Nikola Jovanoski

M.S.

Universität Basel

Ph.D.

PLCO (Learn more about this study)

PLCO-281

Jul 3, 2017

Localised Prostate Cancer Treatment: The Role of Risk-Aversion

Patients detected with localised prostate cancer can choose to treat with or without curative intent. As it cannot be determined in advance whether a localised cancer would spread and cause problems the choice is arduous. There are problems inherent with both treatment sorts. Curative treatments – such as radiation treatment – can be used to cure a cancer but can however cause serious side-effects. A patient with localised prostate cancer that would have not spread and not caused problems could therefore have more health problems with curative treatment than without it. Non-curative treatments such as active surveillance could be used to avoid this situation. With active surveillance, curative treatment is only used if it is determined that the cancer has become more active or spread. A concern with such treatments are however that a delay in treatment could cede the chance to ultimately cure the cancer. Based on the problem with curative treatments, clinical recommendations advise that patients with very low-risk and low-risk localised prostate cancer should opt for non-curative treatment options, as there is a chance they may not need curative treatment. Despite the recommendation, active surveillance, for example, continues to be underused. The research at hand intends to approach this concern from an economic perspective. As the treatment decision is characterised by uncertainty, attention is centred on patient risk-preferences. It has theoretically been shown that risk-averse patients would decide to use curative treatment at a lower a priori probability that the cancer would spread than risk-neutral ones. Intuitively, curative treatment enables the risk-averse patient to avoid low health with non-curative treatment if the cancer spreads.

1. What is the role of risk-aversion in the decision to treat localised prostate cancer?
2. Identify which other determinants could influence the treatment decision at hand?

Data from the prostate component, and the baseline, diet history and supplemental questionnaires would be used to undertake the research. In respect to point 1, certain patient behaviours would be used as proxies for the level of risk-taking – smoking, exercise and alcohol drinking behaviour – to empirically determine whether risk-preferences do direct the treatment decision for localised prostate cancer. In respect to point 2, patient characteristics would be used – age, income etc. If the research confirms point 1, it would be important to consider the risk-preferences in shared medical decision making.