ASTRO criticizes urologist self-referral for IMRT

For the second time in a month, urologists are being criticized for self-referred ancillary services?this time by radiologists for providing intensity-modulated radiotherapy (IMRT) treatment for prostate cancer patients in urologists' own radiation therapy centers.

For the second time in a month, urologists are being criticized for self-referred ancillary services-this time by radiologists for providing intensity-modulated radiotherapy (IMRT) treatment for prostate cancer patients in urologists' own radiation therapy centers.

The American Society for Radiation Oncology (ASTRO) has blamed expanding ownership of IMRT equipment by urology practices for concerns about IMRT “overtreatment” expressed in a urologist-authored study published in the April issue of Health Affairs (2012; 31:750-9).

"The expansion of these mega-urology practices can dominate prostate cancer diagnosis and treatment services in their market areas, and likely played a role in the growth of IMRT use during the study period," ASTRO said in statement.

The study, conducted by researchers at the University of Michigan, Ann Arbor, found rapid adoption of IMRT treatment among men diagnosed with prostate cancer from 2001 through 2007, despite what it said was uncertainty about its relative effectiveness. From 2001 to 2003, men with high-risk disease were more likely to receive IMRT, said the authors, whereas by 2004 and on into 2007, men with low-risk disease were about as likely to receive IMRT. The authors, led by Brent K. Hollenbeck, MD, MS, said the findings raise concerns about overtreatment, as well as considerably higher health care costs.

David F. Penson, MD, MPH, AUA vice chair of health policy, said the study contained no data on ownership and that the findings were similar to a recent study in the Journal of Urology.

"Both showed that IMRT has effectively replaced 3-D conformal beam as the most common form of radiation treatment for prostate cancer," Dr. Penson said. "Neither addresses the issue of whether ownership is driving this."

Dr. Penson noted that from 2000 to 2007, nearly two-thirds of IMRT treatments for prostate cancer were in the outpatient hospital setting, where self-referral is not an issue, and added, "So it seems to me that if ownership and self-referral had anything to do with the increase in IMRT use, it played only a very small role."

Pathologists and radiation oncologists are competing with urologists to provide services, and this has influenced the views they have been stating, said Dr. Penson.

ASTRO is part of the Alliance for Integrity in Medicine, which "applauded" another study in the same issue of Health Affairs that found self-referring urologists with pathology labs billed Medicare more for prostate biopsy testing and detected fewer cancers than urologists who did not self-refer (2012; 31:741-9).

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