Can you use "Game Theory" to help with PCa decsions?

Alf - currently in Ontario, Canada they are working on Pathways as part of their Cancer Care Ontario - they have already setup Pathways ( look like algorithms) for diagnosis and treatment of Colon Cancer and Breast Cancer - and I was part of a workshop that helped develop what is currently being finalized a Pathway for Prostate Cancer care - diagnosis and treatment.
The variables that come into it are patient reaction and response as well as Doctor's training and experience. It does not give a definite answer but allows for all options to be considered.
Wishing you all the best,
Bronson

.. but is www.adrianalima.com/ game?

This is exactly what the Partin tables or neuro networks do. They look at the various stats available then calculate the probabilities of cure based on thousands of previous experiences. They only deal in cancer control effectiveness and not side effects. Although the probabilities are very accurrate for the total group, individual outcomes are always different. Just like gambling; your odds of throwing a 7 in dice are 6 in 36 and over thousands of throws this will absolutely happen; but you can also throw 4 sevens in a row on you next 4 throws.
This is also why some wars don't end up like they were planned.
JT

Personally, I found the nomograms to be a sufficient tool for treatment choices.   But it was important to remind myself of the fact that nomograms describe the risks of an outcome for a large number of men with similarly characterized cases rather than predict what will actually happen to ME (ie. it's not a crystal ball with certain outcomes; it's simply a risk management tool).   When it seems like I’ve heard (in other threads) comments like the “nomograms didn’t work for me,” I believe that not everyone reminded themselves of this fundamental fact.   After treatment, however, I found myself more closely adopting the perspective of “ Pascal’s Wager ” (which Carlos just recently introduced to me in another thread ; I adopted the perspective without knowing that it had a formal name, so I had given it my own name:   “stacking the odds in my favor.”) Pascal’s Wager is described fairly well on several sources, including THIS Wikipedia page, as the first formal use of decision theory , and a groundbreaking advancement on probability theory . Here’s an interesting sampling of how Pascal’s Wager may be applied: 1.     Suppose you hear reports that your house is on fire and your children are inside . You do not know whether the reports are true or false. What is the reasonable thing to do—to ignore them or to take the time to run home or at least phone home just in case the reports are true? 2.     Suppose a winning sweepstakes ticket is worth a million dollars , and there are only two tickets left. You know that one of them is the winning ticket, while the other is worth nothing, and you are allowed to buy only one of the two tickets, at random. Would it be a good investment to spend a dollar on the good chance of winning a million? 3.     Suppose someone terribly precious to you lay dying, and the doctor offered to try a new "pill" that was not "100% proven" but that seemed to have a 50-50 chance of saving your beloved friend's life. Would it be reasonable to try it, even if it cost a little money? And suppose it were free—wouldn't it be utterly reasonable to try it and unreasonable not to?   When I saw that noted medical statistician and nomogram developer (now at MSK), Dr Michael Kattan had written in the Journal of Urology that “ age, fitness and body weight have a far bigger effect on survival than PSA, Gleason score, or any type of treatment ,” I realized the tremendous magnitude of my after treatment decisions.     edit:   fixed link Post Edited (Casey59) : 2/17/2012 12:21:43 PM (GMT-7)

I understand how statistics work and realize that there are no honest fortune tellers. The smart move is to play the odds based upon data that is tuned for your case.
You guys know I am a data driven engineer. Up until the instant I was first diagnosed, I believed my predicted my life expectancy was 96. That meant there was a 50-50 chance I would even exceed that age. The analysis was based upon all the medical and lifestyle information I cared to enter into a simulation program I encountered about 8-10 years ago. (Age, height, weight, smoking, eating habits, blood work, risky behaviors, etc.) , I used that info for financial planning purposes.

After I received my PCa news and about 1 day after getting my states, I became physically ill looking at the nomograms and realized that I was the highest risk in 3 out of 4 categories and with a PSA of 20+ that was considered off the chart.
I took a big gamble and selected my treatment, while rejecting others based upon my general health, lifestyle and my internal measure of the importance of QOL issues. Post surgery, I knew I had an 18 week window to get the best shot at after treatment but valued incontinence and ED so much I took the gamble and rejected radiation which would have left me with total ED and incontinence rather than a chance of ED and incontinence.
The biopsy alphabet soup, (EPE, PNI, etc.) and my follow up results indicate the odds of BCR in 8 years at 12% (or 88% no BCR in a glass half full kind of way). What does that mean to me? With no data whatsoever, I have reduced my life expectancy from 96 to 88 for planning purposes.

The most important takeaway message I have is to make every day count.
J

Jeff, glad you got your calculator out.
Another factor to include is of course fertility. My first uro's question was almost "do you have chidlren?"

I'm rubbish at statistics, algebra etc however a puzzle gives me something to think about when I'm lying awake at night after getting up to have a pee.

So what things are going to be proportional and what inversly proportional to making decision.

