Follow-up costs after external radiation for low risk prostate cancer

Some routine follow-up costs for external radiation for prostate cancer might not be justifiable. To study this possibility, we reviewed the follow-up costs and clinical course of 36 consecutive, unselected patients treated with external beam radiation (EBRT) for low-risk prostate cancer at the University of Washington.

Thirty-six consecutive patients with Stage T1/T2 prostate cancer and pretreatment prostate specific antigen (PSA) < 10 ng/ml were treated with EBRT with curative intent at the University of Washington from 1990 through 1996. All follow-up visits with each patient's urologist and radiation oncologist, and all laboratory tests were tabulated. Charges quoted in this report are based on University of Washington billing.

A total of 8 patients demonstrated biochemical evidence of tumor progression/persistence, none of whom has had any therapeutic intervention for progressive cancer. No patient had local disease progression by physical examination. One patient experienced a Radiation Therapy Oncology Group (RTOG) grade 3 bowel complication (obstruction), not detected on routine follow-up. The average combined PSA and physician follow-up charges for the first 2 years after therapy was $1,013.

The data presented here suggests that for low-risk prostate cancer (PSA < 10 ng/ml), frequent follow-up by physical examinations and PSAs during the first 2 years after therapy is not warranted.