Top Line: Do online predictive tools help men with localized prostate cancer make better treatment decisions?
The Study: Predict Prostate is a free online tool that can be used to communicate many of the complex variables men with localized prostate cancer must consider when making treatment decisions. You input various clinical and pathologic variables and can then navigate through different visualizations of overall disease risk, treatment effects, and potential benefits of treatment versus surveillance. Sure, it’s informative, but does Predict Prostate actually impact treatment decision-making for men with newly diagnosed prostate cancer? In this multicenter randomized trial, 145 men with newly diagnosed, localized prostate cancer were asked to complete a questionnaire about their decision-making process after learning of their diagnosis and before embarking on a course of management. Before the questionnaire, though, they were randomized to receive a presentation of their Predict Prostate results. Important factors influencing their decisions included the risk of dying from prostate cancer (83%), risk of urinary and bowel problems (76%), the burden of treatment effects (56%), and finally the risk of sexual dysfunction (49%). As you might expect, men in both groups over-estimated their risk of prostate cancer mortality (PCSM) as well as the survival benefits of treatment. And while Predict Prostate significantly reduced discrepancies in expectation, those men still significantly over-estimated mortality risk and treatment benefit. For example, the average Predict Prostate 15-year prostate cancer specific mortality was ~7%. Men with no additional information estimated 15 year PCSM to be 43% and those exposed to Predict still estimated a 20% risk. Likewise, the absolute survival benefit of radical treatment was overestimated by both groups (although to a lesser extent by those exposed to Predict). Predict reduced decisional conflict scores by 26%, and there was no difference in decision anxiety scores. Finally, there were no differences in treatment preference or final treatment decision between groups.
TBL: Many men with localized prostate cancer tend to overestimate the risk of PCSM and the benefits of radical treatment. Predict Prostate is a useful tool that helps anchor those estimates and reduce decision conflict, although it doesn’t appear to significantly change treatment decisions in the UK. | Thurtle, Eur Urol 2021