Abstract
BackgroundProstate cancer (PCa) is the most common non-skin cancer among men in developed countries. Several novel treatments have been adopted by healthcare systems to manage PCa. Most of the observational studies and randomized trials on PCa have concurrently evaluated fewer treatments over short follow-up. Further, preceding decision analytic models on PCa management have not evaluated various contemporary management options. Therefore, a contemporary decision analytic model was necessary to address limitations to the literature by synthesizing the evidence on novel treatments thereby forecasting short and long-term clinical outcomes.ObjectivesTo develop and validate a Markov Monte Carlo model for the contemporary clinical management of PCa, and to assess the clinical burden of the disease from diagnosis to end-of-life.MethodsA Markov Monte Carlo model was developed to simulate the management of PCa in men 65 years and older from diagnosis to end-of-life. Health states modeled were: risk at diagnosis, active surveillance, active treatment, PCa recurrence, PCa recurrence free, metastatic castrate resistant prostate cancer, overall and PCa death. Treatment trajectories were based on state transition probabilities derived from the literature. Validation and sensitivity analyses assessed the accuracy and robustness of model predicted outcomes.ResultsValidation indicated model predicted rates were comparable to observed rates in the published literature. The simulated distribution of clinical outcomes for the base case was consistent with sensitivity analyses. Predicted rate of clinical outcomes and mortality varied across risk groups. Life expectancy and health adjusted life expectancy predicted for the simulated cohort was 20.9 years (95%CI 20.5–21.3) and 18.2 years (95% CI 17.9–18.5), respectively.ConclusionStudy findings indicated contemporary management strategies improved survival and quality of life in patients with PCa. This model could be used to compare long-term outcomes and life expectancy conferred of PCa management paradigms.
Highlights
Prostate Cancer (PCa) is the most common non-skin cancer and among leading cause of cancer mortality in men in developed countries. [1] In 2013, the agestandardized incidence and mortality rates in Canada were estimated at 103.9 and 17.8 per 100,000, respectively. [2] Further, most men diagnosed with PCa was aged 65 years and older. [2] Various classification systems exist to stratify patients into low, intermediate, and high risks. [3] A range of curative treatment choices are used to manage the disease by risk groups at diagnosis, from diagnosis to endof-life
These models precede [9,10,11] the adoption of newer treatments or health technologies by healthcare systems, such as active surveillance and intensity modulated radiation therapy. [8, 12] Systemic treatments for advanced stage of the disease were not considered by preceding models.[5, 6, 8,9,10,11]
As a result, existing decision analytic models have not assessed the survival and other clinical outcomes attained by contemporary management options and its bearing on clinical burden of the disease.[9,10,11]
Summary
Prostate Cancer (PCa) is the most common non-skin cancer and among leading cause of cancer mortality in men in developed countries. [1] In 2013, the agestandardized incidence and mortality rates in Canada were estimated at 103.9 and 17.8 per 100,000, respectively. [2] Further, most men diagnosed with PCa was aged 65 years and older. [2] Various classification systems exist to stratify patients into low, intermediate, and high risks. [3] A range of curative treatment choices are used to manage the disease by risk groups at diagnosis, from diagnosis to endof-life. The existing literature is limited on decision analytic models for the clinical management of PCa and outcomes in contemporary setting from diagnosis to end-of-life.[9,10,11] these models precede [9,10,11] the adoption of newer treatments or health technologies by healthcare systems, such as active surveillance and intensity modulated radiation therapy. [8, 12] Systemic treatments for advanced stage of the disease were not considered by preceding models.[5, 6, 8,9,10,11] As a result, existing decision analytic models have not assessed the survival and other clinical outcomes attained by contemporary management options and its bearing on clinical burden of the disease.[9,10,11] To date, there is lack of randomized clinical trials that have concurrently evaluated the survival and other outcomes (e.g. recurrence or mCRPC) associated with active surveillance, radical prostatectomy, brachytherapy and intensity modulated radiation therapy.
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