title: Changes in initial treatment for prostate cancer among Medicare beneficiaries, 1999-2007.
abstract: OBJECTIVE
  In the absence of evidence from large clinical trials, optimal therapy for localized prostate cancer remains unclear; however, treatment patterns continue to change. We examined changes in the management of patients with prostate cancer in the Medicare population.
  
  
  METHODS
  We conducted a retrospective claims-based analysis of the use of radiation therapy, surgery, and androgen deprivation therapy in the 12 months after diagnosis of prostate cancer in a nationally representative 5% sample of Medicare claims. Patients were Medicare beneficiaries 67 years or older with incident prostate cancer diagnosed between 1999 and 2007.
  
  
  RESULTS
  There were 20,918 incident cases of prostate cancer between 1999 and 2007. The proportion of patients receiving androgen deprivation therapy decreased from 55% to 36%, and the proportion of patients receiving no active therapy increased from 16% to 23%. Intensity-modulated radiation therapy replaced three-dimensional conformal radiation therapy as the most common method of radiation therapy, accounting for 77% of external beam radiotherapy by 2007. Minimally invasive radical prostatectomy began to replace open surgical approaches, being used in 49% of radical prostatectomies by 2007.
  
  
  CONCLUSIONS
  Between 2002 and 2007, the use of androgen deprivation therapy decreased, open surgical approaches were largely replaced by minimally invasive radical prostatectomy, and intensity-modulated radiation therapy replaced three-dimensional conformal radiation therapy as the predominant method of radiation therapy in the Medicare population. The aging of the population and the increasing use of newer, higher-cost technologies in the treatment of patients with prostate cancer may have important implications for nationwide health care costs.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Dinan
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Robinson
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Zagar
authors.forename: Charles D
authors.initials: CD
authors.lastname: Scales
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.forename: W Robert
authors.initials: WR
authors.lastname: Lee
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Schulman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D011468:Prostatectomy / Q000706:statistics & numerical data / Q000639:trends; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data / Q000639:trends; D050397:Radiotherapy, Intensity-Modulated / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000726:Androgen Antagonists