title: Additional treatments and reimbursement rates associated with prostate cancer treatment for patients undergoing radical prostatectomy, interstitial brachytherapy, and external beam radiotherapy.
abstract: 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.
authors.affiliation: Departments of Urology (the Program in Urologic Oncology and Urology Outcomes Research Group) and Radiation Oncology, University of California, San Francisco, California, USA.
authors.forename: R Z
authors.initials: RZ
authors.lastname: Goharderakhshan
authors.forename: G D
authors.initials: GD
authors.lastname: Grossfeld
authors.forename: A
authors.initials: A
authors.lastname: Kassis
authors.forename: K
authors.initials: K
authors.lastname: Shinohara
authors.forename: M
authors.initials: M
authors.lastname: Roach
authors.forename: P R
authors.initials: PR
authors.lastname: Carroll
mesh_terms: 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