Xiangmei Gu

Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy

CONTEXT Minimally invasive radical prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP). OBJECTIVE To determine the comparative effectiveness of MIRP vs RRP. DESIGN, SETTING, AND PATIENTS Population-based observational cohort study using US Surveillance, Epidemiology, and End Results Medicare linked data from 2003 through 2007. We identified men with prostate cancer who underwent MIRP (n = 1938) vs RRP (n = 6899). MAIN OUTCOME MEASURES We compared postoperative 30-day complications, anastomotic stricture 31 to 365 days postoperatively, long-term incontinence and erectile dysfunction more than 18 months postoperatively, and postoperative use of additional cancer therapies, a surrogate for cancer control. RESULTS Among men undergoing prostatectomy, use of MIRP increased from 9.2% (95% confidence interval [CI], 8.1%-10.5%) in 2003 to 43.2% (95% CI, 39.6%-46.9%) in 2006-2007. Men undergoing MIRP vs RRP were more likely to be recorded as Asian (6.1% vs 3.2%), less likely to be recorded as black (6.2% vs 7.8%) or Hispanic (5.6% vs 7.9%), and more likely to live in areas with at least 90% high school graduation rates (50.2% vs 41.0%) and with median incomes of at least

Cost Implications of the Rapid Adoption of Newer Technologies for Treating Prostate Cancer

60,000 (35.8% vs 21.5%) (all P < .001). In propensity score-adjusted analyses, MIRP vs RRP was associated with shorter length of stay (median, 2.0 vs 3.0 days; P<.001) and lower rates of blood transfusions (2.7% vs 20.8%; P < .001), postoperative respiratory complications (4.3% vs 6.6%; P = .004), miscellaneous surgical complications (4.3% vs 5.6%; P = .03), and anastomotic stricture (5.8% vs 14.0%; P < .001). However, MIRP vs RRP was associated with an increased risk of genitourinary complications (4.7% vs 2.1%; P = .001) and diagnoses of incontinence (15.9 vs 12.2 per 100 person-years; P = .02) and erectile dysfunction (26.8 vs 19.2 per 100 person-years; P = .009). Rates of use of additional cancer therapies did not differ by surgical procedure (8.2 vs 6.9 per 100 person-years; P = .35). CONCLUSION Men undergoing MIRP vs RRP experienced shorter length of stay, fewer respiratory and miscellaneous surgical complications and strictures, and similar postoperative use of additional cancer therapies but experienced more genitourinary complications, incontinence, and erectile dysfunction.

Temporal National Trends of Minimally Invasive and Retropubic Radical Prostatectomy Outcomes from 2003 to 2007: Results from the 100% Medicare Sample

PURPOSE Intensity-modulated radiation therapy (IMRT) and laparoscopic or robotic minimally invasive radical prostatectomy (MIRP) are costlier alternatives to three-dimensional conformal radiation therapy (3D-CRT) and open radical prostatectomy for treating prostate cancer. We assessed temporal trends in their utilization and their impact on national health care spending. METHODS Using Surveillance, Epidemiology, and End Results-Medicare linked data, we determined treatment patterns for 45,636 men age ≥ 65 years who received definitive surgery or radiation for localized prostate cancer diagnosed from 2002 to 2005. Costs attributable to prostate cancer care were the difference in Medicare payments in the year after versus the year before diagnosis. RESULTS Patients received surgery (26%), external RT (38%), or brachytherapy with or without RT (36%). Among surgical patients, MIRP utilization increased substantially (1.5% among 2002 diagnoses v 28.7% among 2005 diagnoses, P < .001). For RT, IMRT utilization increased substantially (28.7% v 81.7%; P < .001) and for men receiving brachytherapy, supplemental IMRT increased significantly (8.5% v 31.1%; P < .001). The mean incremental cost of IMRT versus 3D-CRT was

Overuse of Imaging for Staging Low Risk Prostate Cancer

10,986 (in 2008 dollars); of brachytherapy plus IMRT versus brachytherapy plus 3D-CRT was

Inappropriate utilization of radiographic imaging in men with newly diagnosed prostate cancer in the United States

10,789; of MIRP versus open RP was

Body mass index as a predictor of postoperative complications in reduction mammaplasty.

293. Extrapolating these figures to the total US population results in excess spending of

Determinants of Performing Radical Prostatectomy Pelvic Lymph Node Dissection and the Number of Lymph Nodes Removed in Elderly Men

282 million for IMRT,

Impact of neoadjuvant chemotherapy on breast reconstruction

59 million for brachytherapy plus IMRT, and

Utilization and expense of adjuvant cancer therapies following radical prostatectomy

4 million for MIRP, compared to less costly alternatives for men diagnosed in 2005. CONCLUSION Costlier prostate cancer therapies were rapidly and widely adopted, resulting in additional national spending of more than

Patterns of care and outcomes of radiotherapy for lymph node positivity after radical prostatectomy

350 million among men diagnosed in 2005 and suggesting the need for comparative effectiveness research to weigh their costs against their benefits.