The rise and fall of prostate brachytherapy: use of brachytherapy for the treatment of localized prostate cancer in the National Cancer Data Base

Abstract

Background: Brachytherapy has been shown to be an efficacious and cost-effective treatment among patients with localized prostate cancer. In this study, the authors examined trends in brachytherapy use for localized prostate cancer using a large national cancer registry.

Methods: In the National Cancer Data Base (NCDB), a total of 1,547,941 patients with localized prostate cancer were identified from 1998 through 2010. Excluding patients with lymph node-positive or metastatic disease, the authors examined primary treatment trends focusing on the use of brachytherapy over time. Patients with available data (2004-2009) were stratified by National Comprehensive Cancer Network risk criteria. Controlling for year of diagnosis and demographic, clinical, and pathologic characteristics, multivariate analyses were performed examining the association between patient characteristics and receipt of brachytherapy.

Results: In the study cohort, brachytherapy use reached a peak of 16.7% in 2002, and then steadily declined to a low of 8% in 2010. Of the 719,789 patients with available data for risk stratification, 41.1%, 35.3%, and 23.6%, respectively, met low, intermediate, and high National Comprehensive Cancer Network risk criteria. After adjustment, patients of increasing age and those with Medicare insurance were more likely to receive brachytherapy. In contrast, patients with intermediate-risk or high-risk disease, Medicaid insurance, increasing comorbidity count, and increasing year of diagnosis were less likely to receive brachytherapy.

Conclusions: For patients with localized prostate cancer who are treated at National Cancer Data Base institutions, there has been a steady decline in brachytherapy use since 2003. For low-risk patients, the declining use of brachytherapy monotherapy compared with more costly emerging therapies has significant health policy implications.

Keywords: brachytherapy; clinical practice patterns; prostatectomy; prostatic neoplasms; radiotherapy; use.

Figure 1

Initial therapy for patients with newly diagnosed localized prostate cancer is shown as a percentage. Brachy indicates brachytherapy.

Figure 2

(a) Percentage of patients treated with brachytherapy alone by year from 2004 through 2009 is shown stratified by National Comprehensive Cancer Network risk grouping. (b) Percentage of patients treated with brachytherapy boost by year from 2004 through 2009 is shown stratified by National Comprehensive Cancer Network risk grouping.

Figure 3

Receipt of prostate brachytherapy is shown by type of facility. Comp. Comm. indicates comprehensive community cancer program.