Radiation Right After Prostate Removal is Cost-Effective, But Less Likely to be Recommended by Urologists

“The disagreement between urologists and radiation oncologists highlights the need for additional research to determine the role of adjuvant therapy in selected patients, and is another example of the importance of multidisciplinary prostate cancer care for our patients to make informed medical decisions,” said Leonard Gomella, MD, co-author of the study.

Receiving radiation therapy immediately after a radical prostatectomy is a cost-effective treatment for prostate cancer patients when compared with waiting and acting on elevated prostate-specific antigen (PSA) levels, according to a new study by researchers at Thomas Jefferson University and Hospital.
What’s more, a separate, but related study, found that urologists were less likely than radiation oncologists to recommend adjuvant radiation therapy or to believe it improves overall survival.

There has been question over whether administering adjuvant radiation therapy after removing the prostate is an appropriate course of action because of associated toxicities, risk of overtreatment and costs, even with data supporting its benefits to overall survival, but a new decision analysis published online in the Annals of Oncology on June 9 found that the procedure is a practical option for patients.

“This work demonstrates that adjuvant radiation therapy is a cost-effective strategy for selected patients after prostatectomy,” said Laura Pizzi, PharmD, Associate Professor at the Jefferson School of Pharmacy, and senior author of the study. “It is typical for cancer treatments to provide clinical benefit at a cost; however, the cost per success that we reported for adjuvant radiation therapy is on the low end when one broadly considers the cost per success reported for other cancer treatments.”

The objective of the study was to construct a decision analytic model to estimate the real-world cost of adjuvant radiation therapy versus observation from the payers’ perspective, using peer-reviewed, published data from a Southwest Oncology Group prospective, randomized trial. Side effects, overtreatment and the price tag were taken into account.

Nearly one-third of newly diagnosed men with prostate cancer — almost 220,000 men were diagnosed in 2010—undergo radical prostatectomy. Previous studies have shown that adjuvant radiation therapy improves biochemical progression-free survival and overall survival for these patients; however, most do not receive the treatment.

“Despite being shown to be effective, less than 20 percent of qualifying patients receive it,” said Timothy Showalter, MD, Assistant Professor of Radiation Oncology at Thomas Jefferson University, associate research member of the Kimmel Cancer Center at Jefferson, and lead author of the study. “Although not all patients will benefit from adjuvant radiation therapy, the level of utilization is lower than expected based on the positive, published results of randomized clinical trials.”
 

Published: 06-30-2011

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