Brachytherapy is being used less and less as a treatment for localized prostate cancer (PCa), according to an analysis of data from the National Cancer Data Base.

A team led by Marc C. Smaldone, MD, of Fox Chase Cancer Center in Philadelphia, identified 1.5 million patients with localized PCa during 1998 to 2010. Brachytherapy use peaked in 2002, when 16.7% of patients received the treatment.

The proportion of patients undergoing brachytherapy declined steadily to a low of 8% in 2010, the researchers reported online ahead of print in Cancer. Meanwhile, during the study period, the percentage of patients treated with radical prostatectomy increased from 46.1% in 1998 to 59.1% in 2010.

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The change in clinical practice with the greatest impact on the use of brachytherapy during the study period is likely the substantial increase in the number of radical surgeries performed, possible due to the adoption of robot-assisted laparoscopic prostatectomy, according to the researchers.

Of 719,789 patients with available data for risk stratification, 41.1%, 35.3%, and 23.6%, respectively, met National Comprehensive Cancer Network criteria for low-, intermediate-, and high-risk disease.

In adjusted analyses, increasing age and Medicare coverage were associated with a greater likelihood of receiving brachytherapy. Patients with intermediate- or high-risk PCa, Medicaid insurance, increasing comorbidity burden, and later year of diagnosis were less likely to receive brachytherapy.