The impact of technology diffusion on treatment for prostate cancer.
BACKGROUND
The use of local therapy for prostate cancer may increase because of the perceived advantages of new technologies such as intensity-modulated radiotherapy (IMRT) and robotic prostatectomy.


OBJECTIVE
To examine the association of market-level technological capacity with receipt of local therapy.


METHODS
Retrospective cohort.


METHODS
Patients with localized prostate cancer who were diagnosed between 2003 and 2007 (n=59,043) from the Surveillance Epidemiology and End Results-Medicare database.


METHODS
We measured the capacity for delivering treatment with new technology as the number of providers offering robotic prostatectomy or IMRT per population in a market (hospital referral region). The association of this measure with receipt of prostatectomy, radiotherapy, or observation was examined with multinomial logistic regression.


RESULTS
For each 1000 patients diagnosed with prostate cancer, 174 underwent prostatectomy, 490 radiotherapy, and 336 were observed. Markets with high robotic prostatectomy capacity had higher use of prostatectomy (146 vs. 118 per 1000 men, P=0.008) but a trend toward decreased use of radiotherapy (574 vs. 601 per 1000 men, P=0.068), resulting in a stable rate of local therapy. High versus low IMRT capacity did not significantly impact the use of prostatectomy (129 vs. 129 per 1000 men, P=0.947) and radiotherapy (594 vs. 585 per 1000 men, P=0.579).


CONCLUSIONS
Although there was a small shift from radiotherapy to prostatectomy in markets with high robotic prostatectomy capacity, increased capacity for both robotic prostatectomy and IMRT did not change the overall rate of local therapy. Our findings temper concerns that the new technology spurs additional therapy of prostate cancer.
*Department of Urology, Division of Health Services Research †Department of Urology, Division of Urologic Oncology, University of Michigan, Ann Arbor, MI ‡Departments of Urology and Epidemiology and Health Policy Research, University of Florida College of Medicine, Gainesville, FL §Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
Florian R
FR
Schroeck
Samuel R
SR
Kaufman
Bruce L
BL
Jacobs
Yun
Y
Zhang
Alon Z
AZ
Weizer
Jeffrey S
JS
Montgomery
Scott M
SM
Gilbert
Seth A
SA
Strope
Brent K
BK
Hollenbeck
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004059:Diffusion of Innovation; D006302:Health Services Research; D006801:Humans; D008297:Male; D006278:Medicare; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000628:therapy*; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D012371:Robotics; D018426:SEER Program; D014481:United States; D057832:Watchful Waiting