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Comment & Response
August 2015

Watchful Waiting–Active Surveillance in Low-Risk Prostate Cancer

Author Affiliations
  • 1American Society for Radiation Oncology, Fairfax, Virginia
  • 2Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Rutgers–Robert Wood Johnson Medical School, New Brunswick
  • 3Department of Radiation Oncology, Froedtert and Medical College Clinical Cancer Center, Milwaukee
  • 4Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
JAMA Oncol. 2015;1(5):688-689. doi:10.1001/jamaoncol.2015.1214

To the Editor As the world’s leading radiation oncology society, we are sensitive to the judicious use of radiation therapy. The conclusions of Chamie et al1 in their recent article regarding the underuse of watchful waiting–active surveillance (WW-AS) for patients with low-risk prostate cancer raise several concerns. Specifically:

An analysis by Mitchell6 of Medicare claims from 2005 through 2010 documented an increase in the use of intensity-modulated radiation therapy by self-referring urologists. A report of the Government Accountability Office7 details a 356% increase in intensity-modulated radiation therapy treatments from 2006 through 2010 and directly attributed the increase to self-referral. The American Society for Radiation Oncology is working to close the loophole in the self-referral law to protect patients and to reduce unnecessary spending.

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