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

Da*n you Alf! ;-) You planted a bad seed in my head!

I've been thinking about this for the past couple of days, trying to find a consistent variable that I could use for the negative outcome part of the game theory matrix.
I like the idea of a live questionnaire that tunes itself and personalizes the questions for each individual to determine the cost of negative consequences.

The first part of the questionnaire would ask about you, your health, your hobbies and their importance. For example let's say you enjoy "Sailing". It would then ask you how much you spend on it, and how many hours per year you spend sailing or on sailing related activities. That would show how important it really is to your life. These would be done for other hobbies, interests. and property you own.

Next would be a section where the questions are all answered with Strongly agree, Agree, Neutral , Disagree, Strongly Disagree. (SA,, A, N, D, SD) The questions are tuned from the previous section.
I find Sailing to be relaxing.
I enjoy Hunting.
I consider $100,000 a lot of money.
I would give a family member $50,000 so they could afford a house down payment.
etc.

By asking money questions and interest questions, an economic value and importance will be estimated for each side effect. The questionnaire infers the cost but verifies it in the next sections with tuned, individualized questions. For example:

I would give up "Sailing" forever if I could have my pre PCa erections back. Strongly agree, Agree, Neutral, Disagree, Strongly disagree.
My relationship is fine without erections. SA, A, N, D, SD
I don't miss erections at all. SA, A, N, D, SD
I would forgo having an erection for one year for $10,000.
I would forgo having an erection for two months for $100.
I want to have more children.
etc.

The survey would do the same for incontinence.
I would agree to be incontinent for a year if someone offered to pay me $20,000.
I am incontinent already.
etc.

Then it would look at the odds of SE for each treatment option based upon the best data available and come up with a net negative consequence cost tuned for that particular patient.

For surgery, we know 2/3 of men will be continent at 3 months. 1/3 will not. We know at one year 1/3 of the remaining men will still be incontinent and most likely will need some treatment to regain continence. How much is that worth? Here is where the survey helps.
Let's say after finishing the survey, I value dry pants at $100 per day. Meaning I would be willing to walk around changing pee pads all day long if someone paid me $100. Using the odds above. (Mel can work out the log function, given 100% are incontinent immediately after, 1/3 are incontinent at 3 months and 1/9 at 1 year and half of those unlucky guys will need $20,000 repair surgery.) - I will estimate the average cost to be somewhere 1/3 of 36,000 for that treatment option or 12,000 for the Side effect of incontinence.
Everyone would have different value for that SE.
Same for ED.

Add up the negative consequences for each treatment option , look at the odds of success or failure for each and you have a reasonable Game Theory strategy.

This reminds me of a scene in the movie War Games where the Super computer, WOPR/Joshua, states. "A strange game. The only winning move is not to play."

I agree.
Jeff

Post Edited (Worried Guy) : 2/19/2012 9:09:02 AM (GMT-7)

Alf ,

Awww. Now you're just being cruel.
The purpose of exercise I mentioned above was to help the person weigh the relative worth of the side effects for his particular situation. A young, otherwise healthy guy would most likely value erections much more the than a diabetic 80 yer old who has not had an erection in decades. Conversely a young guy might not worry too much about incontinence knowing he can get it fixed, whereas an elderly person would value that quite high as surgical options might not even be available. The elderly person might not partake in many active hobbies. but has a lot of money. The younger person might enjoy and active life but not have funds to pay for it. The questionnaire would normalize and help quantify it for each guy.

The time factor would be difficult, but not impossible, to incorporate. Remember this is for someone who is just deciding on treatment options. So at minimum they have a PSA reading or two. Some might have biopsy results. I suppose we can work in statistics based upon PSA, PSA doubling time. For example, a short doubling time means an aggressive cancer. We might also assume that an elevated PSA in a young person means a more aggressive tumor than the same number in an elderly person. For example: a PSA of 6 in a 90 year old is not as big a worry as one in a 40 year old. This would all be data driven and statistics based - similar to the life expectancy calculators on line.
The nomograms have all this. What they don't have is the importance and value of side effects.

Now that I think about it, this tool wold be useful for anyone considering Active Surveillance or treatment delay.
I like it.

But, as Joshua suggested, "The only winning move is not to play."
Jeff

Alf,
The scoring of 1 to 10 is an easy concept but I am not sure it really rates the importance to the person. Until a trade-off is forced, e.g. "Would you rather give up Sailing for a year life or the ability to have erections?", we don't have a way to rate the QOL issue. I tried to relate it to dollars as they can be considered one step away from "pleasure units." The number of $ you earn and own relates to the price per pleasure unit.
As you said, it is Monday so this problem will have to continue fermenting in our brains. A glass of wine tionight might help.
Hmmm... Would you rather give up wine for a year or be incontinent?....

Enjoy,
Jeff