Men with higher-risk prostate cancer (PCa) are less likely to require salvage therapy if they receive primary treatment with intensity-modulated radiotherapy (IMRT) rather than three-dimensional conformal therapy (3D-CRT), but the risk of complications requiring intervention is similar for both modalities, a new study found.

Researchers used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 11,039 men who underwent IMRT and 6,976 who underwent 3D-CRT. Among higher-risk patients who did not receive concurrent androgen deprivation therapy, 16% of those treated with IMRT went on to receive salvage therapy compared with 20% of patients who had 3D-CRT, investigators reported online in European Urology. Among lower-risk patients, the likelihood of salvage therapy and complications requiring an intervention were similar for IMRT and 3D-CRT.

The authors, led by Bruce L. Jacobs, MD, of the University of Michigan in Ann Arbor, concluded: “Findings related to the comparative effectiveness of the two approaches showed a modest benefit with IMRT: The need for salvage therapy was less for a subset of men with higher risk disease who did not receive concurrent ADT, whereas the risk of a complication was no different between the two modalities. In this context, society must decide what price it is willing to pay for these benefits.”

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The researchers cited a study (J Clin Oncol 2011;29:1517-1524) showing that IMRT costs approximately $11,000 more per patient than 3D-CRT. The proportion of men receiving IMRT increased from 9% in 2001 to 93% in 2007, Dr. Jacobs’ group reported.

The study cohort included only Medicare beneficiaries, so the findings may not be generalizable to younger patients.