Analysis of diagnostic/therapeutic strategies in prostate cancer. II. Can lymphography help to select patients for staging lymphadenectomy?

J. H.M. Zwetsloot-Schonk, J. S. Pliskin, J. W.H. Leer

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

A stepwise analysis that embodied a utility threshold approach is presented as a method to evaluate the usefulness of an imperfect diagnostic test for staging prostate cancer (lymphography) when a risky perfect test (lymphadenectomy) is available too. Three diagnostic/therapeutic strategies for patients with stage-B prostate cancer are compared: strategy A - curative treatment without performing lymphadenectomy or lymphography; strategy B - performing lymphadenectomy before deciding to initiate curative treatment; and strategy C - lymphography followed by lymphadenectomy in case the lymphogram is positive, and followed by curative treatment in case the result is negative. Two conceptual indices are used to express the various burdens associated with each strategy: Cl, indicating the burden of pelvic lymphadenectomy, Cc, indicating the burden of curative treatment. The ratio of these indices, Cc/Cl, determines the strategy of preference. Threshold values for the ratio are calculated. A questionnaire was developed in which the clinician must answer at most three simple and meaningful questions, resulting in identifying intervals for the ratio and leading to the identification of the recommended strategy. The questionnaire was presented to 67 Dutch radiotherapists. Analysis of their responses revealed a rather wide consensus on the appropriate diagnostic/therapeutic stragety.

Original languageEnglish
Pages (from-to)147-157
Number of pages11
JournalTheoretical Surgery
Volume4
Issue number3
StatePublished - 1 Jan 1989
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Anesthesiology and Pain Medicine

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