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Prostate Cancer Radiation: Good for Patients or Physician Wallets?

NEW YORK, NY--(Marketwired - Dec 17, 2013) - Robotic prostate surgery and radiation therapy are the two leading treatment modalities for prostate cancer. But new research suggests some prostate cancer doctors may be putting themselves before their patients. Over a five-year period, urologists whose facilities acquired intensity-modulated radiation therapy (IMRT) equipment increased their in-house radiation referrals by nearly 20 percent. 

Is financial gain a greater motivator than prostate cancer patient care? It could be, according to a new study highlighting financial gain and IMRT equipment ownership as possible motivators in prostate cancer treatment recommendations. The practice of seemingly excessive radiation self-referrals was uncovered during a five-year comparative review of urologists at private practices and cancer centers across the United States. 

"News like this is hugely damaging to the patient-provider relationship," said David B. Samadi, MD, Chairman of Urology, Chief of Robotic Surgery at Lenox Hill Hospital. "Patients depend on us for treatment advice that's in their best interest, particularly when facing something as serious as prostate cancer." 

The study uncovered a drastic jump in radiation referrals before and after equipment purchase, and found that the increase is highly disproportionate to other practices. Non-self-referring urologists increased their IMRT use by an average of only 1.3 percent during the same timeframe, making the 20 percent climb even more difficult to justify. The study appears in the New England Journal of Medicine, http://www.nejm.org/doi/full/10.1056/NEJMsa1201141

Radiation for prostate cancer can cost upwards of $35,000 per course of treatment and IMRT has the highest Medicare reimbursement rates. That combination can present a rather hefty opportunity for doctors to benefit from each patient referral. Treatments such as robotic prostate surgery and brachytherapy seed radiation are typically half the cost of radiation therapy. 

In addition to the inherent ethical concerns and inflated healthcare costs of these self-referrals, excessive radiation therapy may not always be in the best interest of the patient. According to Dr. Samadi, radiation is not generally advisable as a first line of treatment for localized prostate cancer. After radiation, the prostate is altered in such a way that disease recurrence may be untreatable with surgery, leaving the patient few options. 

"The possibility that these patients were misguided or inappropriately directed to treatment based on the financial gain of their doctors is really a travesty," asserted Dr. Samadi. "But it should also be a strong reminder to patients of the importance of a second opinion. Patients must self-advocate and seek the counsel of multiple prostate cancer experts before making treatment decisions."

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* The benefits of robotic surgery cannot be guaranteed as surgery is both patient and procedure specific. Previous surgical results do not guarantee future outcomes.




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