I usually don't like reinforcing cynical views about
doctors and their motives, but since there's been discussion on the use of ADT for first line use, I thought I'd post this article.
The Los Angeles Times (11/4) reports, "Paying physicians less for a commonly administered prostate cancer therapy can help curb inappropriate use and save healthcare dollars, without having a negative impact on people who need the treatment," according to a paper in the New England Journal of Medicine. "Overall use of the hormone therapy doubled during the 1990s, and by 1999, nearly half of all patients with prostate cancer were receiving it within a year of diagnosis." Use "was prevalent even among men who were 80 years or older and who had low-risk localized tumors, and for whom there is no clear evidence that the therapy improves chances of survival."
According to MedPage Today (11/3, Bankhead), "medical castration with GnRH agonists became a particularly attractive option for physicians because of Medicare's reimbursement structure." In fact, "Medicare reimbursed physicians for subcutaneous or intramuscular administration of GnRH agonists at 95% of the average wholesale price," while "physicians' cost for GnRH agonists averaged 82% of the average wholesale price. Because of the difference between cost and reimbursement, profits from ADT accounted for as much as 40% of revenues in some private urology practices."
But, the "Medicare Modernization Act that went into effect in 2004 and 2005 slashed physicians' reimbursement for androgen-deprivation therapy by about 50 percent," HealthDay (11/3, Gardner) reported. As a result, "unnecessary use of androgen-deprivation therapy declined from 38.7 percent in 2003 to 30.6 percent in 2004, then to 25.7 percent in 2005," researchers at the University of Michigan and University of Texas Medical Branch found. There were, however, "no changes in appropriate use of the therapy, which stayed stable." Reuters (11/4, Fox) also covers the story.
52 at Dx (3/12/10), father died of PCa
PSA: 10/16/09 - 2.8; 1/11/10 - 3.8
RALP 5/19/10, Dr. Lee, U. Penn Presby
Gleason 6, gland involvement < 2%; tumor in peripheral zone both sides; no capsular, extracapsular extension, lymph node, or seminal vesical involvement; no positive margins
Incontinence: no pads except specific exercises
ED: pump. Levitra 10mg every other night. Still no-go.