Watchful Waiting–Active Surveillance in Low-Risk Prostate Cancer

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.