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Estimating patient health in prostate cancer treatment counseling

Prostate Cancer and Prostatic Diseases volume 26, pages 271–275 (2023)Cite this article

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A Correction to this article was published on 31 March 2022

This article has been updated

Abstract

Background

We assessed the concordance among urologists’ judgment of health quartiles for patients with localized prostate cancer, and compared the life expectancy (LE) and ensuing treatment recommendations when following National Comprehensive Cancer Network (NCCN) guidelines based on actuarial life tables versus the Kent model, a validated LE prediction model.

Methods

NCCN suggests using actuarial life tables and relying on surgeon assessment of patient health to increase (for the best quartile) or decrease (for the worst quartile) LE by 50%. Eleven urologic surgeons allocated quartile of health and recommended treatments for ten patient vignettes. The 10-year survival probability was calculated using the Kent model and compared to the life-table estimate based on health quartile by surgeon consensus.

Results

Surgeon assessment agreed with the presumed true quartile of health based on a validated model in 41% of cases. For no case did three-quarters of surgeons assign health quartile correctly; in half of cases, <50% of surgeons assigned the correct quartile. The NCCN comorbidity-adjusted LE estimates underestimated risk of death in the best health quartile and overestimated risk of death in the worst health quartile, compared to the Kent model. Patients with LE > 10 years on NCCN estimation were recommended more frequently for surgery (81%) and those with ≤10 years estimated LE were more commonly recommended for radiation (57%) or observation (29%).

Conclusions

A method based on physician-assessed health quartiles for LE estimation, as suggested by the NCCN guidelines, appears too crude to be used in the treatment counseling of men with localized prostate cancer, as compared to a validated prediction model, such as the Kent model.

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Fig. 1: Surgeon-assessed patient quartile of health, where 1 represents best quartile of health and 4 represents worst quartile of health.

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Acknowledgements

The authors’ work on this paper was supported in part by funding from National Institutes of Health/National Cancer Institute (P30-CA008748) and Sidney Kimmel Center for Prostate and Urologic Cancers. SVC was further supported by the National Institutes of Health/National Cancer Institute (K22-CA234400 and U01-CA199338-02) and the Prevent Cancer Foundation.

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Authors and Affiliations

  1. Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Gregory T. Chesnut

  2. Walter Reed National Military Medical Center, Bethesda, MD, USA

    Gregory T. Chesnut

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Amy L. Tin, Andrew J. Vickers, Daniel D. Sjoberg & Sigrid V. Carlsson

  4. University of Calgary, Calgary, AB, Canada

    Katherine A. Fleshner

  5. Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Nicole E. Benfante, James A. Eastham & Sigrid V. Carlsson

  6. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

    Sigrid V. Carlsson

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  1. Gregory T. Chesnut
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Contributions

GTC: data collection, manuscript writing. ALT: project, development, data collection, data analysis, manuscript writing. KAF: project development, data collection, manuscript editing. NEB: protocol development, data collection, data management, manuscript editing. AJV: project development, data analysis, manuscript writing. JAE: project development, manuscript editing. dd sjoberg: project development, data collection, data analysis, manuscript writing. SVC: project development, protocol development, data collection, manuscript writing.

Corresponding author

Correspondence to Sigrid V. Carlsson.

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Competing interests

AJV is named on a patent for a statistical method to detect prostate cancer. The patent application for the statistical model has been licensed and commercialized as the 4Kscore by OPKO Diagnostics. AJV receives royalties from sales of this test and owns stock options in OPKO.

Ethics approval

The study was approved by the Institutional Review Board at Memorial Sloan Kettering Cancer Center.

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The original online version of this article was revised to replace Fig 1 for better readability.

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Chesnut, G.T., Tin, A.L., Fleshner, K.A. et al. Estimating patient health in prostate cancer treatment counseling. Prostate Cancer Prostatic Dis 26, 271–275 (2023). https://doi.org/10.1038/s41391-021-00467-5

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