title: Impact of national guidelines on brachytherapy monotherapy practice patterns for prostate cancer.
abstract: BACKGROUND
  In 1999 and 2000, 2 national guidelines recommended brachytherapy monotherapy (BT) primarily for treatment of low-risk prostate cancer but not high-risk prostate cancer. This study examined rates of BT use before and after publication of these guidelines, as compared with 4 other treatment options.
  
  
  METHODS
  From 1990 to 2011, 8128 men with localized prostate cancer (≤ T3cN0M0) were treated definitively within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry with 1 of 5 primary treatments: BT, external beam radiotherapy (EBRT), EBRT with androgen deprivation therapy, EBRT+BT, or radical prostatectomy. Men were categorized into low-, intermediate-, and high-risk groups based on the guidelines' risk-group definitions. Within each risk group, logistic regression was used to estimate odds ratios (OR) comparing BT with other treatment options between the 1990-1998 and 1999-2011 periods, adjusting for age, disease characteristics, and clinic type.
  
  
  RESULTS
  In total, 1117 men received BT alone for low- (n = 658), intermediate- (n = 244), or high-risk disease (n = 215). BT comprised 6.1% of all treatments in 1990-1998 versus 16.6% in 1999-2011 (P < .01). The odds of BT use remained increased after adjusting for potential confounders (OR = 3.06; P < .001) and was seen among low- (OR = 4.52; P < .001), intermediate- (OR = 2.67; P < .001), and even high-risk groups (OR = 2.11; P < .001).
  
  
  CONCLUSIONS
  National guidelines did not appear to influence practice patterns, as BT monotherapy use increased relative to other treatments from the 1990-1998 to 1999-2011 periods in unfavorable risk groups including men with high-risk prostate cancer.
authors.affiliation: Harvard Radiation Oncology Program, Boston, Massachusetts.
authors.forename: Yolanda D
authors.initials: YD
authors.lastname: Tseng
authors.forename: Alan T
authors.initials: AT
authors.lastname: Paciorek
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy / Q000592:standards*; D015331:Cohort Studies; D018572:Disease-Free Survival; D006291:Health Policy; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D061766:Proton Therapy; D013534:Survival; D015996:Survival Rate
chemical_list: D000726:Androgen Antagonists
keywords: brachytherapy; guidelines; prostate cancer; public health policy; radiotherapy