Declining use of brachytherapy for the treatment of prostate cancer.
OBJECTIVE
To analyze the recent trends in the utilization of external beam radiation therapy (EBRT) and brachytherapy (BT) for the treatment of prostate cancer.


METHODS
Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all patients diagnosed with localized prostate adenocarcinoma between 2004 and 2009 who were treated with radiation as local therapy. We evaluated the utilization of BT, EBRT, and combination BT+EBRT by the year of diagnosis and performed a multivariable analysis to determine the predictors of BT as treatment choice.


RESULTS
Between 2004 and 2009, EBRT monotherapy use increased from 55.8% to 62.0%, whereas all BT use correspondingly decreased from 44.2% to 38.0% (BT-only use decreased from 30.4% to 25.6%, whereas BT+EBRT use decreased from 13.8% to 12.3%). The decline of BT utilization differed by patient race, SEER registry, median county income, and National Comprehensive Cancer Network risk categorization (all p<0.001), but not by patient age (p=0.763) or marital status (p=0.193). Multivariable analysis found that age, race, marital status, SEER registry, median county income, and National Comprehensive Cancer Network risk category were independent predictors of BT as treatment choice (all p<0.001). Moreover, after controlling for all available patient and tumor characteristics, there was decreasing utilization of BT with increasing year of diagnosis (odds ratio for BT=0.920, 95% confidence interval: 0.911-0.929, p<0.001).


CONCLUSIONS
Our analysis reveals decreasing utilization of BT for prostate cancer. This finding has significant implications in terms of national health care expenditure.
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: umahmood@mdanderson.org.
Usama
U
Mahmood
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Thomas
T
Pugh
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Steven
S
Frank
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Lawrence
L
Levy
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Gary
G
Walker
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Waqar
W
Haque
Department of Cellular and Radiation Oncology, University of Chicago, Chicago, IL.
Matthew
M
Koshy
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
William
W
Graber
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
David
D
Swanson
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Karen
K
Hoffman
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Deborah
D
Kuban
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Andrew
A
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States
Brachytherapy; Health expenditures; Prostatic neoplasms; Radiation; Utilization