Symptom severity and patients' values in the decision to perform a transurethral resection of the prostate

To develop and validate a method to assess patients' subjective values for outcomes of surgical and nonsurgical management of benign prostatic hypertrophy (BPH), the authors studied 20 patients who had symptoms of BPH. Eight were scheduled for prostatic surgery and 12 were not. They conducted an interview, including a time-trade-off (TTO) exercise to elicit values for single and combined outcomes and questions about symptoms used to complete a symptom severity score. Expected gain and symptom severity were independent and significant (p less than 0.001 for both comparisons) determinants of whether surgery was scheduled, while the correlation between these two factors was limited (Spearman = 0.058, p = 0.004). Based on a decision analytic model incorporating TTO values, a high expected gain in quality from surgery was strongly related to whether surgery was scheduled (p = 0.002), and had a higher positive predictive value (0.86) than symptom severity score (0.73). This small study demonstrates the feasibility and validity of using value assessment in this setting and suggests that this approach can be useful to clinicians when counseling patients.