Declining use of brachytherapy for the treatment of prostate cancer
Introduction
Patients diagnosed with prostate cancer have a number of management options available to them and, in certain situations, deferring treatment altogether may be recommended (1). Historically, the major forms of treatment include surgical management and radiation therapy, which includes external beam radiation therapy (EBRT) and brachytherapy (BT). The development of the ultrasound-guided, transperineal technique in the 1980s led to the rapid adoption of BT for the treatment of prostate cancer a decade later. As a result, previous patterns of care analyses had demonstrated increasing use of BT relative to EBRT [2], [3], [4], [5], [6], [7]. Over the past decade, however, we have witnessed the development of sophisticated EBRT techniques, such as intensity-modulated radiation therapy (IMRT) that, within a short period of time, have replaced the use of conventional EBRT for the treatment of prostate cancer [8], [9]. Whether the proliferation of these novel EBRT techniques has impacted the utilization of BT has not previously been demonstrated.
The Surveillance, Epidemiology, and End Results (SEER) database is a cancer registry overseen by the National Cancer Institute that collects information regarding patient demographics, tumor characteristics, treatment course, and patient survival from approximately 26% of the U.S. population (10). One of its many roles is to allow for assessment of national patterns of cancer care. Using the SEER database, we sought to analyze recent trends in the utilization of EBRT and BT for the treatment of prostate cancer.
Section snippets
Methods and materials
The SEER database (“SEER 18 Regs Research Data +Hurricane Katrina Impacted Louisiana Cases, Nov 2011 Sub [1973–2009 varying]”) was queried using SEER*Stat software, version 7.1.0 to identify men aged 20 years and older diagnosed with locoregionally confined, microscopically confirmed prostate adenocarcinoma (ICD-O-3 morphology code 8140) between 2004 and 2009 (the most recent data available at the time of our analysis). This specific time period was chosen given the limitations of the SEER
Results
A total of 182,123 men were included in our analysis. The number of patients diagnosed, treated with surgery, and treated with radiation therapy are summarized in Fig. 1. As can be seen, the number of patients diagnosed with prostate adenocarcinoma reached a peak in 2007 and subsequently declined. Correspondingly, the number of patients treated with surgery and radiation therapy also reached in a peak in 2007. Of note, however, the number of patients treated with surgery increased relative to
Discussion
Previous studies had demonstrated increasing use of BT relative to EBRT for the treatment of prostate cancer [2], [3], [4], [5], [6], [7]. In the most recent of these studies, for example, Jani et al. (4), using the SEER database, noted that radiation therapy (RT) use steadily increased from 9.1% in 1973 to 26.0% in 2004; and, within RT, EBRT use decreased from 99.3% to 59.3%, whereas BT use increased from 0.0% to 40.7% during the same time period.
Our study, which continues where the study from
Conclusion
In summary, our analysis of this nationwide database reveals evidence of a reversal in the previously increasing utilization of BT for the treatment of prostate cancer. Further followup will be required to determine if this trend persists and for how long. Moreover, further investigation to determine the impact of this trend on health care expenditure is warranted.
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2022, BrachytherapyCitation Excerpt :Patients were included if they met the following criteria: 18 years of age or older, diagnosed with locoregionally confined adenocarcinoma of the prostate (ICD morphology code 8140) between the years of 2010 and 2015. We included locoregionally confined disease to mirror the paper by Mahmood et al. in order to make a meaningful comparison between their study cohort and our own, providing a longitudinal evaluation of brachytherapy trends over time [12]. We chose to start our data collection from 2010 to provide an update from the previously reported data by Mahmood et al., which looked at brachytherapy trends from 2004 to 2009.
Financial disclosures: SF serves as the director of C4 Imaging, Houston, TX.