Is The Increase In Orchiectomy For Prostate Cancer Patients Appropriate?

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 30 May 2008 - 0:00 PDT

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UroToday.com - In the online version of Cancer, Gerald W. Chodak writes an editorial on the article "Androgen deprivation falls as orchiectomy rates rise after changes in reimbursement in the U.S. Medicare population.", (Cancer. 2008;epub) from Dr. Weight and colleagues at the Cleveland Clinic.

He points out how the Medicare Modernization Act reduced reimbursement for the overly high compensation of LHRH agonist administration. Prior to this, less that 9% of men in the US receiving androgen deprivation therapy (ADT) got orchiectomies. Now orchiectomies are increasing and LHRH agonist use decreasing.

He also points out that most patients treated with ADT do not need it long term, and for them surgical castration would be inappropriate. However, there is no data as to who is now undergoing surgical castration to answer this question. Dr. Chodak feels that the data regarding intermittent ADT is not yet the standard, otherwise surgical castration would be inappropriate for these patients as well.

Since the increase in orchiectomy has not completely offset the drop in LHRH use, he suggests that economics are not the sole reason for the change in practice. The reimbursement rate of an LHRH agonist was 106% of allowable wholesale cost and this could mean a financial loss to the provider if any but one drug spared from this calculation is used. Urologists often give the prescription and ask the patient to take the drug to the clinic for injection to avoid this loss.

He concludes that an open discussion with the patients is best to determine the most appropriate form of ADT in an individual.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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