Transcript from our site here - Prostate Cancer Support Group

SLIDES EXTRACTED FROM PRESENTATION
“COMPARING TREATMENT RESULTS OF PROSTATE
CANCER”, DATED 15_01_2013(3)

These slides were extracted from a larger set of comprising a presentation
entitled “Comparing Treatment Results of PROSTATE CANCER” dated
15_01_2013(3).

That presentation reports the results of an ongoing meta-analysis being
conducted by the Prostate Cancer Results Study Group (PCRSG), led by
Peter Grimm DO, of the Prostate Cancer Treatment Center in Seattle

A description of the work of the PCRSG is available through this link to the
Prostate Cancer Treatment Center.

The work of the PCRSG is directed at providing patients with a simple
means of comparing the cancer control rates of modern prostate cancer
treatment methods

This short extract has been prepared by the Prostate Cancer Support Group
– ACT Region
1
ABOUT THIS REVIEW STUDY



23,000+ prostate studies were
published between 2000 and 2012
989 of those studies featured
treatment results
195 of those met the criteria to be
included in this review study. (*1 & 2 group)
Some treatment methods are underrepresented due to failure to meet
criteria
st

15_01_2013(3)
nd
2
Criteria for Inclusion of Article*
1. Patients should be separated into Low,
Intermediate, and High Risk
2. Success must be determined by PSA analysis
3. All Treatment types considered: Seeds (Brachy),
Surgery (Standard or Robotic), IMRT (Intensity
Modulated Radiation), HIFU (High Frequency
Ultrasound), CRYO (Cryo Therapy), Protons, HDR
(High dose Rate Brachytherapy)
4.
Article must be in a Peer Reviewed Journal
* Expert panel consensus
15_01_2013(3)
3
5. Low Risk articles must have a minimum of 100
patients
6. Intermediate Risk articles must have a minimum of
100 patients
7. High Risk articles, because of fewer patients, need
only 50 patients to meet criteria
8. Patients must have been followed for a median of 5
years
For additional criteria information contact: [email protected]
15_01_2013(3)
4
RP
EBRT/
IMRT
Cryo
Brachy/
HDR
Robot
RP
Proton HIFU
8.7%
10.6%
6%
19%
6%
23%
3%
25/285 28/263
2/33
51/275
4/65
3/13
1/33
Total of 989 Treatment Articles. Some articles addressed several treatments and were
counted as separate articles for each treatment. *A few articles evaluated other/minor treatments and are
not listed here. These calculations only include primary accepted articles, and do not include secondary acceptance totals.
15_01_2013(3)
5
EXPLANATORY NOTES FOR FOLLOWING SELECTED
CHARTS


“Strict criteria” = studies that meet the criteria specified in earlier
charts
“Relaxed criteria” = studies that met the strict criteria PLUS studies
which:
 (a) relate to to patients for whom there is only 40 to 59 months of follow-
up (instead of 5 years or more), or
 (b) relate to low risk or intermediate risk patients with 5 years or more of
follow-up but with less than 100 patients, or
 (c) relate to high risk patients with 5 years or more of follow-up but with
less than 50 patients

“Weighted” means that the ellipses shown have taken into account
the numbers of patients in each study
15_01_2013(3)
6
How to Interpret the Results -1




Each treatment is given a symbol. For example Seed implant
alone (Brachy) is given a blue dot with a number in it.27
The number in the symbol refers to the article. The article
can be found in the notes section below the slide ( go into
“view” in up left corner of PowerPoint and click on note
section, then click on this portion and scroll down to see all
the references)
Treatment Success % = Percent of men whose PSA numbers
do not indicate cancer progression. (progression free) at a
specific point in time
The bottom line indicates the number years the study is out
An example, the blue dot with 27 inside indicates that, as per
article 27, 97% of the patients treated with seeds alone in low
risk patients at 12 years were free of disease progression
according to PSA numbers
15_01_2013(3)
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How to Interpret the Results - 2
First Establish your clinical risk group* by looking at
the definitions or ask your physician Refer only to
those slides for your risk group
 Make your own judgment and then ask a doctor in
each discipline ( Seeds, External Radiation Surgery,
etc) to tell you where his/her own peer reviewed
published Treatment Success % would fit on this
plot.

