for each, patients can more easily compare scores and decide.

The author observes that running the model repeatedly for different types of patients yields several observations. Most controversial, he writes, is that external radiation is used too often to treat prostate cancer.

"Although it can provide a moderate reduction in side effects," writes Simon, "its cure rate is lower than many people believe because many articles on radiation treatments for contain a systematic censoring and backdating error."

Among other observations are that surgery usually results in the highest life score for younger men; seed radiation is occasionally more desirable for early stage cancer; and combining low-dose seed radiation and external radiation might be preferable for patients especially concerned about side effects. Confirming general medical practice, the model suggests less aggressive treatment for older patients.

Dr. Simon and colleagues are currently working on an extension of this research that would provide a decision-making tool for men over 40 in the initial stages of prostate screening. Undiagnosed men in this group often have to make successive decisions about whether or not to have a biopsy and how to interpret PSA results.

Source: Institute for Operations Research and the Management Sciences (news : web)

Explore further: Cholesterol unlocks clues to prostate cancer spread

add to favorites email to friend print save as pdf

Related Stories

Radiation therapy combo cures prostate cancer long-term

Jan 04, 2007

Seventy-four percent of men treated with a combination of radiation seed implants and external beam radiation therapy for prostate cancer are cured of their disease 15 years following their treatment, according to a study ...

MRI findings help forecast prostate cancer prognosis

Mar 25, 2008

Magnetic resonance imaging (MRI) findings in patients about to undergo radiation therapy for prostate cancer can help predict the likelihood that the cancer will return and spread post-treatment, according to a new study ...

Recommended for you

Survival hope for melanoma patients thanks to new vaccine

3 hours ago

(Medical Xpress)—University of Adelaide researchers have discovered that a new trial vaccine offers the most promising treatment to date for melanoma that has spread, with increased patient survival rates and improved ability ...

New clinical trial launched for advance lung cancer

7 hours ago

Cancer Research UK is partnering with pharmaceutical companies AstraZeneca and Pfizer to create a pioneering clinical trial for patients with advanced lung cancer – marking a new era of research into personalised medicines ...

User comments : 0

More news stories

Bionic ankle 'emulates nature'

These days, Hugh Herr, an associate professor of media arts and sciences at MIT, gets about 100 emails daily from people across the world interested in his bionic limbs.

Cosmologists weigh cosmic filaments and voids

(Phys.org) —Cosmologists have established that much of the stuff of the universe is made of dark matter, a mysterious, invisible substance that can't be directly detected but which exerts a gravitational ...