{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T03:01:28Z","timestamp":1789095688198,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2025,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Radical prostatectomy (RP) and radiotherapy (RT) are standard\u2010of\u2010care treatments for localized prostate cancer. The authors studied the utilization and total health care and patient\u2010incurred costs of RP and RT in the United States using the Merative MarketScan Medicare (Medicare Supplemental and Coordination of Benefits [MDCR]) and Commercial (Commercial Claims and Encounters [CCAE]) databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Men were identified who had nonmetastatic prostate cancer treated with RP, external\u2010beam RT (EBRT), brachytherapy (BT), EBRT combined with BT (EBRT\u00a0+\u00a0BT), stereotactic body RT (SBRT), or proton\u2010beam therapy (PBT) between 2009 and 2022. Year\u2010to\u2010year treatment utilization was compared using the Kendall Tau\u2010b test. Mean total health care and patient out\u2010of\u2010pocket costs within 12 months of treatment were compared using the Kruskal\u2013Wallis test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the MDCR database, 44,937 patients were identified who received treatment with RP (<jats:italic>n<\/jats:italic>\u00a0=\u00a012,879), EBRT (<jats:italic>n<\/jats:italic>\u00a0=\u00a026,193), BT (<jats:italic>n<\/jats:italic>\u00a0=\u00a0926), EBRT\u00a0+\u00a0BT (<jats:italic>n<\/jats:italic>\u00a0=\u00a04706), PBT (<jats:italic>n<\/jats:italic>\u00a0=\u00a057), or SBRT (<jats:italic>n<\/jats:italic>\u00a0=\u00a0176). Between 2009 and 2021, EBRT use increased from 52.5% to 62.2% (<jats:italic>p<\/jats:italic> for trend\u00a0&lt;\u00a0.001), SBRT increased from 0.4% to 0.5% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), BT decreased from 3.1% to 1.0% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), and EBRT\u00a0+\u00a0BT decreased from 14.8% to 6.8% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001); whereas use remained similar for RP (from 29.1% to 29.4%; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.82) and PBT (from 0.1% to 0.1%; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.93). In the CCAE database, 75,626 patients were identified who received treatment with RP (<jats:italic>n<\/jats:italic>\u00a0=\u00a050,278), EBRT (<jats:italic>n<\/jats:italic>\u00a0=\u00a016,985), BT (<jats:italic>n<\/jats:italic>\u00a0=\u00a01243), EBRT\u00a0+\u00a0BT (<jats:italic>n<\/jats:italic>\u00a0=\u00a06811), PBT (<jats:italic>n<\/jats:italic>\u00a0=\u00a092), or SBRT (<jats:italic>n<\/jats:italic>\u00a0=\u00a0217). EBRT use increased from 20.0% to 24.9% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), SBRT increased from 0.1% to 0.8% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), BT decreased from 2.5% to 0.7% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), and EBRT\u00a0+\u00a0BT decreased from 10.6% to 7.4% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001); whereas use remained similar for RP (from 66.8% to 66.1%; <jats:italic>p<\/jats:italic> for trend\u00a0=\u00a0.82), and PBT (from 0.1% to 0.1%; <jats:italic>p<\/jats:italic> for trend\u00a0=\u00a0.76). In the MDCR and CCAE databases, PBT had the highest total cost, whereas BT had the lowest.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Between 2009 and 2021, there was increasing use of EBRT and SBRT, whereas use of RP remained stable. Although BT was the least costly, its utilization as monotherapy and combined with EBRT declined.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.35795","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T17:11:49Z","timestamp":1741713109000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Utilization, health care expenditures, and patient costs of definitive treatment modalities for localized prostate cancer in the United States"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3977-7867","authenticated-orcid":false,"given":"Nikhil T.","family":"Sebastian","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8242-9825","authenticated-orcid":false,"given":"Dattatraya","family":"Patil","sequence":"additional","affiliation":[{"name":"Department of Urology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pretesh R.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashesh B.","family":"Jani","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce W.","family":"Hershatter","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal R.","family":"Dhere","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen D.","family":"Godette","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8943-9049","authenticated-orcid":false,"given":"C. Adam","family":"Lorentz","sequence":"additional","affiliation":[{"name":"Department of Urology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron D.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Urology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0020-5298","authenticated-orcid":false,"given":"Shreyas S.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Urology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin G.","family":"Sanda","sequence":"additional","affiliation":[{"name":"Department of Urology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagar A.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Winship Cancer Institute Emory University  Atlanta Georgia USA"},{"name":"Department of Urology Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21820"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0587"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2214122"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.22.01856"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2022.11.005"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(19)31131\u20106"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1470\u20102045(22)00517\u20104"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.07.2335"},{"key":"e_1_2_9_10_1","unstructured":"Massachusetts General Hospital.Proton therapy vs. IMRT for low or intermediate risk prostate cancer (PARTIQoL). Accessed August 26 2024.https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01617161"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.14338\/ijpt\u201020\u201000031.1"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0895\u20104356(00)00256\u20100"},{"key":"e_1_2_9_13_1","volume-title":"Income in the United States: 2021","author":"US Census Bureau","year":"2022"},{"key":"e_1_2_9_14_1","volume-title":"Measuring Price Change in the CPI: Medical Care","author":"US Bureau of Labor Statistics","year":"2024"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2023.4267"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11934\u2010010\u20100102\u2010z"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32604"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41391\u2010019\u20100157\u2010y"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1078\u20101439(98)00025\u20108"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010020\u201005656\u2010x"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2015.09.018"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.19941"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.12214"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2012.04.002"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2018.07.009"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2016.11.026"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.10.023"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2019.07.001"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.12.024"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1200\/op.21.00347"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.21037\/tau.2017.12.38"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.35795","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T16:56:58Z","timestamp":1760288218000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.35795"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,3,15]]}},"alternative-id":["10.1002\/cncr.35795"],"URL":"https:\/\/doi.org\/10.1002\/cncr.35795","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]},"assertion":[{"value":"2024-11-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e35795"}}