title: Trends in the use of radiation therapy for stage IIA prostate cancer from 2004 to 2013: a retrospective analysis using the National Cancer Database.
abstract: Recent studies have shown a decrease in the overall use of radiation therapy in the treatment of prostate cancer over the past several decades, as well as a more conservative overall treatment approach. We aim to determine whether this trend continued from 2004 to 2013, and to determine whether there were changes in utilization for various types of radiation.
  
  
  
  We conducted this retrospective study using the National Cancer Database. We identified 706 877 patients with sufficient treatment information diagnosed with stage IIA prostate cancer between 2004 and 2013. Logistic regression models were used to evaluate the yearly trend in radiation therapy utilization.
  
  
  
  There was a significant decline in the use of radiation therapy from 2004 to 2013, from 54.4% in 2004 to 34.5% in 2013 compared with all the other treatments. The use of external beam radiation therapy (EBRT) declined from 27.1% in 2004 to 25.0% in 2013, brachytherapy declined from 19.7% in 2004 to 6.1% in 2013, and combination therapy declined from 6.8% in 2004 to 2.6% in 2013. However, when considering only patients receiving radiation treatments, the use of EBRT steadily increased from 50.6% in 2004 to 74.0% in 2013, whereas the use of brachytherapy declined from 36.7% in 2004 to 18.2% in 2013. Finally, although the proportion of patients receiving combination radiation therapy initially declined from 2004 to 2009 (from 12.7 to 8.3%), there was little change in utilization from 2009 to 2013 (8.3 to 8.5%).
  
  
  
  There has been a significant decline in the use of overall radiation therapy, as well as for each radiotherapy modality, for the treatment of prostate cancer since 2004. For patients that are receiving radiation, the use of EBRT has increased while brachytherapy use has decreased. These data serve to encourage further analysis as to the causes of these trends and how they affect patient care.
authors.affiliation: Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: T
authors.initials: T
authors.lastname: Malouff
authors.affiliation: Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: N W
authors.initials: NW
authors.lastname: Mathy
authors.affiliation: Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: S
authors.initials: S
authors.lastname: Marsh
authors.affiliation: Department of Medicine, CHI Health Creighton University Medical Center, Omaha, NE, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Walters
authors.affiliation: Department of Hematology/Oncology, CHI Health Creighton University Medical Center, Omaha, NE, USA.
authors.forename: P T
authors.initials: PT
authors.lastname: Silberstein
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000639:trends*; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome