Variations in treatment modality use for the definitive management of prostate cancer in the United States.

174 Background: No prospective, randomized comparative efficacy trial exists to guide treatment of definitively managed prostate cancer patients. Despite this, treatment selection varies nationally and we attempt to assess these patterns of use. Methods: The SEER database was queried to identify cases of prostate cancer diagnosed between 1998-2008. The modalities identified were brachytherapy (brachy), combination of brachytherapy and external beam radiation (CombRT), external beam radiotherapy (EBRT), radical prostatectomy and external beam radiotherapy (RP+RT), and radical prostatectomy (RP). The number of cases by year, patient age and SEER region was computed. Results: There were 361,135 men in this analysis: 12.4% brachy, 6.8% CombRT, 27.5% EBRT, 3.1% RP+RT, and 50.3% RP. As expected, treatment modality varied by age with younger men more likely to receive RP and older man more likely to receive EBRT or brachy. There was some variation in choice of treatment modality over time: 6.6% for brachy; 4.2% for CombRT; 1.9% for EBRT; 2.0% for RP+RT; and 7.8% for RP. The variation in treatment modality by region was surprisingly wide (table): 14.4% for brachy; 25.5% for CombRT; 28.5% for EBRT; 3.8% for RP+RT; and 26.8% for RP. Conclusions: Choice of prostate cancer treatment modality varies by age, year of treatment, and most notably geographical region. Surprisingly the changes in reimbursement rates over the study period seem to have had minimal impact on choice of treatment modality. The regional variation implies that affiliations among healthcare providers significantly impact treatment. [Table: see text]

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Salvage Radical Prostatectomy after External Beam Radiation Therapy: A Systematic Review of Current Approaches

Urologia Internationalis ◽

10.1159/000371893 ◽

2015 ◽

Vol 94 (4) ◽

pp. 373-382 ◽

Cited By ~ 21

Author(s):

Deliu Victor Matei ◽

Matteo Ferro ◽

Barbara Alicja Jereczek-Fossa ◽

Giuseppe Renne ◽

Nicolae Crisan ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Salvage Therapy ◽

External Beam Radiotherapy ◽

Local Treatment ◽

Localized Prostate Cancer ◽

External Beam Radiation ◽

External Beam ◽

Beam Radiation ◽

Selection Of

Background: Radical external beam radiotherapy (EBRT) is a standard treatment for prostate cancer patients. Despite this, the rate of intraprostatic relapses after primary EBRT is still not negligible. There is no consensus on the most appropriate management of these patients after EBRT failure. For these patients, local salvage therapy such as radical prostatectomy, cryotherapy, and brachytherapy may be indicated. Objective: The objectives of this review were to analyze the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. Methods: A review of the literature was performed to identify studies of local salvage therapy for patients who had failed primary EBRT for localized prostate cancer. Results: Most studies demonstrated that local salvage therapy after EBRT may provide long-term local control in appropriately selected patients, although toxicity is often significant. Conclusions: Our results suggest that for localized prostate cancer recurrence after EBRT, the selection of a local treatment modality should be made on a patient-by-patient basis. An improvement in selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological outcome and least comorbidity.

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Salvage Brachytherapy for Castration-Resistant and External Beam Radiotherapy-Resistant Local Recurrence 17 Years after Radical Prostatectomy

Case Reports in Urology ◽

10.1155/2015/839738 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Shogo Hosogoe ◽

Osamu Soma ◽

Teppei Matsumoto ◽

Atsushi Imai ◽

Shingo Hatakeyama ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Local Recurrence ◽

Ct Scan ◽

External Beam Radiotherapy ◽

External Beam Radiation ◽

External Beam ◽

Beam Radiation ◽

Old Japanese ◽

Salvage Brachytherapy

A 47-year-old Japanese man was diagnosed with prostate cancer in February 1995 (Initial PSA 77.2 ng/mL, GS3 + 4, cT3N0M0). He underwent radical prostatectomy after androgen deprivation therapy (ADT) in June 1995. Nine years after operation, he was diagnosed with local recurrence of prostate cancer and he received postoperative external beam radiation therapy (EBRT) (70 Gy). By May 2008, the PSA dropped to 0.33 ng/mL, and a CT scan showed that the mass had disappeared. On April 2012, the PSA once again rose to 3.1 ng/mL. CT scan and MRI revealed a mass in the prostatic bed. We diagnosed local recurrence of prostate cancer. We underwent salvage low-dose brachytherapy after obtaining informed consent. The prescribed dose of the salvage brachytherapy was 145 Gy to control the tumor considering the hormone resistant prostatic cancer and high-risk feature. PSA level rapidly decreased to 0.66 ng/mL by 6 months after seed implantation. No adverse events were seen during the follow-up period.

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