San Francisco, CA—The popularity of minimally invasive radical prostatectomy (MIRP), intensity-modulated radiation therapy (IMRT), and of brachytherapy combined with IMRT for prostate cancer started to take off after 2002, a new database analysis has confirmed.
At the American Society of Clinical Oncology’s 2010 Genitourinary Cancers Symposium, Paul L. Nguyen, MD, presented the results of his team’s analysis of data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database.
Dr Nguyen, director of Prostate Brachytherapy, Dana-Farber/Brigham and Women’s Hospital, Harvard Medical School, Boston, and his coinvestigators found MIRP jumped from 1.5% of radical prostatectomies (RPs) in 2002 to 28.7% in 2005. They also found that IMRT soared from 8.7% of external radiation treatments for prostate cancer to 81.7%. In addition, brachytherapy was combined with IMRT in only 8.5% of brachytherapy treatments in 2002, but in 31.1% in 2005.
Danil Makarov, MD, Robert Wood Johnson Foundation Clinical Scholar, Yale University School of Medicine, New Haven, Conn, commented that the investigators’ study is broadly relevant.
“It’s one thing to come to these conclusions about patients that have private insurance or can afford to pay for these expensive procedures out of their own pockets. But since these are Medicare data they are very relevant to public policy because this is government-funded; we’re all paying for it,” he said.
Dr Nguyen also performed a univariate regression analysis that revealed factors significantly associated with having the latest technology. They include being highly educated, having a high income, living in the Northeast or West, having a highgrade or clinical T1 tumor, and being Asian. Being an African American or Hispanic was associated with having an open RP rather than MIRP. And, perhaps surprisingly, being either an African American or white was associated with having 3D-CRT rather than IMRT.
Dr Nguyen noted that comparative effectiveness research into these more expensive therapies has yet to be conducted.
“So for MIRP, for example, there are still not enough data to define exactly what the benefits are over RP, or what the downsides are,” he told Value-Based Cancer Care.
