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Radical Prostatectomy for Low-Risk Prostate Cancer: Incidence and Cost



David Gill, MD, Intermountain Healthcare, Salt Lake City, Utah, discusses a study evaluating the incidence and cost of radical prostatectomy for NCCN low-risk prostate cancer in the state of Utah.

This study was presented at the virtual 2021 ASCO Genitourinary Cancers Symposium.


I’m Dr. David Gill. I’m the system‑wide lead for Genitourinary Oncology for Intermountain Healthcare, and I’m presenting a poster that we are presenting at Genitourinary ASCO 2021, “Incidence and Costs of Radical Prostatectomy for NCCN Low‑Risk Prostate Cancer in Utah.”

This is a project that I’m doing in collaboration with principal investor Dr. Jonathan Tward, who is a radiation oncologist at Huntsman Cancer Institute. This is a novel grant that is a collaboration between Intermountain Healthcare and the Huntsman Cancer Institute to fund research that is applicable to large populations of Utahans with cancer.

As a collaboration, we decided to take a look at rates of overtreatment of NCCN low‑risk prostate cancer throughout the state. We are pretty uniquely situated in that the vast majority of prostatectomies are performed by urologists either employed by Intermountain, affiliated with Intermountain, or employed by Huntsman Cancer Institute.

Using recently published data, we assumed a hypothesis that approximately 10 to 30% of prostatectomies would be done for NCCN low‑risk prostate cancer. We both have different cancer databases.

The Huntsman has an institutional database of prostate cancer, and Intermountain uses the Utah cancer database. Using this, we searched for men who had had a prostatectomy for Gleason 3+3, PSA less than 10, and less than T2A clinical stage.

Doing so, we found that over a 3‑year period from 2017 to 2019, 69 of the 1,155 prostatectomies were done on patients with NCCN low‑risk prostate cancer. Extrapolating from data published by Dr. Trogden in JAMA Oncology, we estimate approximately $1 million in increased health care expenditure compared to active surveillance if these men had pursued that as their treatment option.

Subsequent to submitting this abstract, we also investigated the rates of external beam radiation therapy and brachytherapy for low‑risk prostate cancer. We found similar percentages of low‑risk prostate cancer in that population as well, so accounting for 15 of 340 patients who received radiation had low‑risk disease, from the 2017 to 2019 period.

We are now performing financial analyses to estimate the increased costs in that population. We’re also looking at SHIM, as well as other patient‑reported outcome scores, to evaluate the symptomatic toxicity of overtreatment, not just the financial toxicity.

We are hoping to implement a novel education system that’s targeted at patient‑level education to review active surveillance, external beam radiation, and prostatectomy in these men with low‑risk disease. We hope that all men will receive this education outside of their clinic appointment prior to making their final decision for their treatment choice.

That’s something that we’re hoping to do across institutions in 2021. Thank you. 


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