Words of Wisdom Re: Active Surveillance for Prostate Cancer Compared

Increasing concern about access to health care and the asso-ciated cost has prompted a necessary investigation into cost– benefit analysis of current standard of care policies. Keegan et al. created a theoretical cohort of 120 000men to determine the associated cost of active surveillance (AS) for prostate cancer (PCa) with delayed treatment compared with immedi-ate treatment in the setting of low-risk PCa, using a simulated Markov model. The probability of exit from AS to one of five possible treatment options (radical prostatectomy [RP]; image-guided radiotherapy, with or without androgen depri-vation therapy [ADT]; brachytherapy; and ADT monotherapy) was assumed to be 7 % each year during years 1–5 and 4.5% during years 6–10, based on published AS series. Results at 5 yr indicated a savings of $1.9 billion or $16 042 per patient, and $9994 per patient at 10 yr for th