Fig. 1.

Schematic diagram of the state-transition Markov model for men undergoing conservative management of prostate cancer showing all the possible states that men in the model can be in and all the possible transitions between states. At the start, men have been diagnosed with PCa and have chosen conservative management. Some were classified accurately with Gleason 6 (grade group 1), while others were misclassified and have undetected higher-grade disease. During each model cycle, individuals can remain on conservative management, undergo treatment for reclassification (then into a post-treatment state), develop metastases, or die. PCa = prostate cancer; Prog = progression; Tx = treatment. Biopsy, treatment and post-treatment states are silent during watchful waiting. In the efficacy analysis shown in this paper, patients only undergo treatment for evidence of reclassification.