Utilization of standard treatments for localized prostate cancer by Medicare beneficiaries


In a new paper just published on-line in the Journal of Urology, Kapoor et al. have provided data on trends in the utilization of various major types of treatment for the management of localized prostate cancer among Medicare beneficiaries in the USA between 2006 and 2008.

The paper’s analysis is based solely on data from Medicare patients covered under Medicare Part B. Also, because at the time this study was being  conducted, no data were available on the incidence of prostate cancer from the SEER database for 2007 or 2008, the study correlated the numbers of actual treatments covered in each year to the number of diagnostic needle biopsies of the prostate (diagnostic NBPs) covered under Medicare Part B in the same year.

The complete data are provided in the table below.


The following key points are worth noting:

  • The percentage of Medicare beneficiaries receiving therapy (when indexed against the number of  NBPs) increased from 43.8 percent in 2006 to 49.0 percent in 2008.
  • The overall use of the three “standard” forms of surgical treatment increased from 9.6 percent in 2006 to 10.3 percent in 2008 (a 7.3 percent relative increase in utilization).
  • The overall use of radiation-based treatments increased from 32.2 percent in 2006 to 35.9 percent in 2008 (an 11.9 percent relative increase in utilization).
  • Among the “newer” forms of therapy, when indexed against the number of NBPs, there was
    • A 42.1 percent relative increase in utilization of intensity-modulated radiation therapy (IMRT)
    • A 38.6 percent relative increase in utilization of laparoscopic radical prostatectomy — whether robot-assisted or not (LRP/RALP)
    • A 300 percent relative increase in the utilization of stereotactic body radiation therapy (SBRT) — although based on small numbers of patients
  • Conversely, among the “older” forms of therapy, again indexed against the number of NBPs, there was
    • A 29.1 percent relative reduction in the utilization of three-dimensional conformal beam radiation therapy (3D-CRT)
    • A 12.0 percent relative reduction in the utilization of brachytherapy
    • A 17.6 percent relative reduction in utilization of open forms of radical prostatectomy
  • Also among the “newer” forms of therapy, there was
    • An absolute increase of 25.4 percent in the number of IMRT procedures
    • An absolute increase of 22.1 percent in the number of LRP/RALP procedures
    • An absolute increase of nearly 500 percent in the number of SBRT procedures
  • And also conversely, among the older forms of therapy, there was
    • An absolute decrease of 37.6 percent in the number of 3D-CRT procedures
    • An absolute decrease of 22.7 percent in the number of brachytherapy procedures
    • An absolute decrease of 27.9 percent in the number of open radical prostatectomies

Since these data address only the treatment of Medicare patients covered under Part B, it is difficult to know how much to “read into” these data, with a single exception:

  • Trends in the use of surgery and radiation to treat men with a diagnosis of localized prostate cancer strongly appear to favor newer technologies.

This is not exactly the most surprising finding, and reflects

  • The real and documentable clinical benefits of these new technologies
  • Strong (but not always ethical) marketing of these new technologies by the manufacturers, hospitals, and other treatment centers
  • Patient perceptions that newer technologies are in some ways “better” than older technologies (which may well be justifiable, at least to some extent)

The authors also use the data they collected to make the case that there has been no change in the utilization of IMRT at specific sites of service, but this is probably of less significance to patients.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: