Article Title

Diffusion of New Technologies for Patients With Prostate Cancer

Publication Date



prostate, technology


Background/Aims: Prostate cancer is the most common and costly cancer among U.S. men and offers a portfolio of case studies and clinical problems. Among these, the documented increases in use of robotic radical prostatectomy (RRP) and intensity-modulated radiotherapy (IMRT) are illustrative of rapid diffusion of costly, unproven technological innovations. Evidence of these case studies has been limited to the traditional Medicare fee-for-service (FFS) aged population and may provide a potentially biased view of the universe of cancer care in the U.S. To address this issue, we examine treatment patterns among prostate cancer patients enrolled in two integrated health care delivery systems.

Methods: The sample included a retrospective cohort of patients diagnosed with nonmetastatic prostate cancer between 2000 and 2008 at the Northwest and Colorado regions of Kaiser Permanente. Choice of radiation therapy was defined as the receipt of external beam radiotherapy (three-dimensional [3D] conformal radiation therapy vs. IMRT) as primary treatment within one year of diagnosis. Choice of prostatectomy was defined as the receipt of surgery as primary treatment (open radical prostatectomy vs. minimally-invasive/robotic radical prostatectomy). A pooled time-series cross-section design was used to analyze the medical care resource use for treating prostate cancer.

Results: Both RRP and IMRT were introduced in the two health systems in 2003, and their use has been steadily increasing since then. Use of traditional treatments has either remained stable: open radical prostatectomy; or decreased: 3D conformal radiation therapy.

Discussion: We hypothesize that diffusion rates of RRP and IMRT have been slower among HMO enrollees compared with FFS patients. This study improves our understanding of patterns of prostate cancer care in the U.S. by using a large sample of managed care enrollees across the age spectrum, including men younger than 65 relative to men older than 65 years.




March 20th, 2015


April 15th, 2015