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Cost-effectiveness analysis
Conservative management for low-risk prostate cancer improves quality-adjusted life expectancy at lower cost compared with initial treatment
  1. Laurence Klotz
  1. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to: Dr Laurence Klotz, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room MG 408, Toronto, ON, Canada M4N 3M5; laurence.klotz{at}sunnybrook.ca

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What is the best treatment for localised prostate cancer? This simple question, for a common disease now affecting about one in six North American men, does not have a clear answer. This is not a ‘normal’ situation in medicine. For most common diseases, including most primary cancers, there is usually a consensus as to the best therapeutic approach. Not so for localised prostate cancer. Surgery contends with radiation of various types and conservative management, particularly active surveillance, which has made inroads against both of these for favourable risk disease. The lack of consensus reflects many factors, including difficulty in successfully completing randomised comparative trials (RCTs), long timelines to achieve robust endpoints and trade-offs between survival and quality of …

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