Prostate Cancer Results Study Group Results Comparing Treatment of Prostate Cancer Peter Grimm, DO Seattle, WA About This Review Study,000+ prostate studies were published between 00 and June 3, of those studies featured treatment results 33 of those met the criteria to be included in this review study (*st & nd group) Some treatment methods are underrepresented due to failure to meet criteria
Prostate Cancer Results Study Group David Bostwick, MD Bostwick Laboratories David Crawford, MD University of Colorado, Denver, CO Brian Davis, MD Mayo Clinic, Rochester, MN Adam Dicker, MD Thomas Jefferson University, Philadelphia, PA Steven Frank, MD MD Andersen, Houston, TX Peter Grimm, DO, WA Jos Immerzeel, MD De Prostaat Kliniek, the Netherlands Stephen Langley, MD St Luke's Cancer Centre, Guildford, England Alvaro Martinez, MD William Beaumont, Royal lokmi Oak, Mira Keyes, MD BC Cancer Agency, Vancouver, Canada Patrick Kupelian, MD UCLA Medical Center, Los Angeles, CA Robert Lee, MD Duke University Medical Center, Durham, NC 3 Prostate Cancer Results Study Group Stefan Machtens, MD University Bergisch, Gladbach, Germany Jyoti Mayadev, MD UC Davis, Davis, CA Brian Moran, MD Chicago Prostate Institute, Chicago, IL Gregory Merrick, MD Schiffler hffl Cancer Center, Wheeling, WV Jeremy Millar, MD Alfred Health and Monash University, Melbourne, Australia Mack Roach, MD University of California San Francisco, CA Richard Stock, MD Mt. Sinai, New York, NY Katsuto Shinohara, MD University of California San Francisco, CA Mark Scholz, MD Prostate Cancer Research Institute, Marina del Ray, CA Edward dweber, MD, Seattle, WA Anthony Zietman, MD Harvard Joint Center, Boston, MA Michael Zelefsky, MD Memorial Sloan Kettering, New York, NY Jason Wong, MD University of California Irvine, CA Robyn Vera, DO Radiant Oncology, Lacey, WA
Prostate Cancer Results Study Group Problem: Patients, physicians, and carriers need a simple, unbiased means to compare the cancer control rates of modern prostate cancer treatment methods Prostate Cancer Results Study Group Expert Panel from key treating disciplines: Surgery, External Radiation, Internal (or Brachytherapy), High Frequency Ultrasound, and Proton Therapy Purpose: Comprehensive comparative review of the current literature on prostate cancer treatment 3
Criteria for Inclusion of Article*.Patients should be separated into Low, Intermediate, and High Risk.Success must be determined by PSA analysis 3.All treatment types considered: seeds (brachy), surgery (standard or robotic), IMRT (intensitymodulated radiation), HIFU (high frequency ultrasound), CRYO (cryotherapy), protons, (high dose rate brachytherapy).article must be in a peer reviewed journal * Expert panel consensus Criteria for Inclusion of Article (Cont d).low risk articles must have a minimum of 0 patients 6.Intermediate risk articles must have a minimum of 0 patients.high risk articles, because of fewer patients, need only 0 patients to meet criteria 8.Patients must have been followed for a median of years 9.For additional criteria information, contact lisa@prostatecancertc.com
% Articles Meeting Criteria RP EBRT/ IMRT Cryo Brachy/ Robot RP Proton HIFU 9% 3%.% %.3% % 8% /0 0/30 /3 6/306 /6 / 3/38 Total of, 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. Low Risk Group Definition Clinical stage: T or Ta,b Gleason score: 6 PSA: ng/ml
Low Risk Results Treatment Success % PSA Progression Free 8 3 3 3 3 6 3 33 3 9 8 6 36 9 0 0 6 9 9 8 EBRT & Seeds CRYO HIFU 9 6// Update of BJU Int,, Vol. 9(Supp. ) Low Risk Results Weighted Treatment Success % PSA Progression Fre ee EBRT/IMRT 3 3 8 3 3 6 3 33 3 9 8 6 36 9 0 0 6 9 9 3 LDR Brachy 9 Surgery 8 EBRT & Seeds CRYO HIFU 6// Update of BJU Int,, Vol. 9(Supp. ) 6
