Medicare Explores Prostate Treatment Options

医疗保障探索摄护腺治疗选择

Barbara Kram, Editor | April 22, 2010
MEDCAC focuses on
prostate cancer treatment
The Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) met Wednesday to focus on prostate cancer treatment. MEDCAC provides advice and recommendations to CMS about scientific evidence for what is covered by Medicare and Medicaid.

The meeting focused on the current evidence about the risks, benefits and outcomes for radiation therapy (including external beam and brachytherapy) for the treatment of localized prostate cancer.

As reported in DOTmed News, professional organizations with expertise in prostate cancer have varying guidelines on the best approach to treat the condition (see DM 11880).

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CMS explored the scientific evidence to determine how well radiation therapy for the treatment of localized prostate cancer affects health outcomes such as mortality (death rates) and morbidity (diseases and adverse effects on patients).

What evidence exists about the best ways to treat prostate cancer? What studies are needed to fill the gaps in understanding? Is the high-tech approach to treatment best? Or, should we use a watchful waiting approach for more patients? These are the types of questions explored at the meeting.

Generally the tone of the meeting was that clinician presenters expressed confidence in the value of having a number of radiation therapy treatment options at their disposal. While research may be needed, doctors want Medicare to continue funding radiation therapy modalities so that treatments can be tailored individually. Although a federal program, coverage may differ by state, impacting patient access to some therapies.

ASTRO President Anthony Zietman, M.D., was among the speakers at the meeting, which was broadcast on the web.

In his remarks, Dr. Zietman, an expert in radiation therapy treatments for prostate cancer from Massachusetts General Hospital and Harvard University in Boston, provided data on how successful radiation therapy techniques, including external beam radiation therapy and brachytherapy, are at treating prostate cancer without significant side effects.

He acknowledged that it is possible some men are receiving treatments for prostate cancer that would have done well without treatment through watchful waiting or active surveillance (a step up from watchful waiting in which intervention may be called for). However, doctors currently have little way to tell if a man's prostate cancer will progress to be life-threatening or if it will remain somewhat asymptomatic.

With respect to stereotactic body radiation therapy (SBRT), Dr. Zietman said that the treatment, which pinpoints high doses of radiation to the prostate over a few days instead of several weeks, shows promise as a non-invasive way to cure prostate cancer. However, he cautioned that SBRT needed further study in clinical trials to fully capture survival and quality of life measures.

"Prostate cancer is the number one cancer diagnosed in men. I applaud MEDCAC for studying this important issue and appreciate the opportunity to participate in the forum," Dr. Zietman said.

Get more details:

Read about the meeting and get links to the agenda and participants:
http://www.cms.hhs.gov/mcd/viewmcac.asp?where=index&mid=54

To read Dr. Zietman's full remarks, visit
www.astro.org/PublicPolicyCommentLettersTestimonyAndReports