title: Comparative effectiveness of cryotherapy vs brachytherapy for localised prostate cancer.
abstract: Despite the increased popularity of emerging therapies for localised prostate cancer, such as cryotherapy and brachytherapy, outcomes data remains sparse beyond single-centre comparative studies. The present study identified that although less costly, cryotherapy was associated with more urinary and ED complications and a greater need for salvage ADT. Conversely, cryotherapy was associated with fewer bowel complications. Patients and providers alike should consider these population-based outcomes when discussing therapeutic options for localised prostate cancer.
  
  
  OBJECTIVE
  To compare prostate cryotherapy vs brachytherapy outcomes and costs, as despite the greater popularity of these emerging therapies for localised prostate cancer, outcomes data remains sparse beyond single-centre comparative studies.
  
  
  METHODS
  Observational study of 10 928 men who underwent primary cryotherapy (943 patients) or brachytherapy (9985) with ≥2 years of follow-up using USA Surveillance, Epidemiology, and End Results (SEER-) Medicare linked data. Weighted propensity score methods were used.
  
  
  RESULTS
  Use of cryotherapy increased four-fold whereas brachytherapy utilization remained the same from 2001 to 2005 (P < 0.001). Men who underwent cryotherapy vs brachytherapy were older (P < 0.001), more likely to be Black (P < 0.001), less likely to live in areas of higher education (P < 0.001), less likely to live in areas with greater income (P < 0.001), and were more likely to live in urban vs rural areas (P = 0.007). In propensity score-weighted analyses, cryotherapy was associated with more urinary (41.4% vs 22.2%, P < 0.001) and erectile dysfunction (ED) complications (34.7% vs 21.0%, P < 0.001) while brachytherapy was associated with more bowel complications (19.0% vs 12.1%, P < 0.001). Cryotherapy was associated with greater use of salvage androgen deprivation therapy (ADT; 1.4 vs 0.5 per 100 person-years, P < 0.001), suggesting worse cancer control. Finally costs were significantly greater for brachytherapy vs cryotherapy ($16 887 vs $12 629 USA dollars, P < 0.001).
  
  
  CONCLUSIONS
  Although less costly, cryotherapy was associated with more urinary and ED complications and greater need for salvage ADT. Conversely, cryotherapy was associated with fewer bowel complications. Patients and providers alike should consider these population-based outcomes when discussing therapeutic options for localised prostate cancer.
authors.affiliation: Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. swilliams22@partners.org
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Williams
authors.forename: Yin
authors.initials: Y
authors.lastname: Lei
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Gu
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Hua-Yin
authors.initials: HY
authors.lastname: Yu
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017679:Cryotherapy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008297:Male; D057216:Propensity Score; D011471:Prostatic Neoplasms / Q000628:therapy*; D012959:Socioeconomic Factors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D000970:Antineoplastic Agents