Urologists Denounce Flawed New England Journal of Medicine Article Regarding Prostate Cancer Treatment

CHICAGO, Oct. 24, 2013 /PRNewswire/ -- LUGPA, an organization advocating for integrated and coordinated urological care with more than 2,000 physician experts across the U.S., has carefully reviewed the article "Urologists' Use of Intensity-Modulated Radiation Therapy for Prostate Cancer" (Mitchell, JM, New England Journal of Medicine 369:17, October 24, 2013) and finds it to be methodologically flawed and factually inaccurate and, as such, does not contribute to the useful interchange of ideas needed to improve healthcare or increase value.

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"The Mitchell study was commissioned and funded by the American Society for Radiation Oncology (ASTRO) 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 Congress, MedPAC and the GAO," said Dr. Deepak A. Kapoor, President of LUGPA and Chairman and CEO of Integrated Medical Professionals, PLLC. "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."

Mitchell's data shows that less than one-third of newly-diagnosed prostate cancer patients who sought treatment from an integrated urology group received Intensity-Modulated Radiation Therapy (IMRT). This figure is fully in line with data from academic literature that predates the development of integrated groups.^[1],[2]  Mitchell did not match her control group for practice size, patient demographics or severity of disease  - indeed, her selection bias is evidenced by her own bizarre results. For example, there has been a clear national trend trends towards less invasive IMRT and away from brachytherapy seen nationally across all sites of service;^[3],[4]  paradoxically, over the six year study period, the use of IMRT and brachytherapy remained flat in Mitchell's control group.  The fact that integrated groups' rates of active surveillance and surgery held constant further illustrates 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 Kapoor.

The ASTRO study serves only one purpose - to undermine competition in the market place. Utilizing such erroneous data that demonizes groups practicing evidence-based medicine in an attempt to manipulate market share by legislative fiat is both inappropriate and offensive. Legislative changes based on such bogus 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.   

About LUGPA
LUGPA represents 121 large urology group practices in the United States, with more than 2,000 physicians who make up more than 20 percent of the nation's practicing urologists. LUGPA and its member practices are committed to best practices, research, data collection and benchmarking to promote quality clinical outcomes. For more information, visit lugpa.org.

[1] Nguyen PL, Gu X, Lipsitz SR, et al.  Cost Implications of the Rapid Adoption of Newer Technologies for Treating Prostate Cancer. J Clin Onc. 2010; Mar; 3: 1217
[2] Jang TL, Bekelman JE, Liu Y, et al. Physician visits prior to treatment for clinically localized prostate cancer. Arch Intern Med. 2010;170(5):440-450.
[3] Kapoor DA, Zimberg SH, Ohrin LM, et al. Utilization trends in prostate cancer therapy. J Urol. 2011 Sep;186(3):860-4.
[4] Mahmood U, Pugh T, Frank S et al.  Declining use of brachytherapy for the treatment of prostate cancer.  Brachytherapy, in press.  Accessed at:  http://dx.doi.org/10.1016/j.brachy.2013.08.005

SOURCE LUGPA