Cost comparison of curative therapies for localized prostate cancer in Japan: a single-institution experience.

PURPOSE: In addition to open surgery, curative therapies for prostate cancer now include endoscopic surgery and radiation therapies. Because of the expansion and subdivision of treatment methods for prostate cancer, the medical fee point schedule in Japan was revised in fiscal year 2006. We examined changes in medical income and expenditure after this revision of the medical fee system. MATERIALS AND METHODS: We studied income and expenditure, after institution of the new medical fee schedule, for the five types of therapies for prostate cancer performed at our hospital: two surgical therapies (radical retropubic prostatectomy and laparoscopic prostatectomy) and three radiation therapies (three-dimensional conformal radiation therapy, (192)Ir high-dose-rate brachytherapy, and (125)I low-dose-rate brachytherapy). RESULTS: Low-dose-rate brachytherapy was found to be associated with a profit of yen199 per patient. Laparoscopic prostatectomy, a highly advanced medical treatment that the fee revision changed from a partially insured to an insured procedure, yielded a profit of yen75,672 per patient. However, high-dose-rate brachytherapy was associated with a loss of yen654,016 per patient. CONCLUSION: Given the loss in hospital income per patient undergoing high-dose-rate brachytherapy, the medical fee point system for this procedure should be reassessed.

Interactive-plan technique conquers the disadvantages of volume-reducing hormone therapy in 125I permanent implantation for localized prostate cancer.

BACKGROUND: The purpose of this study was to assess the impact of hormone therapy on post-implant dosimetry in patients in whom pre-plan and interactive-plan techniques were used for transperineal brachytherapy against prostatic cancer. METHODS: The subjects comprised 244 patients treated using (125)I seed implantation as monotherapy. The prescribed dose to the periphery of the prostate was 145 Gy. The pre-plan technique was used for 116 patients, and the interactive-plan technique for 128 patients. Hormone therapy was used in 71 patients (29.1%). The D90 (dose to 90% of prostate volume) of post-implant computed tomography (CT) analysis was assessed in both groups. In addition, the ratio of post-implant CT volume to preoperative ultrasonography (US) volume was assessed. RESULTS: In the pre-plan group, D90 was significantly lower for patients who received hormone therapy than for those who did not (P = 0.035). However, in the interactive-plan group, D90 did not differ between patients with and without hormone therapy (P = 0.467). The CT-to-US prostate volume ratio was 1.022 for patients who received hormone therapy and 0.960 for patients who did not (P = 0.021). CONCLUSION: Post-traumatic swelling following implantation is increased by cessation of hormone therapy and may reduce D90. However, the present results suggest that the interactive-plan technique overcomes this disadvantage of hormone therapy.