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Modeling-Based Decision Support System for Radical Prostatectomy Versus External Beam Radiotherapy for Prostate Cancer Incorporating an In Silico Clinical Trial and a Cost–Utility Study

1
The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
2
Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
3
Department of Radiation Oncology (MAASTRO), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
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Department of Urology, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
*
Author to whom correspondence should be addressed.
Academic Editors: Andreas Stadlbauer, Alessio Giuseppe Morganti, Anke Meyer-Baese and Max Zimmermann
Cancers 2021, 13(11), 2687; https://doi.org/10.3390/cancers13112687
Received: 26 April 2021 / Revised: 20 May 2021 / Accepted: 24 May 2021 / Published: 29 May 2021
(This article belongs to the Collection Artificial Intelligence in Oncology)
Low–intermediate prostate cancer has a number of viable treatment options, such as radical prostatectomy and radiotherapy, with similar survival outcomes but different treatment-related side effects. The aim of this study is to facilitate patient-specific treatment selection by developing a decision support system (DSS) that incorporates predictive models for cancer-free survival and treatment-related side effects. We challenged this DSS by validating it against randomized clinical trials and assessing the benefit through a cost–utility analysis. We aim to expand upon the applications of this DSS by using it as the basis for an in silico clinical trial for an underrepresented patient group. This modeling study shows that DSS-based treatment decisions will result in a clinically relevant increase in the patients’ quality of life and can be used for in silico trials.
The aim of this study is to build a decision support system (DSS) to select radical prostatectomy (RP) or external beam radiotherapy (EBRT) for low- to intermediate-risk prostate cancer patients. We used an individual state-transition model based on predictive models for estimating tumor control and toxicity probabilities. We performed analyses on a synthetically generated dataset of 1000 patients with realistic clinical parameters, externally validated by comparison to randomized clinical trials, and set up an in silico clinical trial for elderly patients. We assessed the cost-effectiveness (CE) of the DSS for treatment selection by comparing it to randomized treatment allotment. Using the DSS, 47.8% of synthetic patients were selected for RP and 52.2% for EBRT. During validation, differences with the simulations of late toxicity and biochemical failure never exceeded 2%. The in silico trial showed that for elderly patients, toxicity has more influence on the decision than TCP, and the predicted QoL depends on the initial erectile function. The DSS is estimated to result in cost savings (EUR 323 (95% CI: EUR 213–433)) and more quality-adjusted life years (QALYs; 0.11 years, 95% CI: 0.00–0.22) than randomized treatment selection. View Full-Text
Keywords: prostate cancer; decision support system; in silico trial; cost-effectiveness; radical prostatectomy; external beam radiotherapy prostate cancer; decision support system; in silico trial; cost-effectiveness; radical prostatectomy; external beam radiotherapy
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MDPI and ACS Style

van Wijk, Y.; Ramaekers, B.; Vanneste, B.G.L.; Halilaj, I.; Oberije, C.; Chatterjee, A.; Marcelissen, T.; Jochems, A.; Woodruff, H.C.; Lambin, P. Modeling-Based Decision Support System for Radical Prostatectomy Versus External Beam Radiotherapy for Prostate Cancer Incorporating an In Silico Clinical Trial and a Cost–Utility Study. Cancers 2021, 13, 2687. https://doi.org/10.3390/cancers13112687

AMA Style

van Wijk Y, Ramaekers B, Vanneste BGL, Halilaj I, Oberije C, Chatterjee A, Marcelissen T, Jochems A, Woodruff HC, Lambin P. Modeling-Based Decision Support System for Radical Prostatectomy Versus External Beam Radiotherapy for Prostate Cancer Incorporating an In Silico Clinical Trial and a Cost–Utility Study. Cancers. 2021; 13(11):2687. https://doi.org/10.3390/cancers13112687

Chicago/Turabian Style

van Wijk, Yvonka, Bram Ramaekers, Ben G.L. Vanneste, Iva Halilaj, Cary Oberije, Avishek Chatterjee, Tom Marcelissen, Arthur Jochems, Henry C. Woodruff, and Philippe Lambin. 2021. "Modeling-Based Decision Support System for Radical Prostatectomy Versus External Beam Radiotherapy for Prostate Cancer Incorporating an In Silico Clinical Trial and a Cost–Utility Study" Cancers 13, no. 11: 2687. https://doi.org/10.3390/cancers13112687

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