Radiotherapy for Prostate Cancer Is on the Rise

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BOSTON—Use of radiotherapy (RT) for prostate cancer has been increasing over the past three decades, according to researchers. Brachytherapy, either as part of treatment or as monotherapy, has paralleled this rise.

The finding is based on a review of data from 823,294 prostate cancer patients in the Surveillance, Epidemiology, and End Results (SEER) database by researchers at Emory University School of Medicine in Atlanta. Overall RT use increased from 9.1% in 1973 to 26% in 2004.

Analysis revealed that external beam radiotherapy (EBRT) use decreased from 99.3% of RT procedures to 59.3% while brachytherapy use rose from 0.0% to 29.6%, and combination therapy use increased from 0.0% to 11.1%. The increase in brachytherapy and combination therapy use began in the mid-1980s. Since 2000, brachytherapy has been used more frequently than combination therapy.

Throughout the study period, RT use remained stable for poorly differentiated disease and stage II-III disease. For stage II disease, a decline in EBRT use corresponded with an equal rise in the use of brachytherapy and combination therapy.

“What it says is that patients are being exposed to a greater distribution of options and they are making more informed decisions,” said lead investigator Ashesh Jani, MD, associate professor of radiation oncology.

“It is good because all of these treatments have relative strengths and weakness, and in the past, things were maybe being done in a cookie-cutter fashion. Now, they are being more tailored to individual expectations and desires.” He reported findings here at the American Society for Therapeutic Radiology and Oncology annual meeting.

Urologists could look at how their practice, region, or community compares with what is happening nationally “so they can get an estimate of whether they are making appropriate referrals,” Dr. Jani said.

“Knowing referral patterns is important. If you are at a location that does 90% surgery, then you know you are getting skewed toward one treatment.”

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