title: 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.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Martin
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Handorf
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bekelman
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horwitz
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D004522:Educational Status; D006801:Humans; D007182:Income; D007348:Insurance, Health; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000191:economics / Q000208:ethnology / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012042:Registries; D012424:Rural Population / Q000706:statistics & numerical data; D013383:Suburban Population / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D014600:Utilization Review
keywords: brachytherapy; clinical practice patterns; prostatectomy; prostatic neoplasms; radiotherapy; use
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