brachytheropy

Brachytherapy utilization for PC has been on a steady decline for 10 years.

Several reasons for that, but one is that BT worked best on men who didn't really need treatment anyhow (seems like a sham, doesn't it?), and there has been a sharp increase in the last 10 years in favorable risk men opting for Active Surveillance instead of aggressive treatment.

I have been told by docs that it doesn't pay enough and ro's can make much more on extended treatments.

Of course there are also those who cannot avail themselves of Brachy because of physical limitations but that in and of itself would not create the low usage referred to.

Brachy = $13,000;
IMRT= $70,000 to 100,000

Pretty simple reason as few patients comparison shop treatments. This is what you get when a 3rd party pays and the consumer doesn't make decisions based on price. this is also why the US medical costs are over twice those of other advanced countries with worse or similar outcomes.

I think it's due to relatively few doctors offering it and relatively few men going out of their way to find a treatment center for it. And SBRT taking some of the guys who might've gone for HDR in the past. My uro mentioned it in his summary of available treatments but did not specifically recommend it.

I had to seek out a treatment center for it after researching options, and I might've gone for 5 sessions of SBRT except that I was warned my health insurance might not approve it.

For me SBRT was a better option than LDBT with equal or slightly better cure rates and equal or slightly better quality of life out comes. Plus SBRT did not have any restrictions regarding being near my grandchildren. I think going forward both Medicare and our Insurance companies will actually start to realize these benifts and encourage it’s growth. Forty something treatments versus five treatments to get the same outcome with less cost should become significant incentive. RT has some limitations and surgery for some guys is a better choice.

When I had "the talk" with my uro, I felt that he was being very even-handed and balanced in his presentation of treatment options for my favorable intermediate risk PCa. I asked him about LDBT, and he said that his practice group probably hasn't referred one patient for LDBT in the last 10 years. He told me about surgery (remember, he is a surgeon), IMRT (they have their own clinic) and mentioned that there are other specialty clinics in the area like CyberKnife. I had already done my homework, and immediately questioned him about CyberKnife. He made a referral to the CK clinic at the major regional hospital where he does surgery. That's where I went.

I later found that there is a very highly regarded BT practitioner (Dr. Moran at, IIRC, Chicago Prostate Center), and they do what must be thousands of cases a year.

I later discussed this with the uro, and his take is that he does not know Dr. Moran, and all of the other BT practitioners he once knew have retired. The new RO's are focusing on the newer radiation methods like SBRT, so LDBT seems to be a niche market. The docs who specialize in it own the market. I would probably not go to anyone less than a "market leader" for that sort of procedure.

I have met a number of patients who had LDBT some years ago, and many of them are now fighting recurrent PCa. I have also met recent patients who were told that this is because the imaging tools back 10 or more years were not so good, and that techniques have progressed so that they now have better long term results.

Philmire,

I was in the position where I had to do both RT's, brachytherapy and external beam radiation.

The bottom line is that my RO said that it doesn't pay enough, therefore less trained drs for brachytherapy.

6 years later an I am doing great!!!

Dave