based cost comparison between BT and EBRT
using intensity-modulated radiation therapy.
The cost of BT using LDR was $2,719 per
patient; with HDR, it increased to $6,517;
and with EBRT, depending on the number
of fractions, the cost varied from $4,173
to $5,507. The total reimbursement for BT
was $3,123 versus approximately $8,000 to
$10,000 with EBRT. The attending physician
time requirement, however, was 1. 5 to 2
times greater for BT. The financial incentives
relative to time are out of balance. 18
Will the ASCENDE-RT lead to changes
in this trend? Perhaps. The University of
Pittsburgh Medical Center, PA, for example,
changed its clinical pathway in January
2016 to indicate EBRT with BB as the first
choice approach for high-risk prostate
cancer. A retrospective review of patients
treated at the hospital between December
2011 and July 2017 showed an increase in
patients planned for BB from 25. 2 percent
to 45. 4 percent. The main reason listed
for patients not getting a BB was not
patient preference ( 19. 9 percent), but rather
physician preference ( 59. 7 percent). 19
With prostate cancer rates as high as
they are, physicians must continue to
find ways to improve not just survival,
but QOL and financial health as well. As
newer technologies have paved the way for
earlier detection, better treatment options,
and more cures, we also must continue to
reduce overtreatment, unnecessary side
effects, and avoidable costs. Analysis of
the data, cost structures, and the rationale
for our current choices will help to guide
these efforts moving forward. ♦
11. Lardas LM, Liew M, van der Bergh RC, et al. Quality of life
outcomes after primary treatment for clinically localized prostate
cancer: A systematic review. Eur Urol. 2017; 72( 6):869-885.
12. Chen RC, Basak R, Meyer AM, et al. Association bet ween choice
of radical prostatectomy, external beam radiotherapy or active
surveillance and patient-reported quality of life among men with
localized prostate cancer. JAMA. 2017;317( 11):1141-1150.
13. Wilson LS, Tesoro R, Elkin EP, et al. Cumulative cost pattern
comparison of prostate cancer treatments. Cancer. 2007;109( 3):518-
14. Martin JM, Handorf EA, Kutikov A, et al. The rise and fall of
prostate brachytherapy: Use of brachytherapy for the treatment of
localized prostate cancer in the National Cancer Database. Cancer.
15. Glaser SM, Dohopolski MJ, Balasubramani GK, Benoit
RM, Smith RP, Beriwal S. Brachytherapy boost for prostate
cancer: Trends in care and survival outcomes. Brachytherapy.
2017; 16( 2):330-341.
16. Safdieh J, Wong A, Weiner JP, Schwartz D, Schreiber D.
Utilization of brachytherapy for low risk prostate cancer: Is the
decline overstated? J Contemp Brachytherapy. 2016; 8( 4):289-293.
17. Orio PF III, Nguyen PL, Buzurovic I, Cali DW, Chen YW.
Prostate brachytherapy case volumes by academic and
nonacademic practices: Implications for future residency
training. Int J Radiat Oncol Biol Phys. 2016;96( 3):624-628.
18. Dutta SW, Bauer-Nilsen K, Sanders JC, et al. Time-driven
activity-based cost comparison of prostate cancer, brachytherapy,
and intensity-modulated radiation therapy. Brachytherapy.
2018; 17( 3):556-563.
19. 19. Ling DC, Karukonda P, Smith RP, Heron DE, Beriwal S.
Declining brachytherapy utilization for high-risk prostate
cancer: Can clinical pathways reverse the trend? Brachytherapy.
2018; 17( 6):895-898.
As newer technologies have paved the way for earlier
detection, better treatment options, and more cures,
we also must continue to reduce overtreatment,
unnecessary side effects, and avoidable costs.