NLM Director’s Comments Transcript
Increase in High Tech Prostate Cancer Treatment: 07/29/2013

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Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.

The use of advanced, expensive technologies to treat men with slow moving, low mortality risk prostate cancer increased significantly between 2004-2009, suggests a national study recently published in the Journal of the American Medical Association. The findings suggest some physicians are reluctant to recommend watchful waiting or active surveillance for men with a low risk of dying from prostate cancer.
Specifically, the study found the use of high-end technological treatments, such as robotic surgery and high-precision radiation (also known as intensity-modulated radiation therapy), increased from 32 percent in 2004 to 44 percent in 2009 within a large, national sample of men after age 66 with low mortality risk prostate cancer.
Similarly, the study found the use of the same technologies among men with low risk prostate cancer (who were at risk of dying from other serious health problems) increased from 36 percent to 57 percent between 2004-2009.
The study is based on Medicare’s database of about 56,000 men with low risk prostate cancer from across the U.S. Medicare is the U.S. government’s health insurance program for elderly and disabled Americans. The Medicare database, which is widely used by other medical researchers, is called the Surveillance, Epidemiology, and End Results (or SEER). The study’s findings are not applicable to men age 65 or younger.
A news story in Reuters that accompanied the study’s release noted the findings suggest some physicians hesitate to recommend watchful waiting or active surveillance to low risk prostate cancer patients and instead use high tech, expensive treatments. A website from the American Cancer Society (available in the ‘treatment’ section of MedlinePlus.gov’s prostate cancer health topic page) explains watchful waiting is a reasonable option for some men with slow-growing cancers because it is not known whether treating prostate cancer with surgery or radiation will actually help patients live longer. In addition, the American Cancer Society website explains aggressive treatments have risks and side effects that may outweigh the possible benefits for some men with low mortality risk prostate cancer.
Dr. Brian Hollenbeck M.D., University of Michigan School of Medicine (and the study’s corresponding author), told Reuters (and we quote): ‘You can’t get at what the right rate (of treatment use) is from our study, but what we did find was treatment with these advanced technologies increased over the past decade, and was fairly common’ (end of quote).
The study’s 11 authors do not specifically address whether the findings suggest there is widespread prostate cancer overtreatment via high tech interventions. However, the authors imply the findings provide more evidence of a need to address the higher expense and appropriate clinical balance to treat low mortality risk prostate cancer.
The authors explain the high tech treatments that are increasingly used used to treat low risk prostate cancer (and we quote): ‘are considerably more expensive than the prior standards’ (end of quote).
The authors write (and we quote): ‘Perhaps more important, the implementation of these technologies in populations unlikely to benefit from treatment occurred during a time of increasing awareness about the indolent nature of some prostate cancers and of growing dialogue about limiting treatment in these patients’ (end of quote).
Meanwhile, MedlinePlus.gov’s prostate cancer health topic page provides comprehensive information about prostate cancer’s diagnosis/symptoms, prevention/screening, and treatment.
The American Cancer Society additionally provides a detailed guide to prostate cancer that is accessible within the ‘overviews’ section of MedlinePlus.gov’s prostate cancer health topic page.
MedlinePlus.gov’s prostate cancer health topic page also contains research summaries, which are available in the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. Information about related clinical trials in your area is available in the ‘clinical trials’ section. You can sign up to receive updates about prostate cancer as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s prostate cancer health topic page, type ‘prostate cancer’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘prostate cancer (National Library of Medicine).’ MedlinePlus.gov additionally features a health topic page on prostate diseases.
We realize the evidence about prostate cancer treatment (and screening) is complex, challenging, and changing. Similar to other clinical areas where the evidence and recommendations are shifting, we will continue to highlight comprehensive research findings as well as their treatment and screening implications.
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