Peter F. Orio III, DO, MS

Peter F. Orio III, DO, MS

Dana-Farber Brigham Cancer Centers / Harvard Medical School

Boston, Massachusetts

Peter F. Orio III, DO, MS, is Vice Chair of Network Operations for the Dana Farber Brigham Cancer Centers in Boston, Massachusetts. He also serves as the Director of Prostate Brachytherapy for the Dana Farber Brigham Cancer Centers and is an Associate Professor at Harvard Medical School. Dr. Orio earned his Bachelor of Arts in Biology/Psychology from the College of the Holy Cross, his Master’s of Science in Public Health from the University of Massachusetts at Amherst and his Doctor of Osteopathic Medicine degree from the University of New England College of Osteopathic Medicine. He completed his residency in radiation oncology at the University of Washington Medical Center. Dr. Orio served in the US Army as Assistant Chief of Radiation Oncology at Brooke Army Medical Center, where he rose to the rank of Lieutenant Colonel. Dr. Orio is active in the American Brachytherapy Society (ABS) and the American Society for Radiation Oncology (ASTRO), focusing his efforts on the advancement of brachytherapy for prostate cancer and the socioeconomics of medicine.


Talks by Peter F. Orio III, DO, MS

New Spacer Technology for Prostate Cancer Radiation Therapy

Peter F. Orio III, DO, MS, discusses the critical role of rectal spacing in reducing the toxicity associated with radiation therapies in the treatment of prostate cancer. While not yet FDA approved, Dr. Orio reviews several pivotal trials on SpaceOAR and Barrigel which support the use of rectal spacing technology in prostate cancer treatment.

Dr. Orio underscores the role of rectal spacing technology in a patient-centric approach to cancer care. Throughout his presentation, Dr. Orio focuses on the mechanisms behind rectal spacing technology which preserve patient quality of life more effectively than traditional approaches when done correctly.

Dr. Orio then reviews the weaknesses and dangers of rectal spacer technology and analyzes reports in the FDA MAUDE database for SpaceOAR Classic, SpaceOAR Vue, and Barrigel. He cautions physicians and surgeons to know their own skill-level and to always choose the safety of the patient.

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Treatment of Localized Disease

Peter F. Orio III, DO, MS, discusses the treatment of localized prostate cancer, with emphasis on maximizing the value for the patient. Dr. Orio explains Michael Porter’s equation for determining patient value: patient-relevant outcomes, divided by the cost to achieve the outcomes.

Dr. Orio then reviews the benefits and limitations of common treatments for prostate cancer, including:

External Beam Radiation Therapy with and without Androgen Deprivation Therapy
Radical Prostatectomy with and without Pelvic Lymph Node Dissection
Focal Therapies

Dr. Orio concludes by emphasizing that the goal of treatment is to cure the patient and avoid reducing QoL as much as possible. As long as the physician keeps that goal top of mind, the journey to remission will be different for every patient

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Identification of Localized Disease

Peter F. Orio III, DO, MS, discusses the process of identifying localized prostate cancer. Dr. Orio emphasizes that prostate cancer is a spectrum of disease, rather than a binary, as prostate cancer is not necessarily confined to the prostate organ alone, and that the ultimate goal of treatment is reduction of harm to the patient’s future self.

Dr. Orio reviews the current screening, imaging, and testing steps to identifying localized prostate cancer, including the best candidates for screening. He notes that mandatory DREs discourages patients from coming in to the urologist, and suggests that screening should eliminate them.

Dr. Orio offers the more sensitive and less invasive PSA tests in combination with MRIs as an alternative first step in screening. He concludes by offering PSA – MRI – Fusion Biopsy – Germline Testing – FHX – FNX Imaging as the new path for screening and identifying localized prostate cancer.

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The Wild, Wild West of Radiation Oncology: An Update on Radiation Tools, Toys and Trials

In this 12-minute presentation, Peter F. Orio III, DO, MS, Vice Chair of Network Operations for Dana-Farber/Brigham and Women’s Cancer Center Department of Radiation Oncology and Associate Professor of Radiation Oncology at Harvard Medical School in Boston, Massachusetts, explains prostate brachytherapy is effective, efficient, and convenient, and he says it is “the right thing to do for patients.” He sees a threat to patients posed by radiation oncology without brachytherapy and concludes by encouraging urologists to explore a broad range of treatments to maximize the benefit to patients.

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Socioeconomic Aspects of Prostate Brachytherapy

As part of a special course on brachytherapy for prostate cancer from the American Brachytherapy Society (ABS) and Grand Rounds in Urology, Peter F. Orio III, DO, MS, Vice Chair of Network Operations for Dana-Farber/Brigham and Women’s Cancer Center Department of Radiation Oncology and Associate Professor of Radiation Oncology at Harvard Medical School in Boston, Massachusetts, discusses socioeconomic influences on the use of prostate brachytherapy. He begins by listing nine factors that he believes have led to a decline in the use of prostate brachytherapy: (1) a decrease in PSA screening and prostate cancer diagnosis; (2) an increase in patients electing active surveillance; (3) Nuclear Regulatory Commission requirements; (4) an increase in the number of robotic prostatectomies; (5) a suboptimal volume of prostate brachytherapy procedures being performed; (6) negative press about brachytherapy from procedures performed at the Philadelphia VA; (7) the increased technical sophistication of external beam radiation technologies; (8) a lack of knowledge of brachytherapy’s efficacy; and, most significantly, (9) markedly decreased reimbursement rates for brachytherapy. Focusing on this last point, Dr. Orio considers a report by the Government Accountability Office which found that if there was a self-referring interest in a center that offered intensity-modulated radiation therapy (IMRT), use of IMRT would increase by about 50%, while radical prostatectomies would decrease by 27% and brachytherapy procedures would decrease by 50%. He explains that in a fee-for-service model, a treatment like brachytherapy which requires one implant is reimbursed for far less than a treatment like IMRT which requires weeks of treatment over the course of multiple sessions. This creates, Dr. Orio argues, a disincentive to perform brachytherapy even though it is less expensive and results in better quality of life than IMRT. He suggests that implementation of the radiation oncology alternative payment model (RO-APM) may solve this problem. Dr. Orio explains that the RO-APM, which is being tested in certain zip codes, represents a shift to value-based care and is intended to simplify coding and reduce Medicare costs. Under the RO-APM, he notes, regardless of the modality of treatment, the payment is the same, so brachytherapy monotherapy will likely benefit from an increase in payment. Dr. Orio concludes that the RO-APM may lead to a resurgence in prostate brachytherapy by removing financial disincentives to performing the procedure.

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