Use of advanced treatment technologies for prostate cancer increases among men with low-risk disease

June 25, 2013, The JAMA Network Journals

Use of advanced treatment technologies for prostate cancer, such as intensity-modulated radiotherapy and robotic prostatectomy, has increased among men with low-risk disease, high risk of noncancer mortality, or both, a population of patients who are unlikely to benefit from these treatments, according to a study in the June 26 issue of JAMA.

" is a common and expensive disease in the United States. In part because of the untoward of traditional radiation and surgical therapies, advances in the treatment of localized disease have evolved over the last decade. Chief among these are the development of intensity-modulated radiotherapy (IMRT) and robotic ," according to background information in the article. "During a period of increasing population-based rates of , both of these advanced treatment technologies have disseminated rapidly. However, the rapid growth of IMRT and robotic prostatectomy may have occurred among men with a low risk of dying from prostate cancer. Recognizing the protracted clinical course for most of these cancers, clinical guidelines recommend local treatment only for men with at least a 10-year ."

"Aggressive direct-to-consumer marketing and incentives associated with fee-for-service payment may promote the use of these advanced treatment technologies," the authors write. "The extent to which these advanced treatment technologies have disseminated among patients at low risk of dying from prostate cancer is uncertain." They add that understanding patterns of new technology use in this population is particularly important given the growing concerns about overtreatment.

Bruce L. Jacobs, M.D., M.P.H., of the University of Michigan, Ann Arbor, and colleagues conducted a study to assess the use of advanced treatment technologies, compared with prior standards (i.e., traditional treatment [EBRT] and open ) and observation, among men with a low risk of dying from prostate cancer. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, the researchers identified a retrospective group of men diagnosed with prostate cancer between 2004 and 2009 who underwent IMRT (n = 23,633), EBRT (n = 3,926), robotic prostatectomy (n = 5,881), open radical prostatectomy (n = 6,123), or observation (n = 16,384). Follow-up data were available through December 2010. Low-risk disease was defined as clinical stage ≤T2a, biopsy Gleason score ≤6, and prostate-specific antigen level ≤10 ng/mL. High risk of noncancer mortality was defined as the predicted probability of death within 10 years in the absence of a cancer diagnosis.

The researchers found that the use of advanced treatment technologies was common among men with low-risk disease (an increase from 32 percent in 2004 to 44 percent in 2009), those with a high risk of noncancer mortality (from 36 percent in 2004 to 57 percent in 2009), and those with both low-risk disease and a of noncancer mortality (from 25 percent in 2004 to 34 percent in 2009).

Among all patients diagnosed with prostate cancer in SEER, the use of advanced treatment technologies for men unlikely to die of prostate cancer increased from 13 percent in 2004 to 24 percent in 2009, a relative increase of 85 percent. "That is, rates of IMRT and robotic prostatectomy use increased from 129.2 per 1,000 patients in 2004 to 244.2 per 1,000 patients diagnosed with prostate cancer in 2009. At the same time, the use of prior standard treatments for men least likely to benefit decreased from 11 percent in 2004 to 3 percent in 2009," the authors write.

"The increasing use of both IMRT and robotic prostatectomy in populations unlikely to benefit from treatment was largely explained by their substitution for the treatments they aim to replace, namely EBRT and open radical prostatectomy."

The researchers suggest that the absolute magnitude of the use of advanced treatment technologies in these populations has two important implications. "First, both treatments are considerably more expensive than the prior standards. Start-up costs for both approach $2 million. Further, IMRT is associated with higher total episode payments, which translate into an additional $1.4 billion in spending annually. Thus, the implications of any potential overtreatment with these advanced treatment technologies are amplified in financial terms."

"Second, and perhaps more important, the implementation of these technologies in populations unlikely to benefit from treatment occurred during a time of increasing awareness about the indolent nature of some prostate cancers and of growing dialogue about limiting treatment in these patients. Our findings suggest that even during this period of enhanced stewardship, incentives favoring the diffusion of these technologies outweighed those related to implementing a more conservative management strategy."

"Continued efforts to differentiate indolent from aggressive disease and to improve the prediction of patient life expectancy may help reduce the use of advanced treatment technologies in this patient population," the authors conclude.

Explore further: Two radiotherapy treatments show similar morbidity, cancer control after prostatectomy

More information: JAMA. 2013;309(24):2587-2595

Related Stories

Two radiotherapy treatments show similar morbidity, cancer control after prostatectomy

May 20, 2013
Intensity-modulated radiation therapy has become the most commonly used type of radiation in prostate cancer, but research from the University of North Carolina suggests that the therapy may not be more effective than older, ...

Observation is safe, cost-saving in low-risk prostate cancer

June 17, 2013
Many men with low-risk, localized prostate cancers can safely choose active surveillance or "watchful waiting" instead of undergoing immediate treatment and have better quality of life while reducing health care costs, according ...

A rise in early diagnosis of prostate cancer

June 3, 2013
(Medical Xpress)—Over the last two decades, incremental gains have been made in the number of men given early diagnosis of prostate cancer, and the way they are treated, a Victorian study found.

Racial discrepancy in oncologic outcomes for low-risk PCa

June 18, 2013
(HealthDay)—Among men with very-low-risk prostate cancer (PCa) who meet criteria for active surveillance but undergo radical prostatectomy, African-American race is associated with poorer outcomes, with higher rates of ...

Radical prostatectomy doesn't cut mortality versus observation

July 19, 2012
(HealthDay) -- For men with clinically localized prostate cancer, radical prostatectomy does not significantly reduce all-cause or prostate-cancer mortality compared with observation through 12 years of follow-up, according ...

African Americans experience longer delays between diagnosis and treatment of prostate cancer

May 28, 2013
Among men with prostate cancer, African Americans experience longer treatment delays after being diagnosed than Caucasians. That is the finding of an analysis published early online in CANCER, a peer-reviewed journal of the ...

Recommended for you

New approach attacks 'undruggable' cancers from the outside in

January 23, 2018
Cancer researchers have made great strides in developing targeted therapies that treat the specific genetic mutations underlying a patient's cancer. However, many of the most common cancer-causing genes are so central to ...

Scientists block the siren call of two aggressive cancers

January 23, 2018
Aggressive cancers like glioblastoma and metastatic breast cancer have in common a siren call that beckons the bone marrow to send along whatever the tumors need to survive and thrive.

'Hijacker' drives cancer in some patients with high-risk neuroblastoma

January 23, 2018
Researchers have identified mechanisms that drive about 10 percent of high-risk neuroblastoma cases and have used a new approach to show how the cancer genome "hijacks" DNA that regulates other genes. The resulting insights ...

Enzyme inhibitor combined with chemotherapy delays glioblastoma growth

January 23, 2018
In animal experiments, a human-derived glioblastoma significantly regressed when treated with the combination of an experimental enzyme inhibitor and the standard glioblastoma chemotherapy drug, temozolomide.

Study: Cells of three advanced cancers die with drug-like compounds that reverse chemo failure

January 23, 2018
Researchers at Southern Methodist University have discovered three drug-like compounds that successfully reverse chemotherapy failure in three of the most commonly aggressive cancers—ovarian, prostate and breast.

Researchers identify a protein that keeps metastatic breast cancer cells dormant

January 23, 2018
A study headed by ICREA researcher Roger Gomis at the Institute for Research in Biomedicine (IRB Barcelona) has identified the genes involved in the latent asymptomatic state of breast cancer metastases. The work sheds light ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.