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CMAJ • April 4, 2000; 162 (7)
© 2000 Canadian Medical Association or its licensors

Research
Recherche

The clinical burden of prostate cancer in Canada: forecasts from the Montreal Prostate Cancer Model

Steven A. Grover, Louis Coupal, Hanna Zowall, Raghu Rajan, John Trachtenberg, Mostafa Elhilali, Michael Chetner and Larry Goldenberg

From the Centre for the Analysis of Cost-Effective Care and the Divisions of General Internal Medicine, Urology and Clinical Epidemiology, Montreal General Hospital, Montreal, Que., the Departments of Medicine and of Epidemiology and Biostatistics, McGill University, Montreal, Que., the Department of Surgery, University of Toronto, Toronto, Ont., and the Department of Surgery, University of British Columbia, Vancouver, BC

Objectives: The incidence of prostate cancer is increasing, as is the number of diagnostic and therapeutic interventions to manage this disease. We developed a Markov state-transition model - the Montreal Prostate Cancer Model - for improved forecasting of the health care requirements and outcomes associated with prostate cancer. We then validated the model by comparing its forecasted outcomes with published observations for various cohorts of men.

Methods: We combined aggregate data on the age-specific incidence of prostate cancer, the distribution of diagnosed tumours according to patient age, clinical stage and tumour grade, initial treatment, treatment complications, and progression rates to metastatic disease and death. Five treatments were considered: prostatectomy, radiation therapy, hormonal therapies, combination therapies and watchful waiting. The resulting model was used to calculate age-, stage-, grade- and treatment-specific clinical outcomes such as expected age at prostate cancer diagnosis and death, and metastasis-free, disease-specific and overall survival.

Results: We compared the model's forecasts with available cohort data from the Surveillance, Epidemiology and End Results (SEER) Program, based on over 59 000 cases of localized prostate cancer. Among the SEER cases, the 10-year disease-specific survival rates following prostatectomy for tumour grades 1, 2 and 3 were 98%, 91% and 76% respectively, as compared with the model's estimates of 96%, 92% and 84%. We also compared the model's forecasts with the grade-specific survival among patients from the Connecticut Tumor Registry (CTR). The 10-year disease-specific survival among the CTR cases for grades 1, 2 and 3 were 91%, 76% and 54%, as compared with the model's estimates of 91%, 73% and 37%.

Interpretation: The Montreal Prostate Cancer Model can be used to support health policy decision-making for the management of prostate cancer. The model can also be used to forecast clinical outcomes for individual men who have prostate cancer or are at risk of the disease.




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