Patient preferences for outcomes associated with surgical management of prostate cancer

We used utility assessment to evaluate patient preferences for current urinary and sexual function after radical prostatectomy.

We measured preferences in 209 community volunteers enrolled in a prostate cancer screening study who underwent radical prostatectomy between 1994 and 1998. We compared preferences in 3 outcome groups, namely men bothered by current urinary and sexual functioning, only bothered by current sexual functioning and not bothered by current sexual or urinary functioning. Preferences were assessed via a computer based interview using time trade-off and standard gamble methods. Current functioning was assessed via a standardized questionnaire.

Median time trade-off and standard gamble utilities were high at 0.9 across outcome groups, indicating that men were not willing to give up many remaining life years (10% of remaining life expectancy) with current functioning to achieve ideal functioning. However, mean time trade-off and standard gamble scores significantly decreased as the burden increased in men bothered by current sexual and urinary function (0.77 and 0.82), bothered by current sexual function only (0.87 and 0.89) and not bothered by sexual or urinary function (0.92 and 0.96, respectively).

Health related quality of life was generally good in this observational study of patients treated for prostate cancer with radical prostatectomy. In addition, those bothered by urinary and/or sexual function would not be willing to trade much of the remaining life span to achieve perfect functioning. However, the perception of side effects was bothersome enough in some men to warrant appropriate patient counseling regarding the potential risks and benefits.