Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity.
Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions.
A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes.
A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively.
Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue.
We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.
European urology oncology. 2024 Jul 06 [Epub ahead of print]
Martin J Connor, Mesfin Genie, Tim Dudderidge, Hangjian Wu, Johanna Sukumar, Mark Beresford, Diletta Bianchini, Chee Goh, Gail Horan, Pasquale Innominato, Vincent Khoo, Natalia Klimowska-Nassar, Sanjeev Madaan, Stephen Mangar, Stuart McCracken, Peter Ostler, Sangeeta Paisey, Angus Robinson, Bhavan Rai, Naveed Sarwar, Narayanan Srihari, Kamal Thippu Jayaprakash, Mohini Varughese, Mathias Winkler, Hashim U Ahmed, Verity Watson, IP5-MATTER Trial Investigators
Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: ., Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK; Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia; Department of Population Health Sciences, Duke University, Durham, USA., Urology, University Hospital Southampton, Southampton, UK., Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK., Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial College Clinical Trials Unit, Imperial College London, London, UK., Department of Oncology, Royal United Hospitals Bath, Bath, UK., Department of Oncology and Urology, Medway Maritime Hospital, Kent, UK., Department of Oncology, East Surrey Hospital, Redhill, UK., Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust & The Cancer Centre, Addenbrooke's Hospital, Cambridge, UK., Department of Oncology, Betsi Cadwaladr University Health Board, Bangor, UK., Department of Oncology, The Royal Marsden Hospital, London, UK., Imperial College Clinical Trials Unit, Imperial College London, London, UK., Department of Urology, Dartford and Gravesham NHS Trust, Kent, UK., Department of Oncology, Imperial College Healthcare NHS Trust, London, UK., Department of Urology, Sunderland Royal Hospital, Sunderland, UK., Department of Oncology, Luton and Dunstable University Hospital, Luton, UK., Department of Oncology, Hampshire Hospitals NHS Foundation Trust, Basingstoke and Winchester, UK., Department of Oncology, Royal Sussex County Hospital, Brighton, UK., Department of Urology, Newcastle Freeman Hospital, Newcastle, UK., Department of Oncology, Royal Shrewsbury Hospital, Shrewsbury, UK., Department of Oncology, Royal Devon and Exeter NHS Foundation Trust, Oncology, Exeter, UK., Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Urology, West Middlesex University Hospital, London, UK., Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/38972831