对于诊断为新发同步转移性激素敏感性前列腺癌 (mHSPC) 的患者来说，细胞减灭治疗比全身治疗可带来更多的生存获益，但这些可能会导致毒性和发病率增加。我们的目标是确定患者对额外的前列腺细胞减灭术和转移导向干预措施的偏好和权衡。2020年12月3日至2023年1月25日期间，在英国30家医院进行了一项前瞻性多中心离散选择实验试验（NCT04590976）。如果个体在开始雄激素剥夺治疗后 4 个月内被诊断患有新发同步 mHSPC 并且体能状态为 0-2，则有资格入选。开发了一种离散选择实验仪器，以引起患者对前列腺细胞减灭放疗、前列腺切除术、前列腺消融和立体定向消融性身体放疗对转移的偏好。患者根据七个属性选择他们首选的治疗方法。使用误差分量条件 Logit 模型来估计治疗属性之间的偏好和权衡。共有 352 名患者入组，其中 303 名完成了研究。中位年龄为 70 岁（四分位距 [IQR] 64-76），前列腺特异性抗原为 94 ng/ml（IQR 28-370）。转移期为 M1a 10.9% (33/303)、M1b 79.9% (242/303) 和 M1c 7.6% (23/303)。患者更喜欢具有较长生存期和无进展期的治疗。除非与转移导向治疗相结合，否则患者不太可能赞成细胞减灭性前列腺切除术联合全身治疗（系数 -0.448；[95% 置信区间 {CI} -0.60 至 -0.29]；p < 0.001）。前列腺细胞减灭放疗或全身治疗消融、医院就诊次数、“日间病例”手术的使用或立体定向消融性身体放疗的添加均不会影响治疗选择。患者愿意接受额外的细胞减灭治疗，尿失禁和疲劳风险增加 10 个百分点，总生存期分别延长 3.4 个月 (95% CI 2.8-4.3) 和 2.7 个月 (95% CI 2.3-3.1) .患者正在接受额外的细胞减灭治疗，以提高 mHSPC 的生存获益，优先考虑保留泌尿功能和避免疲劳。我们进行了一项大型研究，以确定患有晚期（转移性）前列腺癌的患者在首次诊断时如何做出有关额外可用治疗的决定针对前列腺和癌症沉积物（转移）的治疗。治疗不能治愈，但可以减轻癌症负担（细胞减灭术）、延长生命并延长癌症不进展的时间。我们报告说，大多数患者愿意接受额外的治疗以获得生存益处，特别是保留泌尿功能和减少疲劳的治疗。版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。

Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions.A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes.A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively.Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue.We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.