Speak Out: Is comparative effectiveness research for prostate cancer treatment modalities needed?

The outcomes may help us make better decisions.

Right now, various modalities are considered similar, but if we could show one modality has a superior efficacy over another and a better cost per unit, we might begin to utilize it more. It would be useful to me in counseling my patients."

With all the new treatments, I don't really know, especially for a younger man, how much various treatments cost versus surgery, or how they compare in terms of effectiveness.

When you go through all the options with patients, they tend to be more confused than when you started. All treatments have advantages and disadvantages, but if we knew that certain modalities were advantageous, that would be helpful.

Research could help contain costs, but you have to be careful about taking away treatment options based purely on cost. It would be dangerous to say you can't do surgery because radiation is cheaper."

Michael S. Gomez, MD
Chicago

"Without a doubt, this [comparative effectiveness research] can affect health care quality and costs. The recent results of larger prostate cancer screening studies investigating how many patients need to be treated before someone benefits led to the conclusion that we ought not to be screening.

My conclusion is that our treatments need to be better, and we need to be more careful selecting the people we treat. Research could benefit us by providing a biochemical marker from biopsy data that shows us who needs to be treated.

However, you have to be careful evaluating quality of life. You may say that quality of life is adversely affected by incontinence from a radical prostatectomy, but a man cured of cancer may tremendously value the fact he's been cured despite developing incontinence.

The latency of prostate cancer means you have to study outcomes for at least 15 years. What we cite today doesn't reflect today's techniques. Technology tends to leapfrog survival data."

Roger M. McKimmy, MD
Springfield, OR

"It's definitely going to be valuable, because the more knowledge we have, the better informed decisions we'll be able to promote and help our patients make.

The big concerns are that although we can detect cancer early, we have way too many false positives, and we're finding too many cancers that don't need to be treated.

On the flip side are patients whose lives could have been saved if they had been tested the previous year. It's a sticky problem. We see the results of not effectively screening versus patients who may not need curative procedures. We definitely need better detectors and greater specificity to find cancers that will behave more aggressively and affect quality of life as well as quantity of life."

Jon Soble, MD
Santa Maria, CA