Prostate cancer and prostatic diseases
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Prostate Cancer Prostatic Dis. · Dec 2019
Comparative StudyProstate cancer in the medicare shared savings program: are Accountable Care Organizations associated with reduced expenditures for men with prostate cancer?
To assess whether Medicare expenditures for men with incident prostate cancer, treated in Accountable Care Organizations (ACOs) differ from those of men treated in non-ACOs. ⋯ There was no significant difference in Medicare spending on prostate cancer care based on provider ACO affiliation, regardless of treatment type. Although the effects of ACOs on clinical care are complex, this study adds to a growing body of evidence suggesting that ACOs fail to achieve significantly lower charges in certain clinical settings.
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Prostate Cancer Prostatic Dis. · Dec 2019
Review Comparative StudyProton versus photon-based radiation therapy for prostate cancer: emerging evidence and considerations in the era of value-based cancer care.
Advances in radiation technology have transformed treatment options for patients with localized prostate cancer. The evolution of three-dimensional conformal radiation therapy and intensity-modulated radiation therapy (IMRT) have allowed physicians to spare surrounding normal organs and reduce adverse effects. The introduction of proton beam technology and its physical advantage of depositing its energy in tissue at the end-of-range maximum may potentially spare critical organs such as the bladder and rectum in prostate cancer patients. Data thus far are limited to large, observational studies that have not yet demonstrated a definite benefit of protons over conventional treatment with IMRT. The cost of proton beam treatment adds to the controversy within the field. ⋯ Evolving trends in proton treatment delivery and proton center business models are helping to reduce costs. Introduction of existing technology into proton delivery allows further control of organ motion and addressing organs-at-risk. Finally, the much-awaited contemporary studies comparing photon with proton-based treatments, with primary endpoints of patient-reported quality-of-life, will help us understand the differences between proton and photon-based treatments for prostate cancer in the modern era.
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Prostate Cancer Prostatic Dis. · Dec 2019
Clinical TrialA predictive model based on biparametric magnetic resonance imaging and clinical parameters for improved risk assessment and selection of biopsy-naïve men for prostate biopsies.
Prostate cancer risk prediction models and multiparametric magnetic resonance imaging (mpMRI) are used for individualised pre-biopsy risk assessment. However, biparametric MRI (bpMRI) has emerged as a simpler, more rapid MRI approach (fewer scan sequences, no intravenous contrast-media) to reduce costs and facilitate a more widespread clinical implementation. It is unknown how bpMRI and risk models perform conjointly. Therefore, the objective was to develop a predictive model for significant prostate cancer (sPCa) in biopsy-naive men based on bpMRI findings and clinical parameters. ⋯ A predictive model based on bpMRI scores and clinical parameters significantly improved risk stratification for sPCa in biopsy-naïve men and could be used for clinical decision-making and counselling men prior to prostate biopsies.