ProtecT Randomized Clinical Trial: Patient outcomes by treatment received - active monitoring, prostatectomy, or radiation

[Tall_Allen]

This is a planned re-analysis of the only clinical trial ever to randomize men with localized prostate cancer to active monitoring, prostatectomy or radiation therapy. They analyzed by the actual treatment received rather than the intended treatment.

pcnrv.blogspot.com/2020/02/...

[Gemlin_]

A comment or your statement "..the only clinical trial ever ..". At least we have the scandinavian "Surgery Versus Radiotherapy for Locally Advanced Prostate Cancer (SPCG-15)" study

clinicaltrials.gov/ct2/show...

A randomized phase III surgical trial seeks to study whether radical prostatectomy (with or without the combination of external radiation) improves prostate-cancer specific survival in comparison with primary radiation treatment and hormonal treatment among patients diagnosed with locally advanced (T3) prostate cancer.

If we would include cost effectiveness in the equation this analyses of the ProtecT study auajournals.org/doi/10.1097... found radical prostatectomy to be the most cost-effective management of prostate cancer (as I read into QALY or does it not account for the SE differences you wrote about?).

The key outcomes assessed in the cost-effectiveness study were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). ICER is a representation of the difference in cost between treatments relative to the difference in QALYs between treatments. QALYs attempt to take into account treatment side effects such as urinary or sexual symptoms and disease state burdens such as metastatic disease.

...after 10 years of follow-up, AS becomes the least cost-effective treatment. Relative to AS, the ICER for RP was $5,627/QALYs and the ICER for RT was $78,291/QALYs.