Clinical impact of the Predict Prostate risk communication tool in men newly diagnosed with non-metastatic prostate cancer: a multi-centre randomised controlled trial

Abstract

IntroductionPredict Prostate is a freely-available online personalised risk communication tool for men newly diagnosed with non-metastatic prostate cancer. Its accuracy has been assessed in multiple validation studies but the clinical impact of the tool on patient decision-making had not previously been evaluated.MethodsA multi-centre randomised controlled trial was performed across 8 UK centres, wherein newly diagnosed men considering either active surveillance or radical treatment, were randomised to either standard of care (SOC) information or SOC and presentation of Predict Prostate. Validated questionnaires were completed assessing impact of the tool on decisional conflict, uncertainty, anxiety and understanding of survival.Results156 patients were included; mean age 67 years (range 44-80) and PSA of 6.9ng/ml (range 0.5-59.8). 81 were randomised to the Predict Prostate arm, and 75 to SOC information only. Mean decisional conflict scores were 26% lower in the Predict Prostate group (mean = 15.9) than in the SOC group (mean = 21.5) (p=0.01). Scores on the ‘effective decision’, ‘uncertainty’ and ‘value clarity’ subscales all indicated that the Predict Prostate group felt more informed and clear about their decision (all p<0.05). There was no significant difference in anxiety between the two groups.Patient perceptions of 15-year prostate cancer specific mortality (PCSM) and overall survival benefit from radical treatment were considerably lower among men in the Predict Prostate group (p<0.0001). 58% of men reported the Predict Prostate estimates for PCSM were lower than expected, and 35% reported being less likely to select radical treatment. Over 90% of patients in the Predict Prostate group found it useful and 94% would recommend it to others.ConclusionPredict Prostate reduces decisional conflict and uncertainty in non-metastatic prostate cancer and shifts patient perceptions around prognosis to be more realistic. This is the first randomised study of such a tool in this context; it demonstrates Predict Prostate can directly inform the complex decision-making process in prostate cancer.