Additional treatments and reimbursement rates associated with prostate cancer treatment for patients undergoing radical prostatectomy, interstitial brachytherapy, and external beam radiotherapy.
OBJECTIVE
To define patterns of treatment among contemporary patients undergoing radical prostatectomy, interstitial radiation, and external beam radiation for prostate cancer.


METHODS
We analyzed 291 consecutive patients (Stage T1-T3NXM0) who underwent definitive local treatment for prostate cancer with radical prostatectomy, interstitial seed implantation, or external beam radiation. Patients were stratified into three risk groups based on clinical T stage, serum prostate-specific antigen level at diagnosis, and biopsy Gleason score. The frequency of additional treatments, including androgen deprivation and external beam radiation, given within 3 months of initial local therapy was assessed. Patterns of care were compared and adjusted for risk.


RESULTS
Of the 291 patients, 107 (36. 8%) underwent radical prostatectomy, 94 (32.3%) underwent interstitial seed implantation, and 90 (30.9%) underwent external beam radiation. Use of combination therapy differed significantly according to the type of initial local treatment and risk category. No patient in the low-risk group received combination therapy. For patients in the intermediate and high-risk groups, the frequency of combination therapy was significantly lower in the radical prostatectomy group when compared with either the interstitial seed implantation (P <0.001 and P <0.02, respectively) or external beam radiation group (P <0.001 and P <0.001, respectively).


CONCLUSIONS
There are significant differences in resource utilization for contemporary patients undergoing definitive local therapy for prostate cancer. These differences may have a significant effect on treatment cost and morbidity, and they will likely make short-term comparisons between different treatment modalities difficult because of the high use of androgen deprivation in men treated with radiation therapy.
Goharderakhshan
R Z
RZ
Departments of Urology (the Program in Urologic Oncology and Urology Outcomes Research Group) and Radiation Oncology, University of California, San Francisco, California, USA.
Grossfeld
G D
GD
Kassis
A
A
Shinohara
K
K
Roach
M
M
Carroll
P R
PR
D001918:Brachytherapy / Q000191:economics* / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000191:economics; D018588:Fee-for-Service Plans; D015276:Health Care Rationing; D006279:Health Maintenance Organizations; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000191:economics* / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000145:classification / Q000532:radiotherapy* / Q000601:surgery*; D018570:Risk Assessment; D012495:San Francisco