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Use of brachytherapy for localized prostate cancer has declined
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The use of brachytherapy for localized prostate cancer has declined at National Cancer Data Base institutions since 2003, even among low-risk patients for whom more costly approaches might not be necessary, according to study results.
Researchers used the National Cancer Data Base to evaluate data from more than 1.5 million patients with prostate cancer who did not have lymph node-positive or metastatic disease. The data covered 1998 through 2010.
The most common treatments administered to these patients were surgery (49.8%), non-brachytherapy radiotherapy (26.3%), hormone therapy (24.1%), brachytherapy (13.4%) and no therapy (7.8%).
The rate for brachytherapy was highest in 2002 (16.9%) and declined steadily to 8.2% in 2010 (P˂.001).
National Comprehensive Cancer Network risk stratification data were available from 719,789 patients. Data showed 41.1% had low-risk prostate cancer, 35.3% had intermediate-risk disease and 23.6% high-risk disease.
Adjusted analyses indicated patients were less likely to undergo brachytherapy if there were Hispanic (OR=0.89; 95% CI, 0.84-0.94), had intermediate-risk disease (OR=0.67; 95% CI, 0.65-0.69), had high-risk disease (OR=0.40; 95% CI, 0.38-0.42) or had Medicaid insurance (OR=0.88; 95% CI, 0.81-0.95).
Use of brachytherapy was more likely among patients with Medicare (OR=1.10; 95% CI, 1.06-1.15), and it increased according to age from patients aged 51 to 60 years (OR=1.65; 95% CI, 1.57-1.74) to those aged 71 years and older (OR=2.30; 95% CI, 2.10-2.51).
“Prior studies have consistently demonstrated that brachytherapy is among the most cost-effective treatment options for patients with localized prostate cancer,” the researchers wrote. “Identifying barriers to the use of brachytherapy may be an attractive alternative to emerging technologies for patients with low-risk and intermediate-risk prostate cancer who are poor candidates for or who are not interested in active surveillance.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopWilliam Lowrance, MD, MPH
Their findings are fascinating, in that they show the rates of brachytherapy decreasing simultaneously as the rates of radical prostatectomy increased. The popularity and novelty of robotic radical prostatectomy undoubtedly impacted the utilization of brachytherapy in men with prostate cancer during this study period.
This study is somewhat limited in that it only examines data through 2010. Other more contemporary data show decreasing rates in both radical prostatectomy and other forms of definitive therapy for men with lower-risk prostate cancer over the last few years. It appears that active surveillance is gaining ground as a treatment option as more patients understand that low-risk prostate cancer often does not necessitate definitive therapy.
The implementation of new treatment technologies for prostate cancer will continue to alter the utilization of traditional therapies. As a result, we need to closely study these treatment trends, and strive to better understand what drives the usage of various prostate cancer treatments.
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