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Clinical Research

Impact of urologists’ ownership of radiation equipment in the treatment of prostate cancer

Prostate Cancer and Prostatic Diseases volume 20, pages 300–304 (2017)Cite this article

Subjects

Abstract

Background:

Physician practices that offer ancillary medical services may refer their patients for such services, a process known as self-referral. We wanted to evaluate how utilization and cost of care differ for men diagnosed with prostate cancer in a self-referral practice (SRP) compared to a traditional urologic practice.

Methods:

A total of 17 982 men aged 66 years and older diagnosed with localized prostate cancer from 2006 to 2009 were identified from the Texas Cancer Registry. A total of 13 SRPs in the state of Texas were evaluated. We used multilevel logistic regression models that evaluated the odds of receiving a specific type of treatment.

Results:

Men diagnosed in SRPs were more likely to receive upfront treatment (vs watchful waiting/active surveillance) than men diagnosed by traditional practices (92.7% vs 89%; adjusted odds ratio (AOR) 1.61, 95% confidence interval (CI) 1.30–2.00; P<0.001) and were more likely to be treated with external beam radiation (47.4% vs 34.1%; AOR 1.59, 95% CI 1.37–1.84; P<0.001). This persisted for both favorable and unfavorable risk cancer. Median annual prostate cancer care cost was $2460 (95% CI $1663–$3368) higher for men diagnosed by SRPs. Limitations include data limited to men aged 65 years or older and geographic concentration of SRPs in Texas may not depict nationwide patterns.

Conclusions:

Older men diagnosed with prostate cancer in SRPs are more likely to undergo upfront treatment and to receive radiation treatment. This may increase appropriate treatment of unfavorable disease but contribute to overtreatment of favorable disease.

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Acknowledgements

This work was supported by grants from the Cancer Prevention & Research Institute of Texas (RP140020), the American Society for Radiation Oncology (CER 2013-1) and The University of Texas MD Anderson Cancer Center, McCombs Institute, Center for Radiation Oncology Research. This work was also supported by the National Institutes of Health/National Cancer Institute under award number P30CA016672 and used the Biostatistics shared resource. Dr Smith is supported by the Andrew Sabin Family Fellowship and received research funding from Varian Medical Systems but this funding was not used for this research.

Author information

Authors and Affiliations

  1. Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA

    S B Williams

  2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    J Huo & B D Smith

  3. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    B F Chapin

  4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    B D Smith & K E Hoffman

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  1. S B Williams
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  5. K E Hoffman
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Corresponding author

Correspondence to K E Hoffman.

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Competing interests

The authors declare no conflict of interest.

Additional information

These findings were presented at the Institute of Medicine (IOM) National Cancer Policy Forum in 2015, Society of Urologic Oncology Annual Meeting in 2015, Genitourinary Cancers Symposium of the American Society of Clinical Oncology in 2016 and received the Best Research Poster Award at the Annual Meeting of the American Urological Association in 2016.

Supplementary Information accompanies the paper on the Prostate Cancer and Prostatic Diseases website

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Williams, S., Huo, J., Chapin, B. et al. Impact of urologists’ ownership of radiation equipment in the treatment of prostate cancer. Prostate Cancer Prostatic Dis 20, 300–304 (2017). https://doi.org/10.1038/pcan.2017.9

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