An analysis of more than 100,000 prostate cancer patients, presented the fourth annual Genitourinary Cancers Symposium, being held February 2-4, 2012, at the San Francisco Marriott Marquis in San Francisco, Ca, USA, shows that treatment with external beam radiation therapy (EBRT) resulted in higher long-term toxicities and treatment-related costs than prostatectomy and brachytherapy, two other common treatments for the disease. The results provide valuable insight that may influence future decision-making regarding the use of these treatment options.

?Research to date has not given us a clear picture of how each prostate cancer therapy affects men over the long run,? said lead author Jay Ciezki, MD, a staff physician at the Cleveland Clinic. ?Our analysis is one of the first to examine the quality of life (QoL) and financial costs of these three very common prostate cancer treatment strategies for more than five years after treatment. We found that external beam radiotherapy had higher toxicity rates and was the most costly therapy per patient-year. While there are clearly still some high-risk prostate cancer patients who will benefit from external beam radiotherapy, for the approximately 80% or more of prostate cancer patients diagnosed with low- and intermediate-risk disease, brachytherapy or prostatectomy may be even more preferable options than we?ve previously assumed for men with low- and intermediate-risk prostate cancer.?

Treatment-related toxicities and outcomes
Researchers analyzed data in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database collected between 1991 and 2007; median follow-up was 71 months. They compared treatment-related toxicities and related outcomes among men who received external beam radiation, prostatectomy or brachytherapy (radiation therapy administered through surgically implanted radiation-emitting ?seeds?). Because the SEER-Medicare database provides information on cancer diagnoses and outcomes, along with individual patient costs, it allowed the investigators to obtain Medicare reimbursement data for both the initial treatment and any subsequent treatments related to the toxicities. They then calculated the total cost per patient-year for each of the three therapies over time.

?We were able to get a good picture of the long-term costs of patient care and were surprised to see such dramatic differences among the three treatment strategies,? Ciezki noted.

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Therapy-related effectIn all, records of 137,427 patients were examined, including 59,559 (43%) treated with prostatectomy, 60,806 (44.2%) who received EBRT, and 17,062 (12.4%) who were treated by brachytherapy. Overall, 10,585 (7.3%) needed some type of treatment intervention for a therapy-related effect. The researchers were not able to determine the stage of prostate cancer in individual patients included in the study. The study was limited to patients older than 65 with prostate cancer as their only cancer diagnosis.

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Brachytherapy
The investigators found that brachytherapy had the lowest cost per patient-year: $2,557.36. Prostatectomy came in slightly more expensive, at $3,205.71, followed by EBRT, at $6,412.29. EBRT also resulted in the most treatment-related toxicities: 7.1% of patients who received EBRT experienced genitourinary toxicity, such as urethral strictures and bladder bleeding, compared to 6.7% of those treated with prostatectomy and 3.4% of those treated with brachytherapy. Similarly, 1.7% of EBRT patients had gastrointestinal effects, compared to only 0.1% of prostatectomy patients and 0.3% of brachytherapy patients.

Preliminary findings
The researchers caution that the study findings are preliminary, and they plan to more closely examine the data and the differences they observed, including differences in toxicities found between older and newer techniques, and whether certain types of patients might be predisposed to long-term effects from particular therapies.

For more information:
Ciezki JP, Reddy CA, Angermeier K, Ulchaker J, Stephans KL, Tendulkar RD, Altman A, Chehade N, Klein EA. Long-term toxicity and associated cost of initial treatment and subsequent toxicity-related intervention for patients treated with prostatectomy, external beam radiotherapy, or brachytherapy: A SEER/Medicare database study. Abstract #4. Fourth Annual Genitourinary Cancers Symposium

What: Oral Abstract Session A
Lead Author: Jay P. Ciezki, MD (Cleveland Clinic, Cleveland, OH)
When: Thursday, February 2, 2012 1:15 PM – 03:05 PM PT

Photo credit: 2012 Genitourinary Cancers Symposium. Jay P. Ciezki, MD discusses Abstract #4 Long-term toxicity and associated cost of initial treatment and subsequent toxicity-related intervention for patients treated with prostatectomy, external beam radiotherapy, or brachytherapy: A SEER/Medicare database study during Oral Abstract Session A: Prostate Cancer at the 2012 Genitourinary Cancers Symposium (GU) meeting at the Marriott Marquis on Thursday February 2, 2012. A record 2500 attendees from around the world were on hand to learn the latest treatment and research in Genitourinary cancers from fellow physicians, researchers, health care professionals, cancer survivors and patient advocates. Photo by ? ASCO/Todd Buchanan.

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