Abstract：
OBJECTIVE: Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients\' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions.
METHODS: A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients\' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes.
UNASSIGNED: A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a \"day-case\" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively.
CONCLUSIONS: Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue.
RESULTS: We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.
METHODS: A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients\' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes.
UNASSIGNED: A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a \"day-case\" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively.
CONCLUSIONS: Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue.
RESULTS: We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.
摘要：
目的：对诊断为新同步转移激素敏感型前列腺癌（mHSPC）的患者进行细胞减灭术治疗可使患者的生存获益超过全身治疗，但这些可能导致增加的毒性和发病率。我们的目标是确定患者的偏好，以及之间的权衡，额外的细胞减灭性前列腺和转移定向干预。
方法：于2020年12月3日至2023年1月25日在英国的30家医院进行了一项前瞻性多中心离散选择实验试验（NCT04590976）。如果个体在开始雄激素剥夺治疗的4个月内被诊断为从头同步mHSPC并且表现状态为0-2，则他们有资格被纳入。开发了一种离散选择实验仪器，以激发患者对细胞减灭性前列腺放疗的偏好，前列腺切除术,前列腺消融,和立体定向消融体放射治疗转移瘤。患者根据七个属性选择了首选的治疗方法。使用误差分量条件logit模型来估计治疗属性之间的偏好和权衡。
■共纳入352名患者，其中303人完成了这项研究。中位年龄为70岁（四分位距[IQR]64-76），前列腺特异性抗原为94ng/ml（IQR28-370）。转移分期为M1a10.9%(33/303)，M1b79.9%（242/303），和M1c7.6%（23/303）。患者更喜欢具有更长生存期和无进展期的治疗。患者不太可能采用全身治疗的细胞减灭性前列腺切除术（Coef。-0.448；[95%置信区间{CI}-0.60至-0.29]；p<0.001)，除非结合转移定向治疗。细胞减灭性前列腺放疗或全身治疗消融，医院就诊次数,使用“日常案例”程序，或增加立体定向消融体放疗并不影响治疗选择。患者愿意接受额外的细胞减灭术治疗，尿失禁和疲劳的风险增加10个百分点，以获得3.4mo（95％CI2.8-4.3）和2.7mo（95％CI2.3-3.1）的总生存期。分别。
结论：患者正在接受额外的细胞减灭术治疗，以提高mHSPC的生存获益，优先保护泌尿功能和避免疲劳。
结果：我们进行了一项大型研究，以确定诊断为晚期（转移性）前列腺癌的患者在首次诊断时如何就其前列腺癌和癌症沉积（转移）的其他可用治疗方法做出决定。治疗不会提供治愈，但可以减少癌症负担（细胞减少），延长寿命,并延长癌症进展的时间。我们报告说，大多数患者愿意接受额外的治疗以获得生存益处，特别是保留泌尿功能和减少疲劳的治疗方法。
方法：于2020年12月3日至2023年1月25日在英国的30家医院进行了一项前瞻性多中心离散选择实验试验（NCT04590976）。如果个体在开始雄激素剥夺治疗的4个月内被诊断为从头同步mHSPC并且表现状态为0-2，则他们有资格被纳入。开发了一种离散选择实验仪器，以激发患者对细胞减灭性前列腺放疗的偏好，前列腺切除术,前列腺消融,和立体定向消融体放射治疗转移瘤。患者根据七个属性选择了首选的治疗方法。使用误差分量条件logit模型来估计治疗属性之间的偏好和权衡。
■共纳入352名患者，其中303人完成了这项研究。中位年龄为70岁（四分位距[IQR]64-76），前列腺特异性抗原为94ng/ml（IQR28-370）。转移分期为M1a10.9%(33/303)，M1b79.9%（242/303），和M1c7.6%（23/303）。患者更喜欢具有更长生存期和无进展期的治疗。患者不太可能采用全身治疗的细胞减灭性前列腺切除术（Coef。-0.448；[95%置信区间{CI}-0.60至-0.29]；p<0.001)，除非结合转移定向治疗。细胞减灭性前列腺放疗或全身治疗消融，医院就诊次数,使用“日常案例”程序，或增加立体定向消融体放疗并不影响治疗选择。患者愿意接受额外的细胞减灭术治疗，尿失禁和疲劳的风险增加10个百分点，以获得3.4mo（95％CI2.8-4.3）和2.7mo（95％CI2.3-3.1）的总生存期。分别。
结论：患者正在接受额外的细胞减灭术治疗，以提高mHSPC的生存获益，优先保护泌尿功能和避免疲劳。
结果：我们进行了一项大型研究，以确定诊断为晚期（转移性）前列腺癌的患者在首次诊断时如何就其前列腺癌和癌症沉积（转移）的其他可用治疗方法做出决定。治疗不会提供治愈，但可以减少癌症负担（细胞减少），延长寿命,并延长癌症进展的时间。我们报告说，大多数患者愿意接受额外的治疗以获得生存益处，特别是保留泌尿功能和减少疲劳的治疗方法。
