The old joke in healthcare research is that nearly every study concludes that more studies are needed. But two new studies on the high cost of low-benefit prostate cancer treatments support that humorous observation.
In one study, published in the Journal of the American Medical Association, researchers found that men with prostate cancer who were at low risk for dying from that condition or were at high risk of dying from other causes received an increasing number of advanced-treatment technologies such as intensity-modulated radiotherapy and robotic prostatectomies.
In a study published in the Annals of Internal Medicine, researchers found that keeping close watch on low-risk prostate cancers in men aged 65 and older rather than initiating radiation or surgical treatment prolonged life expectancy by two months longer than the more advanced treatments and was $10,900 to $24,200 cheaper.
“Aggressive direct-to-consumer marketing and incentives associated with fee-for-service payment may promote the use of these advanced-treatment technologies,” the JAMA report stated. The authors also noted that the increased use of intensity-modulated radiotherapy, or IMRT, and robotic prostatectomy could largely be explained because they were replacements for other therapies such as external beam radiation treatment, or EBRT, and open radical prostatectomy. The authors noted that startup costs for IMRT and robotic surgery facilities are close to $2 million.
Dr. Ralph Weichselbaum, chairman of radiation and cellular oncology for University of Chicago Medicine, said the authors may be understating the issue. “Doctors are doing a lot of expensive, unnecessary stuff—that seems to be the take-home message,” he said.
The Annals of Internal Medicine study offered a similar message. “Mounting evidence suggests that many men with localized, low-risk prostate cancer are treated unnecessarily at substantial personal and societal cost,” the report stated. Its authors estimated that if the number of men with newly diagnosed low-risk prostate cancer who selected a “watchful waiting” observation strategy increased to 50% from 10%, it would result in cost savings of $1 billion.