[Skip to Content]
[Skip to Content Landing]
Article
May 27, 1988

Watchful Waiting vs Immediate Transurethral Resection for Symptomatic ProstatismThe Importance of Patients' Preferences

Author Affiliations

From the General Internal Medicine Unit, Massachusetts Genera! Hospital, and Harvard Medical School (Drs Barry and Mulley) and The Center for Survey Research, University of Massachusetts (Dr Fowler), Boston; and Dartmouth Medical School, Hanover, NH (Dr Wennberg). Dr Mulley is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.

From the General Internal Medicine Unit, Massachusetts Genera! Hospital, and Harvard Medical School (Drs Barry and Mulley) and The Center for Survey Research, University of Massachusetts (Dr Fowler), Boston; and Dartmouth Medical School, Hanover, NH (Dr Wennberg). Dr Mulley is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.

JAMA. 1988;259(20):3010-3017. doi:10.1001/jama.1988.03720200032029
Abstract

The rate of resection for benign prostatic hypertrophy shows considerable variability among small geographic areas. To help inform the decision to recommend prostatectomy to men with prostatism without signs of chronic retention, we performed a decision analysis to compare the expected outcomes with immediate transurethral resection and watchful waiting. Data used in the model originated from the medical literature, Medicare claims data, and patient interview studies. In our base-case analysis for 70-year-old men, immediate surgery resulted in the loss of 1.01 months of life expectancy, but when adjustments were made for quality of life, immediate surgery was favored with a net utility benefit of 2.94 quality-adjusted life-months. However, the analysis was particularly sensitive to the degree of disutility attributed to the index symptoms of prostatism. We conclude that patient preferences should be the dominant factor in the decision whether to recommend prostatectomy.

(JAMA 1988;259:3010-3017)

×