title: Patient characterization and usage trends of proton beam therapy for localized prostate cancer in the United States: A study of the National Cancer Database.
abstract: To evaluate usage trends and identify factors associated with proton beam therapy (PBT) compared to alternative forms of external beam radiation therapy (RT) (EBRT) for localized prostate cancer.
  
  
  
  The National Cancer Database was queried for men with localized (N0, M0) prostate cancer diagnosed between 2004 and 2013, treated with EBRT, with available data on EBRT modality (photon vs. PBT). Binary multiple logistic regression identified variables associated with EBRT modality.
  
  
  
  In total, 143,702 patients were evaluated with relatively few men receiving PBT (5,709 [4.0%]). Significant differences in patient and clinical characteristics were identified between those men treated with PBT compared to those treated with photon (odds ratio [OR]; 95% CI). Patients treated with PBT were generally younger (OR = 0.73; CI: 0.67-0.82), National Comprehensive Cancer Network low-risk compared to intermediate (0.71; 0.65-0.78) or high (0.44; 0.38-0.5) risk, white vs. black race (0.66; 0.58-0.77), with less comorbidity (Charlson-Deyo 0 vs. 2+; 0.70; 0.50-0.98), live in higher income counties (1.55; 1.36-1.78), and live in metropolitan areas compared to urban (0.21; 0.18-0.23) or rural (0.14; 0.10-0.19) areas. Most patients treated with PBT travelled more than 100 miles to the treatment facility. Annual PBT utilization significantly increased in both total number and percentage of EBRT over time (2.7%-5.6%; P<0.001). PBT utilization increased mostly in men classified as National Comprehensive Cancer Network low-risk (4%-10.2%).
  
  
  
  PBT for men with localized prostate cancer significantly increased in the United States from 2004 to 2013. Significant demographic and prognostic differences between those men treated with photons and protons were identified.
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: David
authors.initials: D
authors.lastname: Raben
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO.
authors.forename: E David
authors.initials: ED
authors.lastname: Crawford
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Flaig
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Kessler
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO.
authors.forename: Elaine T
authors.initials: ET
authors.lastname: Lam
authors.affiliation: Department of Surgery, School of Medicine, University of Colorado, Aurora, CO.
authors.forename: Paul
authors.initials: P
authors.lastname: Maroni
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO. Electronic address: thomas.pugh@ucdenver.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Pugh
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D054547:National Cancer Institute (U.S.); D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D061766:Proton Therapy / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States / Q000453:epidemiology
keywords: National Cancer Database (NCDB); Patterns of care; Photons; Prostate cancer; Protons; Utilization