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Invited Commentary
June 24, 2013

Expanding Utilization of Intensity-Modulated Radiotherapy for Prostate Cancer: Soaring Costs, Dubious Benefits: Comment on “Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy”

Author Affiliations

Author Affiliations: Departments of Urology and Epidemiology and Biostatistics, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco.

JAMA Intern Med. 2013;173(12):1143-1144. doi:10.1001/jamainternmed.2013.6755

Prostate cancer in the United States is characterized by a unique epidemiology: a prevalence unrivaled by any other visceral malignant neoplasm among men and a prolonged natural history often measurable in decades rather than years. Early detection and aggressive management of higher-risk prostate cancer explain a substantial proportion of the more than 40% drop in prostate cancer mortality rates observed since the 1990s.1 The price of this remarkable success, however, has been high rates of avoidable overtreatment of both newly diagnosed and recurrent prostate cancer, with excessive attendant morbidity and cost. Reflecting both screening of asymptomatic men and increasingly intensive surveillance (eg, with ultrasensitive prostate-specific antigen [PSA] tests, more extensive biopsies, and growing use of advanced imaging) of those treated, men are receiving both primary and salvage treatments at younger ages and earlier in the natural history of the disease. Reducing the potential morbidity of these treatments remains one of the central goals of prostate cancer clinical research.