title: Technology diffusion and diagnostic testing for prostate cancer.
abstract: OBJECTIVE
  While the dissemination of robotic prostatectomy and intensity modulated radiotherapy may fuel the increased use of prostatectomy and radiotherapy, these new technologies may also have spillover effects related to diagnostic testing for prostate cancer. Therefore, we examined the association of regional technology penetration with the receipt of prostate specific antigen testing and prostate biopsy.
  
  
  METHODS
  In this retrospective cohort study we included 117,857 men 66 years old or older from the 5% sample of Medicare beneficiaries living in Surveillance, Epidemiology and End Results (SEER) areas from 2003 to 2007. Regional technology penetration was measured as the number of providers performing robotic prostatectomy or intensity modulated radiotherapy per population in a health care market, ie hospital referral region. We assessed the association of technology penetration with the prostate specific antigen testing rate and prostate biopsy using generalized estimating equations.
  
  
  RESULTS
  High technology penetration was associated with an increased rate of prostate specific antigen testing (442 vs 425/1,000 person-years, p<0.01) and a similar rate of prostate biopsy (10.1 vs 9.9/1,000 person-years, p=0.69). The impact of technology penetration on prostate specific antigen testing and prostate biopsy was much less than the effect of age, race and comorbidity, eg the prostate specific antigen testing rate per 1,000 person-years was 485 vs 373 for men with only 1 vs 3+ comorbid conditions (p<0.01).
  
  
  CONCLUSIONS
  Increased technology penetration is associated with a slightly higher rate of prostate specific antigen testing and no change in the prostate biopsy rate. Collectively, our findings temper concerns that adopting new technology accelerates diagnostic testing for prostate cancer.
authors.affiliation: Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Florian R
authors.initials: FR
authors.lastname: Schroeck
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Kaufman
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.forename: Alon Z
authors.initials: AZ
authors.lastname: Weizer
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Montgomery
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.forename: Vahakn B
authors.initials: VB
authors.lastname: Shahinian
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
mesh_terms: D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D018581:Technology Transfer
chemical_list: D017430:Prostate-Specific Antigen
keywords: HRR; IMRT; PSA; biomedical technology; hospital referral region; intensity modulated radiotherapy; intensity-modulated; prostate; prostate specific antigen; prostate-specific antigen; prostatic neoplasms; radiotherapy