Declining utilization of prostate brachytherapy.

[pjoshea13]

New U.S. study below. [1]

"We analyzed 178,837 patients {from the National Cancer Database (NCDB)} with localized adenocarcinoma of the prostate treated between 2010 and 2015 with radiation therapy."

"During this period, the use of EBRT {external beam radiation} increased from 67% to 78%,

"BT {brachytherapy} (both monotherapy and combination with EBRT) decreased from 33% to 22%,

"BT monotherapy decreased from 25% to 16% and

"EBRT + BT decreased from 8% to 6%."

"Age >70, government funded insurance or lack of insurance, intermediate or high-risk disease and treatment at an academic center were associated with significantly lower utilization of brachytherapy .., while higher median zip code income was associated with increased use"

I wonder how the trend compares to other countries?

And how the trend has been these past 5 years?

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/344...

Brachytherapy

. 2021 Aug 19;S1538-4721(21)00454-2. doi: 10.1016/j.brachy.2021.07.004. Online ahead of print.

PSA: Declining utilization of prostate brachytherapy

Lauren Andring 1 , Alison Yoder 2 , Todd Pezzi 2 , Chad Tang 2 , Rachit Kumar 3 , Usama Mahmood 4 , Gary V Walker 3

Affiliations collapse

Affiliations

1 Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX. Electronic address: [e-mail].

2 Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX.

3 Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ.

4 Department of Radiation Oncology, Torrance Memorial Medical Center, Torrance, CA.

PMID: 34420862 DOI: 10.1016/j.brachy.2021.07.004

Abstract

Purpose: To analyze rates of brachytherapy use for prostate cancer over time and evaluate patient characteristics, demographics and factors predictive for its utilization.

Methods: Data was retrospectively analyzed from the National Cancer Database (NCDB) for patients with localized prostate cancer treated between 2010 and 2015. Patients were included if they had biopsy confirmed localized adenocarcinoma of the prostate, were treated with radiation as definitive local therapy, and were at least 18 years old. Utilization rates of external beam radiation (EBRT), brachytherapy (BT) and combination (EBRT + BT) were evaluated over time. Univariable (UVA) and backwards elimination multivariable (MVA) analysis were performed to determine characteristics predictive for brachytherapy use.

Results: We analyzed 178,837 patients with localized adenocarcinoma of the prostate treated between 2010 and 2015 with radiation therapy. During this period, the use of EBRT increased from 67% to 78%, BT (both monotherapy and combination with EBRT) decreased from 33% to 22%, BT monotherapy decreased from 25% to 16% and EBRT + BT decreased from 8% to 6%. Age >70, government funded insurance or lack of insurance, intermediate or high-risk disease and treatment at an academic center were associated with significantly lower utilization of brachytherapy (all p <0.001), while higher median zip code income was associated with increased use (p = 0.02). On multivariable analysis patients who were younger, had private insurance, were lower NCCN risk category and treated in non-academic cancer centers, had a higher rate of brachytherapy utilization. Notably, on both UVA and MVA brachytherapy practice decreased with increasing year of diagnosis (OR 0.881, 95% CI 0.853-0.910, p <0.001).

Conclusion: Rates of brachytherapy utilization for the treatment of prostate cancer continue to decrease over time. Treatment at an academic center was associated with reduced likelihood of brachytherapy use. This has significant implications for the training of future radiation oncology residents/fellows and direct consequences for both our patients and healthcare expenditure.

Keywords: Brachytherapy; Health-care expenditure; Prostate cancer; Radiation.

Copyright © 2021 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

[cesces]

Hmmm

What increased?

Adt & Chemo?

Surgery?

[questionanything]

Do you think the decline is a result of being ineffective or for being too expensive for insurance coverage?

[maley2711 in reply to questionanything]

in fact, it is more effective locally than external beam...when done correctly. Compensation for RO is less???? Certainly many men prefer to avoif general anesthesia, and choose external beam.

[doc1947g in reply to maley2711]

Some people like me CAN NOT have anaesthesia due to other chronic diseases.With my emphesyma, I would die on the table.

They can use Epidural or Spinal. Not for me with my back all messed up.

So both my Urologist and my RO with my G(4+3=7) Grade 3 on 85% of the 12 cores, decided to put me on ADT 6months and VMAT-RT 20 Rx of 3Gy for a total of 60Gy on the Prostate & SV & Pelvic Lymphe Nodes..

PSA nadir is <0.01 μg/L (2021/02/11) and my latest one is 0.04 μg/L (2021/05/28).

My PSA get checked every 4 months. So next test is Sept 30.Meanwhile my Lymphoma NH Marginal Zone is on Active Surveillance.

[timotur]

Brachy has some of the best long-term survival rates, but is a draconian procedure compared to its main rival, SBRT. I can see it not being attractive as a speciality to young interns— it takes a special mindset to want to go this path. Hope it survives as a treatment option until there’s a cure. It’s very effective for locally advanced Stg 3 cases with extensions to SV and LN’s, like mine was.

As far as HDR goes, in most cases, the procedure has been streamlined from two sessions over 36 hours, to a one-and-done session, in by 7am, out by 3pm. That’s a lot more palatable, not having to stay all night with tubes inserted into the prostate. LDR is not done as much as HDR now to my knowledge.

[V10fanatic]

Just like everything in life- you've gotta pay to play. From the study-

"while higher median zip code income was associated with increased use"

[LeeLiam]

No mention of LDR vs HDR? I would think HDR would be increasing with LDR dropping.

[j-o-h-n]

I guess the medical profession is taking their cue from seedless watermelons....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 08/24/2021 6:06 PM DST