Claims-Based Analysis of National Utilization Patterns and Regional Variability of Prostate Cancer Ablative Therapies: A Medicare Study

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BACKGROUND: Focal ablative therapy is an alternative treatment option for selected patients with prostate cancer. Despite growing interest, its initial adoption in the United States has been limited, and its real-world utilization remains insufficiently characterized at the national level. With recent expansions in Medicare coverage, we aimed to use national claims data to analyze the utilization patterns and regional variability in ablative therapies across the United States. METHODS: We analyzed 100% Medicare claims data to identify patients newly diagnosed with prostate cancer from 2019 to 2023 who underwent ablative therapies, including high-intensity focused ultrasound, cryoablation, and laser ablation. Regional variability was assessed by hospital referral regions, which are designed to capture regional health care markets. We conducted descriptive analyses to examine the uptake of ablative therapies across sociodemographic and clinical variables, including metro, urban, or rural residence (from most to least densely populated areas), United States region, age, race, Medicare/Medicaid eligibility factors, year of diagnosis, and comorbidities. RESULTS: We identified 5462 Medicare beneficiaries newly diagnosed with prostate cancer who underwent ablative therapies from 2019 to 2023, with a median age of 73 years. Most patients were White (84.9%) and had multiple comorbidities (81.1%). Ablative therapies were more commonly performed in metro areas (78.8%) and the South region (39.6%), with utilization rates varying across 306 hospital referral regions from 0% to 6.13% of newly diagnosed prostate cancer cases. Cryotherapy (74.9%) and high-intensity focused ultrasound (24.3%) were the most frequently used ablation techniques. CONCLUSIONS: Despite expanded insurance coverage, ablative therapies remain infrequently used for prostate cancer, with substantial regional variations in their adoption. These findings highlight the need for continued data collection and outcomes evaluation to define the optimal use of ablative therapy in prostate cancer care.

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