Medicare to cover controversial prostate treatment

Medicare in this region will cover a controversial radiation treatment for prostate cancer that takes fewer days than the most common type of external radiation.

Highmark Medicare Services Inc., which administers payments for 4.2 million Medicare subscribers from Washington, D.C., to Pennsylvania and New Jersey, was considering dropping coverage for stereotactic body radiotherapy (SBRT). Several machines can deliver this treatment, but it is most commonly associated with CyberKnife, made by Accuray Inc. Accuray mounted a public relations campaign against the proposed rule change.

The American Society for Radiation Oncology said last year that SBRT is promising but not yet well proven. Supporters of SBRT say it is cheaper and faster than the more common IMRT (intensity modulated radiation therapy) and that early results are comparable. Men typically get about 40 treatments over eight weeks with IMRT and five higher doses over a week or two with SBRT.

In its decision, effective Oct. 28, Highmark acknowledged that data about treatment with SBRT "is of short term duration relative to the natural history of prostate cancer." It requires doctors to document why they've chosen SBRT and that patients were told about other options.

In a statement, Highmark said its decision "reflects feedback from the provider community . . . and the current state of clinical research of this treatment." It said it will "continue to review the medical literature regarding the clinical effectiveness of this treatment."

Quentin Heim, Accuray's vice president for patient access, said the decision is "great news for patients and shows that the process works." He called the documentation requirements "entirely reasonable."