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We designed this study to determine whether patients with early localized prostate cancer prefer surgical intervention over watchful waiting, which aspects of the 2 management strategies influence patient preferences, and whether there are patient characteristics that predict their preferences for 1 strategy over the other. Structured interviews were used with 140 male patients seen consecutively at a university-based Department of Veterans Affairs Medical Center outpatient clinic. The mean age of the patients was 66.3 years. Of the 140 patients, 53% preferred surgical treatment, 42% preferred observation, 4% preferred that their physician make the decision, and 1% preferred radiotherapy. Of 74 patients selecting surgical intervention, 92% (68) reported that the possibility of complete tumor removal was the strongest factor influencing their decision. Of those selecting observation, 80% (47/59) reported being most influenced by the complications of an operation. Older patients were significantly (P < .002) more likely to prefer expectant management. We conclude that tumor excision is an important factor influencing patient preferences for treatment, irrespective of survival benefits. This factor should be considered when designing approaches to providing information to patients about alternative treatments., (Mazur DJ, Hickam DH: Patient preferences for management of localized prostate cancer. West I Med 1996; 165:26-30) When considering the management of patients with cancer, it must be decided how [...]

PURPOSE: According to probability theory, the interpretation of new information should depend on the prior probability of disease. We asked if this principle applies to interpreting the history in patients with chest pain. We compared the prevalence of coronary artery disease (CAD) in patients who had similar histories but who came from populations with different disease prevalence. PATIENTs AND METHODS: We studied two high-disease-prevalence populations (patients referred for coronary arteriography) and two low-disease-prevalence populations (patients from primary care practices). We used clinical characteristics of one arteriography population to develop a logistic rule for estimating the probability of coronary artery narrowing. The number of clinical findings determined the logistic score, which was proportional to the prevalence of CAD. RESULTS: The prevalence of CAD was much lower in the primary care population than in the arteriography population, even when patients with similar logistic scores, and thus similar clinical histories, were compared. CONCLUSION: A clinician must take account of the overall prevalence of disease in the clinical setting when using the patient's history to estimate the probability of disease. Failure to observe this caution may lead to errors in test selection and interpretation., The probability theory suggests that the interpretation of new information is based on the prior probability of disease. This theory is used as a guide for selecting and interpreting tests used to diagnose a disease. The usefulness of this theory in interpreting the history of a patient with chest pain was assessed. The prevalence of coronary artery disease, which affects the major blood vessels supplying the heart, was compared among patients with similar histories, but who were from populations with different disease prevalence. Two populations had a high disease prevalence and consisted of patients referred for coronary arteriography, the X-ray of the coronary arteries. Another two populations had a low disease prevalence and consisted of patients from primary care practices. The clinical characteristics of one of the populations containing patients referred for arteriography was used to estimate the probability of coronary artery narrowing, thereby relating clinical findings to the prevalence of coronary artery disease. The results show that coronary artery disease was less prevalent among primary care patients when compared with patients referred for arteriography, despite similarities in the clinical histories of the patients. Based on these findings, it is suggested that the clinician must consider the overall prevalence of a disease in a clinical setting when using patient histories to estimate the probability of the disease. (Consumer Summary produced by Reliance Medical Information, Inc.)