title: Utilization of prostate brachytherapy for low risk prostate cancer: Is the decline overstated?
abstract: OBJECTIVE
  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.
  
  
  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 62.9% in 2004 to 51.3% in 2012 (p < 0.001). This decline was noted in both academic facilities (60.8% in 2004 to 47.0% in 2012, p < 0.001) as well as in non-academic facilities (63.7% in 2004 to 53.0% in 2012, p < 0.001). The decline was more pronounced in patients who lived closer to treatment facilities than those who lived further. The use of intensity modulated radiation therapy increased during this same time period from 18.4% in 2004 to 38.2% in 2012 (p < 0.001). On multivariate analysis, treatment at an academic center, increasing age, decreasing distance from the treatment center, and years of diagnosis from 2006-2012 were significantly associated with reduced brachytherapy usage.
  
  
  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.
authors.affiliation: Department of Veteran Affairs, NY Harbor Campus, Brooklyn, NY; SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Safdieh
authors.affiliation: Department of Veteran Affairs, NY Harbor Campus, Brooklyn, NY; SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wong
authors.affiliation: Department of Veteran Affairs, NY Harbor Campus, Brooklyn, NY; SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Weiner
authors.affiliation: Department of Veteran Affairs, NY Harbor Campus, Brooklyn, NY; SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: Department of Veteran Affairs, NY Harbor Campus, Brooklyn, NY; SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schreiber
keywords: NCDB; brachytherapy; low risk; prostate cancer