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Prostate Cancer: Localized: Surgical Therapy III (MP50): Moderated Poster 50: Sunday, September 12, 2021


Jayadevappa, Ravishankar; Chhatre, Sumedha; Guzzo, Thomas; Malkowicz, S. Bruce; Schwartz, J. Sanford

doi: 10.1097/JU.0000000000002076.10
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For localized prostate cancer, the treatment choice is preference sensitive. Objective of our study is to assess the association between utility levels (of treatment attributes) and treatment choice in patients with localized prostate cancer.


For this multi-center, randomized controlled study, we randomized 743 localized prostate cancer patients to either a preference assessment intervention group or to usual care group. Several patient reported outcomes such as satisfaction with care, satisfaction with decision, generic and prostate-specific health related quality of life, depression and anxiety were assessed at baseline, and at follow-up periods. Clinical data (stage of cancer, treatment, PSA, Gleason score and comorbidity) were obtained from medical chart review. We assessed preferences using our web-based adaptive conjoint analysis tool, PreProCare, prior to treatment choice. We used logistic regression to study the association between utility levels of treatment attributes and active surveillance treatment in low-risk prostate cancer patients from the intervention group.


A total of 743 localized prostate cancer patients were recruited and randomized to the PreProCare intervention (n=371) or to a control group (n=372). Demographics and clinical characteristics were comparable across intervention group and usual care group. Among 117 low-risk prostate cancer patients from the intervention group, older age (OR=1.2, CI=1.09, 1.31), sexual function (OR=1.5, CI=1.1, 2.1), fear of surgery (OR=1.5, CI=1.1, 2.2), recovery time (OR=1.1, CI=1.02, 1.9) were associated with higher odds of being on active surveillance. On the other hand, survival was associated with lower odds of being on active surveillance (OR=0.68, CI=0.49, 0.96).


A key component of patient-centered care, preference assessment is feasible among localized prostate cancer patients. Our results demonstrated alignment of patient treatment choice and patient utility levels. Utility levels of treatment such as survival, recovery time and sexual function were associated with active surveillance among low-risk prostate cancer patients. Future studies will identify strategies to reduce over-treatment by ensuring that treatment options are communicated to patients, and thus reduce the burden on healthcare systems.

Source of Funding:

Supported by the Patient-centered Outcomes Research Institute- CE-12-11-4973

© 2021 by American Urological Association Education and Research, Inc.