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Prostate treatment brings questions about conflicts

The nearly 240,000 men in the United States who will be diagnosed with prostate cancer this year have one more thing to worry about: Are their doctors making treatment decisions on the basis of money as much as medicine?

Among several widely used treatments for prostate cancer, one stands out for its profit potential. The approach, a radiation therapy known as IMRT, can mean reimbursement of $47,000 or more per patient.

That is many times the fees that urologists receive for other accepted treatments for the disease, which include surgery and radioactive seed implants. And it may help explain why urologists have started buying multimillion-dollar IMRT equipment and software.

Already, dozens of the nation's 10,000 urologists have purchased intensity modulated radiation therapy technology, which is what IMRT stands for, and some of them are recommending its use for growing numbers of their patients.

Critics see a potential conflict of interest on the part of urologists, the specialists who typically help prostate patients choose a course of treatment. The critics say that urologists who can profit from the new form of therapy may be less likely to recommend other proven approaches, which for some older men can involve forgoing treatment altogether.

Prostate cancer is the second-leading cause of cancer-related death in men, after lung cancer.

Like the other treatments, the new therapy can be highly effective. But doctors say that prostate cancer treatments should be tailored to the individual.

Compared with seed implants, for example, IMRT involves a large time commitment, requiring patients to visit a radiation center 45 times over nine weeks.

Helping drive the trend is a Texas company, Urorad Healthcare, which sells complete packages of IMRT technology and services, and hopes to persuade more urologists to buy them.

"Join the Urorad team and let us show your group how Urorad clients double their practice's revenue," the company says to doctors on its Web site.

Because there is little research directly comparing IMRT with the other treatments, there is little consensus among urologists about which approach is best.

"It's all money-driven, and it's a shame medicine has come down to this," said Dr. Brian Moran, a radiation oncologist in Chicago, who specializes in radioactive-seed implants, in which tiny radioactive pellets are placed into the prostate. His clinic is paid $15,000 or less for the procedure, with the urologist on the case getting about $900.

Dr. Eli Glatstein, a professor of radiation oncology at the University of Pennsylvania, said he was concerned that some urologists would steer patients to the new treatment because they owned the technology and could greatly profit from its use.

"It's not illegal to do this," Glatstein said. "That doesn't make it right."

IMRT can be much more lucrative for doctors who own the technology than alternative treatments. Medicare and other insurers typically pay urologists only $2,000 or less for surgery to remove the prostate or for implanting radioactive seeds. The insurers say the much-higher IMRT payments, which in some cases exceed $50,000, are based on the technology's cost.