The Daily Item, Sunbury, PA

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October 25, 2013

Prostate cancer radiation therapy rises when doctors own machine

By Michelle Fay Cortez

Bloomberg News

MINNEAPOLIS — Urologists who buy their own equipment to provide expensive radiation treatment are more likely to use it to treat prostate cancer even when the benefit for patients is unclear, research shows.

Prostate cancer is the most common tumor diagnosed in the U.S., where an estimated 238,590 men were told they had the disease this year. While only about 12 percent, or 29,270 men, will die from it this year, all will have to decide how, and whether, they want to treat the cancer.

A study published in the New England Journal of Medicine Thursday suggests that profits urologists make from referring patients to their own radiation facilities play an outsized role in the treatment decisions. One third of men whose doctors own radiation equipment get the therapy at a cost of about $35,000 per treatment course. The same doctors prescribed the therapy for just 13 percent of their patients before they had their own equipment and could profit directly.

"The results are striking," said Jean Mitchell, the author of the report and a professor of public policy at Georgetown University in Washington, D.C. "It does appear that what's driving this is financial incentives linked to ownership. Their behavior changes dramatically."

Prostate cancer treatments include radiation, hormone therapy and surgery. The men treated with radiation in the study had low risk disease: newly diagnosed prostate cancer that hadn't spread in the body. The 10-year survival rate for all prostate cancer is 98 percent. Simple monitoring is also an appropriate approach for men with non-metastatic disease.

Mitchell didn't have access to patient-level data, so she couldn't analyze the characteristics of each man to determine if treatment was appropriate.

Instead, she compared the use of the technology, called intensity-modulated radiation therapy, among urologists before and after they integrated the $2 million machines into their practices. She also analyzed its use among doctors who didn't own the technology and urologists at 11 National Comprehensive Cancer Network centers, the country's gold standard of care.

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