Low Risk Results Weighted >0 months follow up or <0 patients Treatment Success s % PSA Progression Free Proton EBRT/IMRT 68 0 9 9 96 66 6 3 38 8 3 3 6 8 3 6 86 69 8 33 60 3 6 8 3 6 98 8 9 89 99 8 99 9 6 93 8 88 6 38 36 9 3 3 8 0 6 8 83 0 6 6 8 6 0 9 80 9 9 9 90 3 63 + Seeds & LDR Brachy EBRT & EBRT & 6 Seeds 9 9 Surgery 8 CRYO HIFU 6// Update of BJU Int,, Vol. 9(Supp. ) Intermediate Risk Patient Definition Zelefsky definition - Only factor - Clinical stage: Tc - Gleason score: > - PSA: > ng/ml D Amico definition - PSA ng/ml, Gleason score, or Stage Tb
Intermediate Risk Results Weighted Treatment Success % PSA Progressio n Free EBRT/IMRT 9 6 60 30 36 6 60 3 8 6 3 9 9 6 6 3 3 3 3 Seeds Alone 8 38 3 0 8 8 33 9 6 Surgery 0 9 + Seeds + Seeds Alone EBRT, Seeds + 6// Update of BJU Int,, Vol. 9(Supp. ) Favorable Single feature Favorable vs Unfavorable* Intermediate Risk Gleason 3+= <0% of biopsy cores + Unfavorable All other intermediate *Zumsteg et al (MSKCC) New Risk Classification system for therapeutic decision making PCA pts undergoing dose escalated EBRT European Urology 6 p 89 90 3 Favorable vs Unfavorable 8
Treatment Success s % PSA Progressio n Free Intermediate Risk Results Weighted Favorable vs Unfavorable* 9 60 30 36 6 60 3 8 EBRT Brachy 6 3 3 3 3 8 6 38 F33 6 3 9 0 9U33 8 8 9 6 3 Surgery 0 9 + Seeds + Seeds Alone EBRT, Seeds + 6// Update of BJU Int,, Vol. 9(Supp. ) Intermediate Risk Results >0 months follow up or <0 patients Treatment Success s n Free % PSA Progressio 9 6 66 9 3 3 9 9 3 9 8 9 6 98 6 96 3 30 36 6 38 60 9 68 69 8 99 8 83 9 6 3 8 6 6 9 60 63 3 3 6 8 93 86 8 6 0 90 9 0 9 8 6 0 3 6 9 60 0 8 8 88 3 8 8 9 33 6 8 89 9 80 3 0 6 9 EBRT + + Seeds + Seeds Alone EBRT, Seeds + 6// Update of BJU Int,, Vol. 9(Supp. ) 9
Intermediate Risk Results Weighted >0 months follow up or <0 patients Treatment Success s n Free % PSA Progressio EBRT 89 9 LDR SEEDS ALONE 9 6 66 3 3 3 9 9 3 8 9 6 98 6 96 3 0 36 6 9 30 38 68 69 8 99 8 83 9 6 3 8 6 9 60 63 3 3 6 6 8 93 86 8 6 0 90 9 0 9 8 6 0 EBRT & SEEDS 3 6 9 60 0 9 8 8 88 3 8 8 9 Surgery 6 8 80 EBRT + + Seeds + Seeds Alone EBRT, Seeds + 6// Update of BJU Int,, Vol. 9(Supp. ) High Risk Patient Definition Zelefsky definition - or more factors - Gleason score: > - PSA: ng/ml - Clinical stage: Tc b D'Amico - Gleason score: 8 - PSA: > ng/ml
High Risk Results Treatment Success % PS SA Progression Free 36 3 0 3 3 3 6 3 8 3 3 6 3 9 9 8 3 6 8 8 8 36 9 33 9 36 6 00 9 6 36 30 6 9 8 3 33 30 9 Surg & EBRT Surg & EBRT & EBRT Seeds + + + 6// Update of BJU Int,, Vol. 9(Supp. ) High Risk Results Weighted Treatment Success Free PSA Progression % EBRT, Seeds & EBRT + EBRT/IMRT 3 36 0 3 3 3 6 3 8 3 3 6 3 9 9 8 3 6 8 8 8 36 9 33 9 36 6 00 9 6 36 30 6 9 8 Surgery 3 33 30 9 Surg & EBRT Surg & EBRT & EBRT Seeds + + 6// Update of BJU Int,, Vol. 9(Supp. )
High Risk Results Weighted >0 months follow up or <0 patients Treatment Success Free PSA Progression % EBRT, Seeds & EBRT + EBRT 9 6 99 9 8 6 EBRT + Seeds 9 80 9 8 8 8 3 36 3 6 0 8 36 3 3 60 3 966 68 9 3 6 8 8 9 0 6 3 8 6 36 90 89 33 3 6 6 9 33 93 36 9 8 6 0 0 9 9 98 3 96 83 8 3 6 63 36 8 30 3 30 6 6 86 8 8 88 3 9 69 9 Surg & EBRT Surg & EBRT & EBRT Seeds + Surgery HIFU + 6// Update of BJU Int,, Vol. 9(Supp. ) Observations For most low risk patients, most therapies will be successful There appears to be a higher cancer control success rate for brachytherapy 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 d for any treatment
For More Information/Slides Peter Grimm, DO peter@grimm.com Or contact PCRSG member website www.prostatecancertreatmentcenter.com 3