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MEN’S
HEALTH

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Figure 2: Biochemical progression-free survival after treatment for low-risk prostate cancer from peer-reviewed papers since
2000. The colored ellipses are mathematically derived according to plotted points for each treatment modality. Each point is
referenced and can be clicked on and the citation detailed at www.pctrf.org.

brachytherapy, with an increase in surgery and IMRT, but these the huge economic burden of IMRT that suddenly developed,
changes were not based upon peer-reviewed evidence. CMS has been aggressively reducing reimbursement over the
past 5-10 years, and it is unlikely that there will be further pro-
Men are less threatened with surgery when it involves “the liferation of IMRT for that reason.
robot,” as it sounds technically advanced and does allow for faster
recovery. But the published data show that curative results are Brachytherapy remains an effective, patient-friendly modality
equivalent to or no better than open surgery. with superior results at centers of excellence throughout the
United States and should continue to be an option offered to all
The upsurge in IMRT reflects the merging of small groups patients that have to deal with the prospect of treatment of early,
of urologists into larger groups starting in 2003 so they could localized prostate cancer, regardless of age or risk status. All treat-
afford to bring the IMRT in-house and benefit from the hugely ments for prostate cancer result in morbidity and lifestyle issues,
higher reimbursement for IMRT compared to either surgery but brachytherapy is the smallest bump in the road for most.
or brachytherapy (Wall Street Journal, Dec. 7, 2010). Due to

14 San Antonio Medicine • December 2015