Toxicities and Costs of Prostate Cancer Treatment for Younger Men

How do various prostate cancer treatments compare on cost and adverse effects? Researchers from the University of Texas MD Anderson Cancer Center in Houston, TX recently investigated these questions, and published the results of their study in the Journal of Clinical Oncology.¹

They specifically focused on men under the age of 65 with private healthcare insurance in order to best approximate the costs associated with proton radiation, stereotactic body radiotherapy (SBRT), and intensity-modulated radiotherapy (IMRT). Men undergoing proton therapy or SBRT were matched to men receiving IMRT on the basis of clinical and sociodemographic factors, and data were collected for the years 2008-2015. Proportional hazards models were used to calculate the cumulative incidence of urinary, bowel, and erectile dysfunction toxicities. Claims data were used to calculate costs.

A total of 693 men who received proton therapy were matched to 3,465 men who received IMRT. At two years following treatment, the proton therapy group had a lower risk of urinary toxicity (33% versus 42%) and erectile dysfunction (21% versus 28%); however, their risk of bowel toxicity was higher (20% versus 15%).

Mean radiation cost was $115,501 for proton therapy and $59,012 for IMRT. A total of 310 men who received SBRT patients were matched to 3,100 men who received IMRT. There were no significant differences between the two groups in urinary, bowel, or erectile dysfunction toxicities; however, there was a small but statistically significant higher risk of urinary fistula among the men treated with SBRT (1% versus 0.1%). Mean radiation cost for SBRT was $49,504 and $57,244 for IMRT.

Studies such as this one provide new information about treatment-associated toxicities and costs, and have applicability to both clinical practice and cost-effective cancer treatment.

Reference

Pan HY, Jiang J, Hoffman KE, et al. Comparative Toxicities and Cost of Intensity-Modulated Radiotherapy, Proton Radiation, and Stereotactic Body Radiotherapy Among Younger Men With Prostate Cancer. J Clin Oncol. 2018 Jun 20;36(18):1823-1830. doi: 10.1200/JCO.2017.75.5371.