Study: Radiation post-radical prostatectomy is cost-effective

Receiving radiation therapy immediately after a radical prostatectomy is a cost-effective treatment for prostate cancer patients when compared with active surveillance, say researchers from Thomas Jefferson University and Hospital, Philadelphia.

"This work demonstrates that adjuvant radiation therapy is a cost-effective strategy for selected patients after prostatectomy," said senior author Laura Pizzi, PharmD. "It is typical for cancer treatments to provide clinical benefit at a cost; however, the cost per success that we reported for adjuvant radiation therapy is on the low end when one broadly considers the cost per success reported for other cancer treatments."

The objective of the study, which was published online in the Annals of Oncology (June 9, 2011), was to construct a decision analysis model to estimate the real-world cost of adjuvant radiation therapy versus observation from the payers’ perspective, using peer-reviewed, published data from a Southwest Oncology Group prospective, randomized trial.

"Despite being shown to be effective, less than 20% of qualifying patients receive [adjuvant radiation therapy]," said lead author Timothy Showalter, MD. "Although not all patients will benefit from adjuvant radiation therapy, the level of utilization is lower than expected based on the positive, published results of randomized clinical trials.

"Studies like this one are an important step toward establishing the value of this treatment and suggest that adjuvant radiation therapy should have a role in the treatment of selected patients."

A separate study by Dr. Showalter and colleagues, published online in the International Journal of Radiation Oncology, Biology and Physics (May 25, 2011), found that urologists were less likely to recommend radiation therapy immediately after a radical prostatectomy than radiation oncologists. Instead, those clinicians most likely opt to perform frequent PSA tests to monitor cancer, recommending salvage therapy if levels become elevated.

A total of 218 radiation oncologists and 92 urologists completed a survey of post-prostatectomy radiation therapy beliefs and policies. The therapy was recommended for qualifying patients by 78% of radiation oncologists and 44% of urologists.

Urologists were also less likely to believe that adjuvant radiation therapy improves overall survival and perceived higher rates of radiation-related toxicities than radiation oncologists.

"These two studies provide important insights into decision-making regarding radiation therapy after prostatectomy," said Leonard Gomella, MD, a co-author of both studies. "The disagreement between urologists and radiation oncologists highlights the need for additional research to determine the role of adjuvant therapy in selected patients, and is another example of the importance of multidisciplinary prostate cancer care for our patients to make informed medical decisions."