The Slow Adoption of Precision Radiation Therapy in Prostate Cancer

Several new types of radiation treatments are being introduced in the clinic for the treatment of prostate cancer and many are seeing increased adoption. However, data to confirm that the new treatments surpass standard radiation remain.

Individuals diagnosed with low-grade prostate cancer that is localized to the prostate gland are often offered radiation treatment, as are patients with localized metastases, in combination with hormone therapy. Radiation is also used in patients with relapsed disease or advanced disease. External beam radiation therapy (EBRT) and brachytherapy (internal radiation) are the 2 main types of radiation used in prostate cancer, according to the American Cancer Society. Newer EBRT treatments have been developed that are more precise and avoid exposure to healthy tissue: 3-dimensional conformal radiation therapy, intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and proton beam radiation therapy.

A review of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database identified an uptick in the adoption rates of IMRT and SBRT following their introduction in the clinic, although demographic differences were identified. Between 2001 and 2005, 5680 men (21%) received IMRT compared with standard radiation (n&thinsp;=&thinsp;21,555). Men who received IMRT were older, had higher-grade tumors, and lived in more populated areas (P <.05). Between 2007 and 2011, 595 men (2%) received SBRT compared with standard radiation (n&thinsp;=&thinsp;28,255)—these men were white, had lower-grade tumors, lived in more populated areas, and were more likely to live in the Northeast (P <.05). In their discussion, the authors indicated that local coverage determinations by Medicare administrative contractors also had a role to play in the adoption of SBRT and IMRT.

However, are these newer forms of radiation treatment better than standard radiation? The question will be answered by a trial being conducted at Case Comprehensive Cancer Center in Cleveland. The trial is designed to question the efficacy of SBRT (5 intense radiation treatments over 2 weeks) compared with standard radiation therapy (28 radiation treatments over 5.5 weeks). The results, though, aren’t expected to come in for another 8 years, mainly because prostate cancer is a very slow-growing tumor—this has given rise to the debate around active surveillance versus treatment for the disease.

Physician bias also weighs heavily on adoption of new treatments. If a physician refuses to enroll patients on a new drug or treatment, the trial would need to be shelved before it comes up to speed.

Finally, cost of the treatment is just another variable in this complicated equation of adopting a new treatment. A comparison of Medicare data for the period between 2004 and 2009 found that while the median cost of a course of radiation therapy for prostate cancer was $18,000, it could range from $11,300 to $25,500, depending on the practice type, geography, and individual radiation therapy provider.