The high-tech prostate treatment train has left the station…before the evidence is in

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Tags reports some staggering numbers that show how “expensive prostate cancer treatments are winning out over the old standards, driving up the cost of treatment before there’s clear evidence that they improve outcomes.” For example:

Robotic and laparoscopic procedures jumped from 1.5% to 28.7% of radical prostatectomies in the Medicare population between 2002 and 2005. MedPageToday reports:

This exponential growth appears to have run ahead of the evidence, which includes a prior analysis by a Brigham and Women’s team showing that minimally invasive prostate surgery doubles risk of genitourinary complications despite shorter hospital stays, and another study suggesting neither benefit nor harm.

Among external beam radiation treatments, intensity-modulated radiation therapy jumped from 28.7% in 2002 to 81.7% in 2005 and perhaps 100% by now.

Within brachytherapy, the addition of intensity-modulated radiation therapy jumped from 8.5% to 31.1% over the same period.

Any evidence of benefit is only coming in now after the fact. But the high-tech train has already left the station. It’s not known how much these technologies are costing Medicare.

And the prediction is that proton beam therapy will dwarf all of these technologies in cost.

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March 9, 2010 at 5:38 am

Here in the UK it is Prostate Cancer Awareness Month required because so many men still do not understand that they need to become prostate aware. We do not have a screening programme. However, amongst those who unfortunately have been diagnosed there is the same rush to get the latest treatment, often before peer review, proper trials and epidemiological study have been conducted causing huge (private) bills.
Health-care shows its ugly head as a double-edged sword in this instance: on one side progress is vital, on the other validation necessary. It is worrying to think that “the-next-best-thing” is more important than what has been shown to work.
Thank you for raising such an important issue.

From the Patient's perspective

March 9, 2010 at 10:01 am

In many cases it is the science and common sense that it leading to early adoption of new modalities. Why wait for a clinical trial to validate the obvious? The physics of a proton are intrinsically superior to a xray. When using an xray, it’s better to hit it from multiple angles than just one to diffuse the toxicity. Why would anyone knowingly want to participate in a clinical trial, and risk getting the inferior modality? If robots can help a surgeon, why not use the tool?