Feasibility of using guidelines to choose treatment for prostate cancer

Introduction: Treatment for localized prostate cancer (LPC) may not improve survival and commonly impairs health related quality of life. National guidelines provide algorithms to choose between treatment or observation for LPC, but the algorithms require the factoring of the patient's baseline comorbidity adjusted life expectancy (CALE). However, no method is available to estimate CALE of 10 or more years. Materials and methods: A mailed survey was completed by newly diagnosed untreated LPC patients. Their baseline CALE was estimated by weighting their age based life expectancy by quartiles of comorbidity scores, and a national guideline was used to find if treatment or observation was recommended for each patient. Demographic, health and cancer characteristics, and beliefs were compared in patients who chose treatment or observation concordant with the guideline, and those who chose under treatment or over treatment. Results: Of 184 survey participants, 10 chose under treatment, 144 chose concordant treatment, and 30 chose over treatment. Under treatment patients had similar sociodemographic and health characteristics to patients who were concordant. In comparison to concordant patients, over treatment patients were older, had a lower Gleason grade or PSA level, a higher comorbidity score, a lower CALE, and lower scores on the Fear of Cancer Recurrence scale. Conclusion: Comorbidity scores can be used to estimate CALE in LPC patients, and estimation of CALE allows the use of guidelines in the choice of treatment. In our study, over treatment occurred more frequently than under treatment. Factors known to limit the survival benefit of treatment were associated with over treatment. Over treatment patients also had lower fear of cancer recurrence.