Urologists Criticize Flawed Findings Regarding Prostate Cancer Treatment

A US urologic organization advocating for integrated and coordinated urologic care with more than 2,000 physician specialists across the United States has carefully reviewed recent literature regarding intensity-modulated radiation therapy (IMRT) for prostate cancer published in a US medical journal and found it to be methodologically flawed and factually inaccurate, and therefore, does not add to the helpful interchange of ideas needed to enhance healthcare or increase value.

The article, “Urologists’ Use of Intensity-Modulated Radiation Therapy for Prostate Cancer,” authored by Mitchell, JM, was published October 24, 2013, in the New England Journal of Medicine. “The Mitchell study was commissioned and funded by the American Society for Radiation Oncology [ASTRO; Fairfax, VA, USA] in an attempt to persuade lawmakers to legislate a monopoly for its members in the use of radiation therapy to treat prostate cancer—an economically driven agenda that has been rejected by [US] Congress, MedPAC, and the GAO,” said Dr. Deepak A. Kapoor, president of LUGPA (Large Urology Group Practice Association; Schaumburg, IL, USA) and chairman and CEO of Integrated Medical Professionals, PLLC (Melville, NY, USA). “Instead of furthering our understanding of the complicated health policy issues around prostate cancer care, Dr. Mitchell’s work appears to be specifically designed to produce talking points for the sponsor’s political agenda, which is primarily to restore their virtual monopoly on the provision of pathology laboratory services.”

Dr. Mitchell’s data revealed that less than one-third of newly detected prostate cancer patients who sought treatment from an integrated urology group received IMRT. This figure is comparable to data from academic literature that precedes the development of integrated groups. Dr. Mitchell did not match her control group for practice size, patient demographics, or severity of disease—LUGPA spokespersons reported that her selection bias is demonstrated by her own inexplicable results. For example, there has been a distinct national tendency towards less invasive IMRT and away from brachytherapy seen across all US sites of service paradoxically, over the six-year study period, the use of IMRT and brachytherapy remained flat in Dr. Mitchell’s control group. The fact that integrated groups’ rates of active surveillance and surgery held constant additionally shows that ownership of IMRT did not affect these groups’ clinical decision making. “Her own data confirms that urologists with ownership of radiation oncology use the technology appropriately and responsibly. That should be the title of Mitchell’s study,” said Dr. Kapoor.

The ASTRO study serves only one purpose, according to LUGPA spokespersons—to undermine competition in the market place. Utilizing such inaccurate data that demonizes groups practicing evidence-based medicine in an attempt to manipulate market share by legislative fiat is both inappropriate and offensive, according to LUGPA. Legislative changes based on such false data will drive up costs, as many patients will be forced to seek care in the more expensive hospital setting, and harm patient access to specialized, integrated care.

LUGPA represents 121 large urology group practices in the United States, with more than 2,000 physicians who comprise more than 20% of the US practicing urologists. LUGPA and its member practices are focused on best practices, data collection, research, and benchmarking to promote quality clinical outcomes.

Related Links:
Large Urology Group Practice Association
American Society for Radiation Oncology