I guess propotional to age, so that the older you are the easier it is to accept you have to be treated.
with the proviso that perhaps the younger you are the greater the need to be treated. (Age is quantifiable)
And inversely proportional to the number of children you have: the more children you have the less of a problem it is if the treatment remnders you infertile. (Number of children is quantifiable)
Inversely proportional to your sex life: the more you want to have sex the less you want to have ED. (That desire has to be ranked, with say marks out of 10, and thus less easier to be sure what the number is)
Inversely proportional the desire to have dry underwear. Thus also give an acceptable level of incontinence in marks out of ten.

However I think it's pretty obvious that ED ranks higher than incontinence so maybe ED risk has to be inversely proportional to the square of one's sexual desire.

And how does one rank being alive or dead with marks out of ten.

Age x children
D = ---------------
ED2 x pad

etc
Alf

This would be nice but...one of the issues with using game theory for PCa decisions is that one has to assume the decisions made will be rational and logical.  As we have seen many times on this forum and elsewhere, PCa is very much an emotional disease and men frequently make emotional decisions rather than purely logical ones. 

One can use the following as examples:

Treatment A and B provide equal rates of cure based on long term data.  Treatment A is invasive, requires hospitalization, requires some weeks or months of recovery, almost assuredly has some short term incontinence (and perhaps long term) and yields long term ED in the range of 50%.  Treatment B is relatively non-invasive, is done on an out-patient basis, usually requires no more than two days of recovery, has almost no chance of incontinence and usually yields no short term ED with long term ED in the range of 35%.  Yet...men frequently pick Treatment A in spite of these facts.  Go figure.

Tudpock (Jim)

We need to come up with a way of putting value on the costs, i.e. the downsides to the game theory outcomes.

For example:
If, magically, someone was able to give me a working winky (forgive the technical term) would I do it for $1000? Heck yeah! Would I do it for $100,000. Yep! Would I do it for $10,000,000? No. How about 5,000,000? No. So somewhere in there is how much I value a life of normal pre-PCa erections. If I was younger and Adriana was calling me every day, I might value it much higher. Heck, I'd pay $10,000,000 just for the bragging rights!
Having experienced the "joy" of incontinence for 1.5 years I have a pretty handle on the value for that.
I can envision a series of questions that would help put a value on the QOL issues. Items like:
Would you rather have a cottage by the lake or have pre-PCa erection capability?
Would people say you are a happy person? Are you happy?
Can you perform your job if you were incontinence?
Do you have children ? Do you want more?
A questionnaire with 100 items and you would have a pretty good feel for it.

NIH grant here we come!!!

Oh and Adrianna dear,
Sorry, I am married. But, I would be delighted to do lunch sometime to discuss this project and how you could support the effort.

J ( Principal Investigator )

So when can we really trust our gut reaction? Or can we? Fight or flight theory comes to mind here. Thank goodness we have the chance to think things over in response to treatment options , and their outcomes,

as opposed to which way do I turn when I see an out of control semi headed toward me on my side of the highway.

The initial response to both is "Uh-oh."

Bob

Tudpock,
Are there really a lot of men who are eligible for brachytherapy who choose RP instead? I wish that would have been an option for me, but my cancer, although there turned out to be not much of it, was too close to the surface for brachytherapy. The choice I was given was between RP or RT+HT, and from what I could find out the tradeoffs looked pretty even, with ED about the same over time and slightly different chances off various damage to the urinary/rectal systems. I never looked into brachy much because I was told it wouldn't work for me, but I guess from what you're saying it's equally effective as a cure but with lots fewer SE's to deal with. If that's true, I'm amazed more guys don't choose it. What are the downsides of brachy that might dissuade them from going that way?

I guess it wasn't the location of my cancer, but I was definitely not a candidate for brach. Perhaps it was the size of my prostate (71cc) or high PSA or number of cores. In fact, the surgeon sent me to a very prestigious RO in the area who was surprised to see me because he didn't have the Kaiser RT contract any more, just the brach contract and he said right from the start that I was not a candidate for that. He did, however, strongly advise me to do RT and his arguments were almost persuasive. It was when I looked into Lupron, which I would have had to take for two years, that I decided on surgery. If the treatment had just been radiation alone, I would have opted for that. You didn't answer my question, though, about what possible downsides to brachytherapy might be keeping some from choosing that path. If there aren't any, I'm with you that it must be the pyschological pull of "get rid of it." Otherwise, why would a man put himself in for the sometimes severe SE's of RP unnecessarily?

Alf,  The system you are describing could easily be done with expert system software.  The most difficult part would be getting some consensus on the best treatment paths.  We could even include variables such as doctor experience, treatment availability and insurance coverage. But in the end I doubt that anything would overcome individual biases.  Even if we include a picture of Tud and John T on the tee box at Pebble Beach two days after Brachy and my friend in ICU with tubes in most body orifices, still in ICU 8 days after surgery I'm afraid the biases will still prevail.

I used to build expert systems for my employer way back in the old days.  They were easy to do and worked off of the type of algorithims you described.  Unfortunately my software ran on DRDOS systems (I am old) and has been in the landfill for many years.

Carlos