Patient Utilities for Complications Do Not Predict Treatment Choice in Men with Clinically Localized Prostate Cancer

• Objective: To ascertain whether the utilities assigned by patients to possible complications of prostate cancer treatment predict their actual treatment choice. • Design: Prospective cohort series. • Setting: A university hospital, a Veterans Administration hospital, and a large county hospital. • Participants: 950 men being evaluated for the presence of prostate cancer. • Outcome measures: Time trade-off utilities for current pelvic functions and future pelvic morbidities were elicited using a laptop application. Health-related quality of life was assessed using the Rand 36-Item Health Survey and UCLA Prostate Cancer Index instruments. Treatment choice for localized prostate cancer was recorded. • Results: Utility measurement was feasible and well accepted. A ceiling effect was noted in utilities elicited by the time trade-off method. In multivariate analysis, none of the utilities elicited was a significant predictor of treatment choice. • Conclusions: The time trade-off method of utility assessment seems to function poorly as a measure of patient preferences in the setting of localized prostate cancer. One possible explanation for this finding is that the metric is actually measuring preferences for years of life (ie, the morbidities evaluated are not worth trading away any life span to avoid). This would imply that the time trade-off method is appropriate for morbidities commonly considered to be extremely severe (eg, blindness).