Unnecessary High-tech Prostate Cancer Treatments Overprescribed

Many men are still receiving potentially unnecessary and costly treatments, even after being diagnosed as having prostate cancer with a low risk of dying.

Last year, the US Preventive Services Task Force determined that the risks of routine prostate-specific antigen (PSA) testing outweighed the benefits. Yet despite their guidelines of using close monitoring in place of routine testing, many men are still receiving potentially unnecessary and costly treatments, even after being diagnosed as having prostate cancer with a low risk of dying.

According to recent findings, patients with low-risk prostate cancer receiving high-tech treatments like intensity-modulated radiotherapy (IMRT) and robotic surgery significantly increased over a 5 year period. The study, which examined Medicare patient data, showed use of high-tech treatments such as IMRT and robotic surgery in low-risk men increased from 32% in 2004, to 44% in 2009.

"The implementation of these technologies occurred in populations at a time when there was an increase in awareness that some prostate cancers might not warrant treatment,” said Dr Brent Hollenback, study co-author, and associate professor of urology and director of the Herbert H. and Grace A. Dow Division of Health Services Research at the University of Michigan.

Most medical experts will discourage low-risk patients from seeking traditional treatments such as surgery, radiation, and prescription drugs, as they can cause serious side effects including incontinence and impotence. Because prostate cancers are often slow-growing, reconsideration of drastic treatments is crucial for a patient’s quality of life.

However, just as proton beam therapy has been shown to be no more effective than less expensive treatments in cancer care, technologies like IMRT and robotic surgery are being utilized because many healthcare providers are still operating in a fee-for-service environment.

Dr Timothy Wilt, a researcher at the Veterans Administration, said, “For men with low risk, observation would be preferred to intervention, whether with robotic surgery, traditional prostate surgery, or IMRT.” Dr Wilt continued, "Patients are receiving and doctors are recommending treatments that are no more effective, no safer, and much more costly."

Due to the rise in unnecessary treatments, most healthcare reform initiatives call for a larger focus on evidence-based research and patient-centered outcomes. Dr Wilt suggests that to avoid the lure of newer, techier, and costly treatments, prostate cancer screenings should be less frequent. His recommendations echo similar sentiments of a recent study in The American Journal of Managed Care, which found various patient and provider factors contribute to both overuse and underuse of cervical cancer screenings.

"It's really important that medical care is driven by good science,” Dr Wilt stated, “We should be cautious about assuming that something must be better just because it's newer."

Around the Web

Final Word: Expert Panel Rejects Routine PSA Tests for Men [NBC News]

Pricey prostate cancer treatments used on men who may not need them [NBC News]

New, Pricey Prostate Cancer Treatments May Be Overused: Study [US News & World Report]

Proton Therapy Treatment Centers in Risk-Sharing Health Systems [AJMC]

Men Pick Robotic Surgery for Prostate Cancer Despite Risks [NPR]

Proton Therapy Treatment Centers in Risk-sharing Health Systems - See more at: http://www.ajmc.com/focus-of-the-week/0613/Proton-Therapy-Treatment-Centers-in-Risk-sharing-Health-Systems#sthash.fWOx2TXz.dpuf

Cervical Cancer Screening Overuse and Underuse: Patient and Physician Factors [AJMC]