In prostate cancer, it is unknown whether stereotactic body radiation therapy (SBRT) is substituting for other radiation treatments, substituting for surgery, or expanding the pool of patients receiving treatment instead of active surveillance.
Using SEER-Medicare, we identified men diagnosed with prostate cancer between 2007 and 2011 and developed physician-hospital networks by identifying each patient's treating physician based on the primary treatment received and subsequently assigning each physician to a hospital. We examined the relative distribution of prostate cancer treatments stratified by whether or not a network performed SBRT by fitting logistic regression models with robust standard errors to account for clustering of patients within networks.
We identified 344 physician-hospital networks, 30 of which (8.7%) performed SBRT and 314 of which (91.3%) did not. Networks performing and not performing SBRT did not differ in their use of robotic prostatectomy, radical prostatectomy, and active surveillance over time (all p>0.05). The relationship with IMRT did not exhibit any consistent temporal pattern, with networks performing SBRT having less IMRT initially but similar rates in the later years. Trends in brachytherapy differed among networks performing and not performing SBRT with use of brachytherapy lower in networks performing SBRT (p=0.03).
Networks performing and not performing SBRT did not differ in rates of surgery and active surveillance, yet networks performing SBRT had lower rates of brachytherapy. SBRT may represent an alternative to brachytherapy more so than for active surveillance.
The Journal of urology. 2019 Jul 30 [Epub ahead of print]
Bruce L Jacobs, Jonathan G Yabes, Samia H Lopa, Dwight E Heron, Chung-Chou H Chang, Justin E Bekelman, Joel B Nelson, Julie P W Bynum, Amber E Barnato, Jeremy M Kahn
Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania., Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania., Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania., Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania., Department of Radiation Oncology, Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Department of Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan., Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.