*Next Slide
15_01_2013(3)
8
Low Risk
Stage: T1 or T2a,b
Gleason Sum < 6
PSA < 10 ng/ml
Intermediate Risk
Stage T1 or T1-2
Stage T1-2
Gleason Score 7 or Gleason 6
PSA < 10
PSA 10-20
High Risk
Stage T2c or T3
Gleason score ≥ 8
PSA > 20 ng/mL
15_01_2013(3)
9
LOW RISK RESULTS – STRICT CRITERIA
Weighted
% PSA Progression Free
Treatment Success
Brachy
EBRT
23
25
4
22
30 6
37
3
31
19
14 21
13 8
24
33
29 101
39103
18
102
38
40
1 100
2 26
7
27
35 17
32
10
28
36
5 16
12
107 106
104
9
EBRT &
Seeds
Robot RP
108
15
Surgery
34
← Years from Treatment →
CRYO
HIFU
Protons
HDR
11
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
15_01_2013(3)
Prostate Cancer Center of Seattle
10
LOW RISK RESULTS – RELAXED CRITERIA
Weighted
% PSA Progression Free
Treatment Success
EBRT
Brachy
68 51 50
92
96
23 46
14 21
97 66 25
22
8
13
48
4 8175 62
37
35
44 86
17
3069641
3
60
82
33
32
71
85
1067
39103
65
28 94
98 84893172 99 29 101
95
42
61 93
18 88102
38
54
36
73
1947 24
43 55
78
2 26
64
12 83
40
58
1 100 7 87
76 56
107 106
77
9
70 80
41
15 45
57 74 79
59
90
53
+
27
5 16
52
104
108
Surgery
63
34
← Years from Treatment →
91
Seeds &
ADT
EBRT &
ADT
EBRT &
Seeds
Robot RP
49
11
CRYO
HIFU
Protons
Hypo EBRT
HDR
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
15_01_2013(3)
Prostate Cancer Center of Seattle
11
INTERMEDIATE RISK RESULTS – STRICT
CRITERIA
EBRT & Seeds
Brachy
% PSA Progression Free
Treatment Success
Weighted
33
14
24 2313
35
49
151
30 36 45
16 4
38
31
42
3
19 5
7
40
32
Seeds + ADT
EBRT & Seeds
39
43
18
+
34
15 44
6 12
Robot RP
37
28
9 26
25
29
41
1
8
10 11
EBRT
20
← Years from Treatment
→
Hypo EBRT
17 27
150
Seeds Alone
48
2
46
Surgery
21
22
HDR
EBRT, Seeds +
ADT
Protons
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
15_01_2013(3)
Prostate Cancer Center of Seattle
12
INTERMEDIATE RISK RESULTS – RELAXED
CRITERIA
WEIGHTED
% PSA Progression Free
Brachy
10459
33
66 55
24 23 13
14
35
79
49
92
98
151
34
1544 96
4
57
16
38 58
68 69
30 36 45
109
99 77
39
83
105 82
107
97 612
42 73
31 91
108
51 106
3 72
62 18 6393 43
71
86
81
95
28
74 67 50
150
90
5
92652
19
65
78 70 7
25
103
29
76 102
41
1
60100
48
8 87
85 88 53
2
10101 11
75
46
84
Robot RP
37
EBRT
Treatment Success
EBRT + ADT
54 56
89 94
← Years from Treatment
→
80
20
+
40
32
17 27
Surgery
21
22
64
Seeds + ADT
EBRT & Seeds
Hypo EBRT
Seeds Alone
HDR
EBRT, Seeds +
ADT
Protons
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
15_01_2013(3)
Prostate Cancer Center of Seattle
13
% PSA Progression Free
Treatment Success
HIGH RISK RESULTS – STRICT CRITERIA
Weighted
EBRT, Seeds & ADT
20
Brachy
16
109
45
19 18
3
22
8
112 4
Surg & ADT
EBRT & ADT
108
17
40
3 34
9 41
13 36
25
101 113
106
118
EBRT
EBRT & Seeds
112
44
43 32
2
48
1
33 111
21
10
114
12
14
28
42
8
110
46
31
Hypo EBRT
104
24
5
12139 119
115 11 26
76
103
35
37
47
117
Surgery
3011627
107
102 15
105
HDR
23 29
← Years from Treatment
→
Protons
49
EBRT Seeds +
ADT
Robot RP
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
15_01_2013(3)
Prostate Cancer Center of Seattle
14
HIGH RISK RESULTS – RELAXED CRITERIA
WEIGHTED
% PSA Progression Free
Treatment Success
Brachy
92 65
81
20
19 18
80
74
78
67
4075
3 85 60
72 54
91 66 34
941 68
71 13643679
50
53 25
101 113
62 106
118
3
22
8
16 45
109
112 4
108
Surg & ADT
EBRT & ADT
17
55
4376
EBRT & Seed
112
57
48 59 10 114
42
56 1
12
8 61
90
110 89
33 111
5
21
14
39
119
70
11
115
103
83 7 8226
35
6
52 63
84
73
31
30116
58 27
77 46
107
86 87
88
102 15
105
51
23 29
from 69
Treatment
2
28
Hypo EBRT
104
24
EBRT
← Years
→
Protons
HDR
Surgery 49
EBRT Seeds +
ADT
Robot RP
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
15_01_2013(3)
37
47
32
44
Prostate Cancer Center of Seattle
HIFU
15
OBSERVATIONS




For most low risk patients, most therapies
will be successful.
There appears to be a higher cancer control
success rate for Brachy over EBRT and
Surgery for all groups. Patients are
encouraged to look at graphs and determine
for themselves
Serious side effect rates must be considered
for any treatment
Relaxing the report selection criteria doesn’t
seem to impact the results substantially
15_01_2013(3)
16

Peter Grimm, DO
 [email protected]

Lisa Grimm, Research Coordinator
 [email protected]
 Or ProstateCancerTC.com


Or contact PCRSG member
Prostate Cancer Treatment Center website
 www.Prostatecancertreatmentcenter.com
15_01_2013(3)
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