PRostatE CancEr Prognosis and Treatment (PRECEPT)

Prostate cancer is the most common cancer in men, but the disease develops to be life threatening in a relatively small proportion of patients compared to other cancers.

An active surveillance strategy in which prostate cancer patients are closely monitored, has been proposed for those with a low risk of disease progression. If the cancer is found to progress, surgery or radiotherapy can be used to actively treat the cancer. However, due to challenges regarding risk stratification, the majority of patients undergoes such a radical treatment upfront rather than opting for an active surveillance strategy first. These patients are at risk of common treatment-related side effects that may substantially impact their quality of life. Furthermore, a substantial proportion of these patients will progress to a more advanced disease stage, regardless of their treatment.

The PRostatE CancEr Prognosis and Treatment (PRECEPT) project is funded by the Prostate Cancer Research Alliance, a joint initiative between the Movember Foundation and the Australian Government, to improve care for localised prostate cancer patients. It has three specific objectives:

1. Develop a tissue and blood test that will predict the future risk of progression in men with prostate cancer at the time of diagnosis.
2. Develop new ‘curative’ treatments in patients with high risk disease.
3. Develop new tests that will predict how patients will respond to treatment.

Led by Professor Maarten IJzerman, the Cancer Health Services Research group of the University of Melbourne Centre for Cancer Research is involved in PRECEPT through a work-package contribution to the first objective – developing a tissue and blood test that will predict the future risk of progression in men with prostate cancer at the time of diagnosis.

This program of work is titled “Decision Making Analysis for Treatment De-escalation” and aims to: obtain insights into the preferences of patients and clinicians to follow a biomarker-based treatment recommendation; consider the potential benefits and disadvantages of a less invasive intervention; and to model the expected health and economic consequences associated with such a biomarker-informed treatment process.

This work includes two systematic reviews of the literature summarising currently available evidence on patient and clinician preferences regarding prostate cancer management, and the health economic impact of using biomarkers to guide management of localised prostate cancer.

Furthermore, a patient and clinician preference study is being developed in collaboration with representatives from the Victorian Comprehensive Cancer Centre – Cancer Consumers Advisory Committee.

Results from these reviews and the preference study will be accumulated in a health economic model to estimate the long-term cost-effectiveness of using biomarkers in this context, aiming to inform biomarker development.