Graph Of Pca Procedures

I had seen online a graph showing for the past few years the changes in which Pca procedures men are choosing. Having trouble finding it again. Has anyone seen this and know where I can find it?

Bingo, gotta be the one!!

Works Out said...
That's the one. Wonder how different the percentages would be for the men on this forum - men have taken the time to become more knowledgable and involved in their treatment than the average guy?

Thanks,

Which group?  The men on this forum?  Or the men that have become more knowledgeable and involved in their treatment?  These two are not necessarily the same.

There's probably been a HW poll that's been done to get a snapshot of the men on this forum...if you are interested, use the search function.

Patient education, or lack thereof, has been identified as one of the key barriers to further take-up of Active Surveillance amongst the subset of men for whom it is most appropriate.  To counteract this, there has been a significant increase in the literature created on "decision-making" which encourages men to take their time, don't rush a low-tisk case, and think through the long-term consequences of aggressive therapies.  Just a few years ago there was almost none of this literature available; it's more readily available now.

Think the men on this forum are by definition more knowledgeable and involved. As opposed to the men who just agreed to whatever their urologist recommended and never looked into options.

Well said, NKinney, WELL SAID.

My quick thoughts about the chart: Robotic surgery seems to be increasing by about the same amount as open surgery is decreasing, so surgery looks pretty flat during this period. IMRT is increasing at a greater rate than EBRT is decreasing, so there's a net gain there. (If I can lump those together, which may or may not be correct.) But interestingly, brachy is decreasing...

Several here have mused about the reasons for decreased usage of brachytherapy …   The American Brachytherapy Society (ABS), in their Winter 2014 newsletter, presents their viewpoints on why it is declining.   Read the newsletter yourself HERE , but I’ll summarize.   They list the following factors: ·          An increase in the number of robotic prostatectomies ·          Advanced radiation delivery systems such as IMRT, SBRT and protons ·          Higher reimbursement with IMRT compared to brachytherapy ·          Suboptimal BT volumes procedures for radiation oncology residents that correlates to BT declines in academic centers This last factor, a 48% decline in BT from academic centers, is significant in that it provides insight on the future of BT.   In response, o ne might expect to see increased advertising from the independent, community based BT centers in an effort to protect and prolong the life of their investment.   The article “ The rise and fall of prostate brachytherapy ” (on PubMed) drills further into the BT trends, reporting that the largest demographic shifts are the declines in usage amongst younger men (inversely correlated to those on Medicaid), men more recently diagnosed, and increased PC case risk.  Discussion at the 2014 ASCO meeting ( HERE ) further exasperated the BT trends amongst low-risk men, highlighting the notion that AS (non-treatment) of low-risk men is increasing, which was the lifeblood of the BT practice.   More men with low-risk cases are realizing that they should treat PC as a chronic illness, not entirely unlike high cholesterol or diabetes, instead of super aggressive therapies.  AS trends seem to be going up at about the same rate as BT rates are going down...there is a correlation, although this does not demonstrate causation.   ABS decries the downward BT trend for reasons including the implications in terms of national health care expenditures…I suppose this is a good tactic from the industry support group.   BT is well documented as an inexpensive and “convenient” (for the patient) mode of treatment.   As I indicated previously, the PC treatment field is crowded with good, not great, treatments.   edit-fixed typo Post Edited (NKinney) : 2/18/2015 12:21:03 PM (GMT-7)

I used HDR brachytherapy and am glad I did so. Too bad it is reducing in use. It has proven to be very effective and minimally invasive compared to any type of surgery. My doctors have actually seen increased use.

Michael_T, the downward trend of the BT data was certainly flattening out and “the rate of decrease” (your term) is certainly slowing down…it’s not going to disappear overnight, but the trend is evident despite continued growth in the total available market.   BTW, brachytherapy is used in treating other cancers besides prostate cancer.   BT is declining in the treatment of cervical cancer (as documented in the ABS newsletter link I provided), and I’m concerned that articles like these are going to hurt the business in other areas, too:   “ Many women treated with brachytherapy aren’t good candidates ” and “ Popular breast cancer treatments [BT] increases risk of mastectomy .”       JNF wrote:   “ My doctors have actually seen increased use. “ This is not a surprising anecdote in context of an individual provider’s narrow viewpoint (particularly if this is outside of the thought-leading academic centers, as previously noted).   ”Industry consolidation” is common in the midst of declining market share.   I would guess—just an educated guess—that your doctor’s business is either a high-volume, private BT clinic or a combo Urologist/Radiation clinic.   Have you noticed a uptick in his advertising, too?  

So now then some additional information and fact regarding the decline in BT for PCa:

From the Journal of Clinical Oncology:

"Although prostate brachytherapy is the least costly alternative, with outcomes as good as if not superior to other modalities, the use of prostate brachytherapy has seen a significant decline over the last decade."

"Frank et al performed a value analysis by using time-driven activity-based costing and outcome data for brachytherapy, IMRT, and proton therapy for intermediate-risk patients with prostate cancer. Brachytherapy was associated with the best value by using combinations of outcomes for the following domains: sexual function, urinary incontinence, urinary bother, bowel function, biochemical relapse-free survival, and cost. The authors concluded that “there is no greater value for the treatment of localized prostate cancer than brachytherapy.”

And from the Cancer Therapy Advisor:

"Whatever the reason for the decline in the use of brachytherapy, it is not because it is ineffective. Numerous studies with up to 12 years of follow-up have demonstrated excellent disease-specific and overall survival for patients with prostate cancer treated with brachytherapy, particularly those at low risk.

Brachytherapy is also the least expensive initial treatment for prostate cancer (other than watchful waiting) and the decline in its use has potentially serious implications for public health policy. “Given the current emphasis on the importance of value in health care reform, we hope that the trend will reverse and brachytherapy utilization will comprise a larger proportion of treatments,” Dr. Martin said."

So to be clear - the decline in use of BT as an option for treating prostate cancer has nothing to do with it's effectiveness, nor cost. Yet, as others have posted on HW in other threads - men continue to choose other modalities and we are seeing this very disturbing downward trend in BT for PCa.

Yooper,

A brachytherapist told me that doctors don't want to go into it because the learning curve is steep and the profitability is low. Without doctors throughout the country who offer it, patients have less access and utilization declines. A few centers of excellence have emerged in Seattle, NY, W.Virginia, Houston, Chicago -- maybe a couple of others, and patients have to travel and have insurance where out-of-state is still in network.

- Allen

A Yooper, I understand your passionate perspective.

This conversation rang a bell for me, as I recall a conversation with my Uro (the one that diagnosed me and was predisposed to Cyberknife

After diagnosis, I met with him to discuss my options. When I brought up BRachy, he told me that hardly anyone in the Long Island area does Brachy anymore., in fact he only knew of one Dr.
I pressed and asked why that is the case, son em ve seen studies showing really good data. His response was pretty much these words... "As embarrassed as I am to say this, as a medical professional, a big reason is that the reimbursement rates are so much lower than other treatments."

Sad