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The Impact of Technology Diffusion on Treatment for Prostate Cancer

Schroeck, Florian R. MD, MS*,†; Kaufman, Samuel R. MA*; Jacobs, Bruce L. MD, MPH*,†; Zhang, Yun PhD*; Weizer, Alon Z. MD, MS; Montgomery, Jeffrey S. MD, MHSA; Gilbert, Scott M. MD, MS; Strope, Seth A. MD, MPH§; Hollenbeck, Brent K. MD, MS*,†

doi: 10.1097/MLR.0000000000000019
Original Articles

Background: The use of local therapy for prostate cancer may increase because of the perceived advantages of new technologies such as intensity-modulated radiotherapy (IMRT) and robotic prostatectomy.

Objective: To examine the association of market-level technological capacity with receipt of local therapy.

Design: Retrospective cohort.

Subjects: Patients with localized prostate cancer who were diagnosed between 2003 and 2007 (n=59,043) from the Surveillance Epidemiology and End Results—Medicare database.

Measures: We measured the capacity for delivering treatment with new technology as the number of providers offering robotic prostatectomy or IMRT per population in a market (hospital referral region). The association of this measure with receipt of prostatectomy, radiotherapy, or observation was examined with multinomial logistic regression.

Results: For each 1000 patients diagnosed with prostate cancer, 174 underwent prostatectomy, 490 radiotherapy, and 336 were observed. Markets with high robotic prostatectomy capacity had higher use of prostatectomy (146 vs. 118 per 1000 men, P=0.008) but a trend toward decreased use of radiotherapy (574 vs. 601 per 1000 men, P=0.068), resulting in a stable rate of local therapy. High versus low IMRT capacity did not significantly impact the use of prostatectomy (129 vs. 129 per 1000 men, P=0.947) and radiotherapy (594 vs. 585 per 1000 men, P=0.579).

Conclusions: Although there was a small shift from radiotherapy to prostatectomy in markets with high robotic prostatectomy capacity, increased capacity for both robotic prostatectomy and IMRT did not change the overall rate of local therapy. Our findings temper concerns that the new technology spurs additional therapy of prostate cancer.

Supplemental Digital Content is available in the text.

*Department of Urology, Division of Health Services Research

Department of Urology, Division of Urologic Oncology, University of Michigan, Ann Arbor, MI

Departments of Urology and Epidemiology and Health Policy Research, University of Florida College of Medicine, Gainesville, FL

§Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

F.R.S. is supported in part by the National Institutes of Health Training Grant NIH 5 T32 DK007782-12 and the American Cancer Society Postdoctoral Fellowship Award PF-12-118-01-CPPB. B.L.J. is supported in part by the American Cancer Society Postdoctoral Fellowship Award 121805-PF-12-008-01-CPHPS. S.A.S. is supported in part by a Washington University Career Development Award KL2 TR000450. B.K.H. is supported in part by the American Cancer Society Research Scholar Grant RSGI-13-323-01-CPHPS.

Each author has made a substantial contribution to conception and design, acquisition of data, or analysis and interpretation of data, has drafted the article or revised it critically for important intellectual content, and has given final approval of the version to be published.

The authors declare no conflict of interest.

Reprints: Brent K. Hollenbeck, MD, MS, Department of Urology, Divisions of Health Services Research and Urologic Oncology, University of Michigan, Bldg 16, First Floor, 2800 Plymouth Rd, Ann Arbor, MI 48109. E-mail:

© 2013 by Lippincott Williams & Wilkins.