Comparative effectiveness, radiation therapy, and prostate cancer treatment

There is an interesting article about assessment of the comparative effectiveness of different types of radiation therapy in the management of prostate cancer in the December 2013 issue of Oncology.

Under the heading “Proton radiotherapy for prostate cancer: how did we get here, and where do we go from here?,” Yu et al. address the problematic issue of how we need to be able to actually demonstgrate that newer, technologically advanced (and commonly more expensive) forms of radiation therapy are any better than the recognized standard of care at a specific point in time. While they use the issue of proton beam radiation therapy (PBRT) as a case study, their commentary actually is relevant way beyond PBRT itself.

Just over a year ago, we suggested on this web site that what we really need is a national radiation therapy registry to address this problem, and the suggestions for payment/reimbursement models put forward by the Centers for Medicare and Medicaid (CMS), which are discussed in the article by Yu et al., would also appear to benefit from the existence of such a registry.

7 Responses

  1. My impression is that those getting proton are much more satisfied than those getting conventional radiation. By doing yet another study, this debate won’t be settled for decades. Why not just go over the records of those who got proton and those who got conventional at least 10 years ago. I bet Loma Linda and Shands would readily agree.

  2. I suspect that prostate cancer deaths will increase because of cuts in Medicare thanks to the Affordable Care Act (ACA).

  3. Doug:

    People have tried to do that. The data show no special benefit to PBRT … except the PBRT advocates don’t want to hear it.

    The people who advocate for PBRT are louder in their advocacy than most people getting high quality IMRT.

  4. Dear s69vette:

    And I suspect that people who never get diagnosed today until they have metastatic disease because they have no insurance are far more likely to get diagnosed in time to get curative treatment because of the ACA.

    Suspicions get us nowhere. What will get us somewhere is actions and changes in mindsets, not simply words.

  5. Why would proton patients be more vocal if suffering serious side effects or if a lot of their cancers were coming back?

    Why would Mayo, a laggard in adopting new technology in treating prostate cancer build 2 Proton facilities?

    It seems to me everyone who owns a proton facility says it’s great and those who don’t (most of the competitors) say it doesn’t work.

  6. Dear Doug:

    (1) The more vocal advocates for proton therapy are the ones who say it is wonderful and that there are no to few side effects.

    (2) The amount of money that people were historically able to charge for PBRT was the driver behind why everyone started to build PBRT centers a few years ago (before the economic collapse). However, at least in part because there are no compelling data to suggest that PBRT really is any better than at least modern IMRT, payers have started to refuse to cover the charges that people used to be able to ask. At least one major center canceled its proposed PBRT center, and at least one other center that I am aware of has been having a really hard time generating enough patients to pay its overhead.

    (3) Of course the people who have a PBRT center (or want one) say how wonderful they are. What else would you expect? Bad surgeons are still praising themselves for their surgical skills too!

    What is missing in all the hype (pro and con) is any really compelling data. And I shall again point out that that lack of compelling data lies squarely at the feet of Loma Linda, whose lead PBRT specialist promised me nearly 20 years ago that they would be publishing such data. I’m still waiting.

  7. I admit not knowing much about proton therapy, but I just want to say that I had IMRT for a Gleason 9 prostate cancer in 2004. It’s almost 10 years now and no sign of recurrence. Needless to say, I am very happy with my results.


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