New Technologies Bring No Upward Shift in Treatment of Local Prostate Cancer

Wayne Kuznar

September 2013, Vol 4, No 7 - Prostate Cancer


Chicago, IL—The rate of therapy for localized prostate cancer does not increase in markets with higher penetration of robotic surgical technology and intensity-modulated radiation therapy (IMRT), according to an examination of trends using the Surveillance, Epidemiology and End Results (SEER)-Medicare–linked data­base, according to a poster presentation at the 2013 American Society of Clinical Oncology meeting by lead investigator Florian Rudolf Schroeck, MD, MS, Clinical Lecturer, Urology, University of Michigan, Ann Arbor.

“The major concern with diffusion of technology is that people might shift their treatment recommendations, either consciously or subconsciously, toward treating more people than they did before they had the new technology,” said Dr Schroeck.

An expansion of the population treated would increase costs and the number of men exposed to treatment-related morbidity.
“But we found that new technology does not spur additional therapy of prostate cancer,” he said.

Dr Schroeck’s group categorized markets as having low, medium, or high technological capacity based on the number of physicians who provided robotic prostatectomy and IMRT. Technology penetration was characterized separately for each hospital referral region and year. Using the SEER-Medicare–linked database, the investigators identified 59,043 patients with locoregional prostate cancer who were treated or managed expectantly from 2003 to 2007. The use of radiotherapy, radical prostatectomy, or observation was obtained from Medicare claims.

Multinomial logistic regression was used to examine the association of technology penetration with receipt of prostatectomy, radiotherapy, or no local therapy.

Technological capacity increased over time. “There was no shift in the overall number of men who got treated, but what we do see is a shift in what kind of treatment they get,” said Dr Schroeck.

With more robotic technology, patients received more prostatectomy at the expense of radiotherapy. Among all age-groups, the adjusted number of men receiving treatment per 1000 men diagnosed was not significantly different in the low- and high-technology markets. Markets with high robotic prostatectomy penetration compared with low penetration had higher use of prostatectomy (175 vs 141 per 1000, respectively; P = .004), but a lower use of radiotherapy (584 vs 613 per 1000, respectively; P = .046).

“It seems like patients are moved, to some extent, from the radiotherapy group to prostatectomy, but we are not expanding the pool of patients that get treated,” he said. “It makes a lot of sense too, because the urologists are the ones seeing the prostate cancer patients first and they’re the ones who have access to the robot.”