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 Most men with prostate cancer have this kind of tumor. Treatment
options include surgery, radiation, or so-called "active
surveillance" that involves holding off on treatment and instead
doing periodic tests to see if the malignancies grow. Often, doctors
and patients struggle to choose the best option, because it's hard
to tell which tumors will grow fast enough to be potentially
life-threatening and which ones might never get big enough to cause
problems.
Some previous research has found when urologists own radiation
equipment, men are more likely to get this treatment instead of
surgery, said senior study author Dr. Karen Hoffman of the
University of Texas MD Anderson Cancer Center in Houston. The
current study, however, suggests that equipment ownership might tip
the scales in favor of any treatment - either surgery or radiation -
over active surveillance.
Compared with men diagnosed by specialists who didn't own radiation
machines, men diagnosed by urologists who did own equipment were 61
percent more likely to receive surgery or radiation, researchers
report in the journal Prostate Cancer and Prostatic Diseases.
"For patients with very favorable prostate cancer, our findings
suggest that urologist ownership of radiation equipment may
contribute to unnecessary treatment," Hoffman said by email.
"However, for patients with disease with aggressive features, our
findings suggest that urologist ownership increases correct
treatment, meaning that these patients who need treatment are more
likely to receive it if they are diagnosed by a urologist with an
ownership interest in radiation therapy," Hoffman added.
For the study, researchers examined data on 17,982 men diagnosed
with localized prostate cancer from 2006 to 2009 in Texas.
Most of the men in the study were 66 to 70 years old, white, and
without other major medical problems.
During the study period, the percentage of men diagnosed by
urologists who owned equipment increased from about 2 percent to
almost 25 percent.
Men diagnosed with so-called favorable risk disease, meaning tumors
less likely to grow and spread enough to be dangerous, were 89
percent more likely to receive treatment instead of active
surveillance when their doctor owned radiation equipment, the study
found.
With so-called unfavorable risk disease, or tumors more likely to
become lethal, men were more than twice as likely to receive
treatment instead of active surveillance when their urologist owned
equipment.
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Equipment ownership was also associated with higher odds than men
would receive external beam radiation (EBRT). Men with favorable
risk were 45 percent more likely to get EBRT when urologists owned
machines, and men with unfavorable risk were 53 percent more likely
to get EBRT with equipment ownership.
The average annual cost of treatment was typically more than $2,000
higher for men who were seen by urologists who owned equipment than
for men who were seen by specialists without an ownership stake in
the machines.
One limitation of the study is that researchers couldn't account for
patient preferences or other factors such as urinary, bowel and
sexual function that may influence the care men receive, the authors
note.
Still, the findings add to a growing body of evidence suggesting
that equipment ownership influences treatment decisions, Dr. Lih-Ming
Wong, a urology researcher at the University of Melbourne who wasn't
involved in the study, said by email.
"Allowing physicians to self-refer may lead to unnecessary treatment
and added health care costs to society and patients," said Dr.
Quick-Dien Trinh, a urology researcher at Brigham and Women's
Hospital and the Dana Farber Cancer Institute Prostate Cancer
Program.
"That said, to be fair, the study does not tell us if self-referral
practices merely diverted their previous use of radiation therapy
from another facility to theirs," Trinh, who wasn't involved in the
study, said by email. "However, it doesn't explain why self-referral
practices are more likely to use radiation therapy regardless of
disease risk."
SOURCE: http://go.nature.com/2paXJD7 Prostate Cancer and Prostatic
Diseases, online March 28, 2017.
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