Trends in Prostate Brachytherapy Utilization in the United States and Implications for Resident Training

Although there is substantial evidence for prostate brachytherapy as an effective and efficient treatment option as monotherapy or part of multimodality regimens, brachytherapy numbers have decreased over the last decade. The purpose of this analysis is to describe prostate brachytherapy trends from 2013 to 2022 and its relationship with resident brachytherapy training.

The Medicare Provider and Other Supplier Public Use File database was searched by provider and state for code 55875 (transperineal placement of needles or catheters into prostate for interstitial radio element application, with or without cystoscopy) for years 2013 to 2022. The top 10 states (and providers/organizations) for total contributions to nationwide total of providers and services were determined. Resident brachytherapy case log information was accessed from the Accreditation Council for Graduate Medical Education and included data until 2023/2024.

Between 2013 and 2022, there was a 50% decrease in total providers, 30% decrease in patients, and 32% decrease in services. Thirty-eight states had decreases in providers and 32 had decreases in services. There were 15 states in the top 10 for providers and 14 states in the top 10 for services for at least 1 year during this period and had a significant contribution to both providers (62%) and services (66%). Highest volume providers were likely to be in private versus academic practices. Meanwhile, residents had a decrease in median low-dose-rate cases between 2017/2018 and 2023/2024 of 4 to 1 and in high dose rate, an increase from 0 to 1.

While there is significant evidence for the use of prostate brachytherapy in many treatment settings, there has been a decrease in the number of practicing providers and the number of patients treated over the last decade. With private practices contributing significantly to services provided, this may be partially responsible to low resident cases being logged. This highlights the need to improve resident training opportunities in academic centers.