Changes in initial treatment for prostate cancer among Medicare beneficiaries, 1999-2007

Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):e781-6. doi: 10.1016/j.ijrobp.2011.11.024. Epub 2012 Feb 11.

Abstract

Purpose: In the absence of evidence from large clinical trials, optimal therapy for localized prostate cancer remains unclear; however, treatment patterns continue to change. We examined changes in the management of patients with prostate cancer in the Medicare population.

Methods and materials: We conducted a retrospective claims-based analysis of the use of radiation therapy, surgery, and androgen deprivation therapy in the 12 months after diagnosis of prostate cancer in a nationally representative 5% sample of Medicare claims. Patients were Medicare beneficiaries 67 years or older with incident prostate cancer diagnosed between 1999 and 2007.

Results: There were 20,918 incident cases of prostate cancer between 1999 and 2007. The proportion of patients receiving androgen deprivation therapy decreased from 55% to 36%, and the proportion of patients receiving no active therapy increased from 16% to 23%. Intensity-modulated radiation therapy replaced three-dimensional conformal radiation therapy as the most common method of radiation therapy, accounting for 77% of external beam radiotherapy by 2007. Minimally invasive radical prostatectomy began to replace open surgical approaches, being used in 49% of radical prostatectomies by 2007.

Conclusions: Between 2002 and 2007, the use of androgen deprivation therapy decreased, open surgical approaches were largely replaced by minimally invasive radical prostatectomy, and intensity-modulated radiation therapy replaced three-dimensional conformal radiation therapy as the predominant method of radiation therapy in the Medicare population. The aging of the population and the increasing use of newer, higher-cost technologies in the treatment of patients with prostate cancer may have important implications for nationwide health care costs.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Androgen Antagonists / therapeutic use
  • Humans
  • Incidence
  • Male
  • Medicare / statistics & numerical data*
  • Prostatectomy / statistics & numerical data
  • Prostatectomy / trends
  • Prostatic Neoplasms / epidemiology
  • Prostatic Neoplasms / therapy*
  • Radiotherapy, Conformal / statistics & numerical data
  • Radiotherapy, Conformal / trends
  • Radiotherapy, Intensity-Modulated / statistics & numerical data
  • Radiotherapy, Intensity-Modulated / trends
  • Retrospective Studies
  • United States / epidemiology

Substances

  • Androgen Antagonists