Impact of national guidelines on brachytherapy monotherapy practice patterns for prostate cancer
Article first published online: 2 DEC 2013
© 2013 American Cancer Society
Volume 120, Issue 6, pages 824–832, 15 March 2014
How to Cite
Tseng, Y. D., Paciorek, A. T., Martin, N. E., D'Amico, A. V., Cooperberg, M. R. and Nguyen, P. L. (2014), Impact of national guidelines on brachytherapy monotherapy practice patterns for prostate cancer. Cancer, 120: 824–832. doi: 10.1002/cncr.28492
- Issue published online: 4 MAR 2014
- Article first published online: 2 DEC 2013
- Manuscript Accepted: 24 OCT 2013
- Manuscript Revised: 22 OCT 2013
- Manuscript Received: 10 SEP 2013
- prostate cancer;
- public health policy;
In 1999 and 2000, 2 national guidelines recommended brachytherapy monotherapy (BT) primarily for treatment of low-risk prostate cancer but not high-risk prostate cancer. This study examined rates of BT use before and after publication of these guidelines, as compared with 4 other treatment options.
From 1990 to 2011, 8128 men with localized prostate cancer (≤ T3cN0M0) were treated definitively within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry with 1 of 5 primary treatments: BT, external beam radiotherapy (EBRT), EBRT with androgen deprivation therapy, EBRT+BT, or radical prostatectomy. Men were categorized into low-, intermediate-, and high-risk groups based on the guidelines' risk-group definitions. Within each risk group, logistic regression was used to estimate odds ratios (OR) comparing BT with other treatment options between the 1990-1998 and 1999-2011 periods, adjusting for age, disease characteristics, and clinic type.
In total, 1117 men received BT alone for low- (n = 658), intermediate- (n = 244), or high-risk disease (n = 215). BT comprised 6.1% of all treatments in 1990-1998 versus 16.6% in 1999-2011 (P < .01). The odds of BT use remained increased after adjusting for potential confounders (OR = 3.06; P < .001) and was seen among low- (OR = 4.52; P < .001), intermediate- (OR = 2.67; P < .001), and even high-risk groups (OR = 2.11; P < .001).
National guidelines did not appear to influence practice patterns, as BT monotherapy use increased relative to other treatments from the 1990-1998 to 1999-2011 periods in unfavorable risk groups including men with high-risk prostate cancer. Cancer 2014;120:824–832. © 2013 American Cancer Society.