Technology doesn’t raise overall PCa therapy rate

Chicago-The rate of therapy for localized prostate cancer does not rise in markets with higher penetration of robotic surgical technology and intensity-modulated radiation therapy (IMRT), according to a study presented at the American Society of Clinical Oncology annual meeting in Chicago.

However, high robotic technology penetration is associated with a shift in treatments from radiotherapy to surgery, researchers from the University of Michigan, Ann Arbor reported.

Additionally, in a separate but related study from the Michigan group that was recently published in JAMA, researchers found that the use of advanced treatment technologies has increased even among low-risk patients who are unlikely to benefit from such treatment.

“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 Florian Rudolf Schroeck, MD, MS, who was a co-author on both studies. “But we found that new technology does not spur additional therapy of prostate cancer.”

In the ASCO study, his group categorized markets as 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 Surveillance Epidemiology and End Results (SEER)-Medicare linked database, they identified 59,043 patients with loco-regional 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 using Healthcare Common Procedure Coding System and ICD-9-CM codes.

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

The authors found that 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, a fellow in urologic oncology and health services research at the University of Michigan, working with Brent K. Hollenbeck, MD, MS, and co-authors.

Robotic RP use trumps IMRT

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 1,000 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 1,000; p=.004) but a lower use of radiotherapy (584 vs. 613 per 1,000; 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.”

Treatment trends in low-risk men

Although the overall number of patients treated was not found to be increasing, it does appear that advanced treatments are being utilized in men for whom such modalities are likely unnecessary, according to the data published in JAMA (2013; 309:2587-95).

In that study, Dr. Hollenbeck and co-authors examined SEER data between 2004 and 2009 for men with prostate cancer whose disease was low risk or those

Dr. Hollenbeckwho were at a high risk to die from other causes. The researchers found that these men increasingly underwent advanced treatment options such as IMRT and robotic prostatectomy.

Among men with low-risk disease, the use of advanced treatments increased from 32% to 44%, the authors found. Similarly, in men with a high risk of non-cancer mortality, the use of these treatments increased from 36% to 57%.

The results of the study suggest that potential overtreatment of prostate cancer is increasing even at a time of greater awareness about the sometimes-indolent nature of the disease, said Dr. Hollenbeck.

“Not only do these procedures offer very limited benefits to this group of patients in terms of survival, they also are significantly more expensive than prior treatment options, amplifying the economic implications of potential overtreatment,” Dr. Hollenbeck said.UT

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