Brachytherapy for low-risk prostate cancer (PCa) may be on the decline, according to study findings presented at the American Society of Clinical Oncology annual meeting in Chicago. In addition, a growing proportion of low-risk PCa cases is not being treated.
Kamran A. Ahmed, MD, and collaborators at the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Fla., analyzed recent trends in the management of clinically localized PCa using 2004–2010 data from the Survival, Epidemiology and End Results (SEER) database. The study population consisted of 216,785 men with low-, intermediate-, and high-risk PCa.
For patients with low-risk PCa, use of brachytherapy decreased by 14.3% over the study period, whereas the use of no treatment increased by 15.7% and use of radical prostatectomy increased by 7.6%.
In multivariate analysis, patients were more likely to receive no treatment if they were single, diagnosed in 2010 compared with earlier years, had low-risk disease versus high-risk disease, were African American versus white, and were older than 65 years compared with 65 or younger.
A decline in the use of brachytherapy for localized PCa has been documented previously. In a study of 1.5 million patients treated for localized PCa from 1998 to 2010, Marc C. Smaldone, MD, and colleagues at Fox Chase Cancer Center in Philadelphia found that the proportion of patients undergoing brachytherapy peaked at 16.8% in 2002 and then declined steadily to a low of 8% in 2010, according to a paper published 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.
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 Dr. Smaldone’s group.
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.