Utilization of Prostate Brachytherapy for Low-Risk Prostate Cancer: Is the Decline Overstated?

Abstract

Purpose: Several prior studies have suggested that brachytherapy utilization has markedly decreased, coinciding with the recent increased utilization of intensity modulated radiation therapy, as well as an increase in urologist-owned centers. We sought to investigate the brachytherapy utilization in a large, hospital-based registry.Material and methods: Men with prostate cancer diagnosed between 2004-2012 and treated with either external beam radiation and/or prostate brachytherapy were abstracted from the National Cancer Database. In order to be included, men had to be clinically staged as T1c-T2aNx-0Mx-0, Gleason 6, PSA ≤ 10.0 ng/ml. Descriptive statistics were used to analyze brachytherapy utilization over time and were compared via χ 2 . Multivariate logistic regression was used to assess for covariables associated with increased brachytherapy usage.Results: There were 89,413 men included in this study, of which 37,054 (41.6%) received only external beam radiation, and 52,089 (58.4%) received prostate brachytherapy. The use of brachytherapy declined over time from Conclusions: In this hospital-based registry, prostate brachytherapy usage has declined for low risk prostate cancer as intensity modulated radiation therapy usage has increased. However, it still remains the treatment of choice for 51.3% of patients as of 2012.

National trends in management of localized prostate cancer: A population based analysis 2004‐2013

“…23 Several possibilities have been suggested to explain this trend, including increased utilization of robotic assisted surgery, replaced by IMRT, and newer therapies such as Stereotactic body radiotherapy (SBRT), 24,25 and possibly financial incentives. 26 In our study, we noted that the sharpest decline in brachytherapy occurred in low-risk patients as the expense of dramatic increased utilization of expectant management, in which group rates of brachytherapy decreased by 19%.…”

AAPM BTSC Report 377: Physicist Brachytherapy Training in 2021—A survey of therapeutic medical physics residency program directors

“…While this may reflect the inability of an individual to change practice patterns at their institution, some expressed the feeling that BT use was declining following the patterns of care described earlier. 1 , 2 , 3 , 4 , 5 , 6 Collaboration with other institutions, fellowship programs, and AAPM‐sponsored cross‐training were ideas that would allow more hands‐on opportunities.…”

“…Recently, there has been a decline in the utilization of BT as a treatment option. 1 , 2 , 3 , 4 , 5 While this decline has clear implications for public health and cancer morbidity, there are related challenges inherent in training future generations of brachytherapists. 1 , 2 , 3 , 4 , 5 , 6 Declining utilization directly correlates with declining opportunities for medical physicists in training to attend BT procedures.…”

“… 1 , 2 , 3 , 4 , 5 While this decline has clear implications for public health and cancer morbidity, there are related challenges inherent in training future generations of brachytherapists. 1 , 2 , 3 , 4 , 5 , 6 Declining utilization directly correlates with declining opportunities for medical physicists in training to attend BT procedures. The path to American Board of Radiology certification for a therapeutic medical physicist now requires a residency to prepare for providing clinical services.…”

“…Brachytherapy (BT) is an important radiotherapy modality that has been in use for various types of cancer treatments for over a century. Recently, there has been a decline in the utilization of BT as a treatment option 1–5 . While this decline has clear implications for public health and cancer morbidity, there are related challenges inherent in training future generations of brachytherapists 1–6 .…”