Peter Grimm, DO Seattle Prostate Institute

Latest update 4/23/09

Problem: In the absence of randomized studies, patients, physicians, carriers, Medicare, etc: need a means to compare the effectiveness of modern treatments

Purpose: The PCRSG will compare and share results for prostate cancer that are utilizable for all those who are interested

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Ignace Billiet,MD Europe David Bostwick, MD Bostwick Laboratories David Crawford, MD Univ Colorado Peter Grimm, DO Seattle Jos Immerzeel, Netherlands Mira Keyes, MD BC Cancer Agency Kupelian, Patrick, MD MD Anderson Orlando Robert Lee Duke University Medical Center Brian Moran, MD Chicago Prostate Institute Greg Merrick, MD Schiffler Cancer Center Jeremy Millar, MD Australia Mack Roach, MD UCSF Richard Stock, MD Mt. Sinai New York

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Katsuto Shinohara, MD UCSF John Sylvester, MD SPI Mark Scholz, MD Prostate Cancer Research

Institute Ed Weber, MD SPI Anthony Zietman, MD Harvard Joint Center Michael Zelefsky, MD Memorial Sloan Kettering Fellows Jason Wong, MD Residents:

Jyoti Mayadev, MD University of Washington Stacy Wentworth, MD Wake forest Robyn Vera, DO Medical College of Virginia

04/10/23 4

Study

>15,000 articles reviewed from 2000-2009

Pub Med, Medline, Google Scholar, Elsevier search

603 Treatment Results Articles Identified

Expert Panel Established Criteria for Inclusion

Treatment Articles screened for study group criteria

1. Patients must be stratified into recognizable Pre-Treatment Risk groups: Low, Intermediate, and High Risk by either D’Amico, Zelefsky or NCCN stratification

2. bRFS standard endpoint ASTRO, Phoenix, and PSA < 0.2 (surgery)

3. Clinical Staging No exclusions: i.e. No Pathologic staging

4. EBRT must be minimum 72 Gy IMRT / conformal

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5. All Treatment modalities considered: Seeds, Surgery, IMRT, HIFU, CRYO Protons, HDR

6. Accepted results: Peer Reviewed Journals Only

7. Low Risk Accepted minimum number 100 pts

8. Int Risk Accepted minimum number 100 pts

9. High Risk Accepted minimum number 50 pts

10.Minimum median F/U : 5 yr

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RP

EBRT Cryo Brachy Robot RP

Proton HIFU

15/206 7/165 2/26 20/157 0/53 1/9 0/27

7% 4% 8% 13% 0% 11% 0%

Total 603 Treatment Articles. Some articles addressed several treatments

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77

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surgery

EBRT

5 5

22 22

16 16

← Years →

CRYO

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

33

13 13

12 12

24 24

14 14 8 8

No TX

22

23 23

HIFU

% P

SA

Pro

gres

sion

Fre

e

20 20

11111515

Protons

21 21

4 4

1818

17 17 19 19

9 9

10 10 EBRT & Seeds

13 13

2525

Robot RP

26 26

04/10/23 9

77

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surgery

EBRT

5 5

22 22

16 16

← Years →

CRYO

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

33

13 13

12 12

24 24

14 14 8 8

No TX

22

23 23

HIFU

% P

SA

Pro

gres

sion

Fre

e

20 20

11111515

Protons

21 21

4 4

1818

17 17 19 19

9 9

10 10 EBRT & Seeds

13 13

2525

Robot RP

26 26

04/10/23 10

Brachy

Surgery

EBRT

04/10/23 11

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surgery

EBRT

5 5

41 41

4949

434316 16 5252

5050

5151

3 3

13 13 12 12

1 1

454577

4747

4545

14 14

23 23 88

22

22 22

% P

rogr

essi

on F

ree

46 46

11111515

5858

5757 4646

44

59 59

6060

48 48 2121

1818

17 17

5454

1919

9 9

101044 44

47475555

63 63 62 62

24 24

5656

6161656526 26

6666

6767

CRYO

No TX

HIFU

Protons

EBRT & Seeds Robot RP

6262

← Years →

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

04/10/23 12

2525

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surgery

EBRT

5 5

41 41

4949

434316 16 5252

5050

5151

3 3

13 13 12 12

1 1

454577

4747

4545

14 14

23 23 88

22

22 22

% P

rogr

essi

on F

ree

46 46

11111515

5858

5757 4646

44

59 59

6060

48 48 2121

1818

17 17

5454

1919

9 9

101044 44

47475555

63 63 62 62

24 24

5656

6161656526 26

6666

6767

CRYO

No TX

HIFU

Protons

EBRT & Seeds Robot RP

6262

← Years →

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

Brachy

EBRT

Surgery

04/10/23 13

2525

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surgery

EBRT

CRYO

HIFU

29 29

3030

2323

1616

21215 5

26262727 1919

31 31

66

% P

SA

Pro

gres

sion

F

ree

181812 12

2828

3 3

17 17

7 7

32 32 14 14

3333

99

88

2 2

2525

3535

34 34 1 1

13 13

Protons

EBRT & Seeds

HDR← Years →

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

04/10/23 14

1515

44 3636

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surgery

EBRT

CRYO

HIFU

29 29

3030

2323

1616

21215 5

26262727 1919

31 31

66

% P

SA

Pro

gres

sion

F

ree

181812 12

2828

3 3

17 17

7 7

32 32 14 14

3333

99

88

2 2

2525

3535

34 34 1 1

13 13

Protons

EBRT & Seeds

HDR← Years →

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

04/10/23 15

1515

44 3636

Brachy

EBRT

Surgery

555533

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surgery

EBRT

CRYO

HIFU

29 29

3030

2323

1616

2121

5

51 51

26262727 1919

72 72

13 13

67 67

3131

66

11

%P

SA

Pro

gres

sion

Fre

e

12

61 61

2828

3 3

53 17 17

60

7

59 59

5656

57

73 73

1414

5454

99

88

2

2525

4

15

5252

5858

6262

6363

3 3 3232

6565

4

6868 6969

7070

71

6464

34 34

3535

4848

7474

75 75

7676

7777

36

80 80

78 78

Protons

EBRT & Seeds

HDR

79 79

← Years →

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

04/10/23 16

18

555533

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surgery

EBRT

CRYO

HIFU

29 29

3030

2323

1616

2121

5

51 51

26262727 1919

72 72

13 13

67 67

3131

66

11

%P

SA

Pro

gres

sion

Fre

e

1812

61 61

2828

3 3

53 17 17

60

7

59 59

5656

57

73 73

1414

5454

99

88

2

2525

4

15

5252

5858

6262

6363

3 3 3232

6565

4

6868 6969

7070

71

6464

34 34

3535

4848

75 75

7676

7777

36

80 80

78 78

Protons

EBRT & Seeds

HDR

79 79

← Years →

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

04/10/23 17

Brachy

EBRT

Surgery

7474

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surg

EBRT

Cryo66

1111

3636

1313

33

25 25

15 15

55

31 31

EBRT Seeds + ADT

19 19 23 23

3030

16 16

10 10

20 20

18 18

33 33

2929

7 7

% P

SA

Pro

gres

sion

Fre

e

4 4 17

32 32

14 14

21 21

88

22

1 1

99

2222

24 24

26 26

27 27

28 28

34 34

3737

38 38

3939

4141

37 37

4141

1212

Protons

EBRT & Seeds

HDR

EBRT & ADT

← Years →

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

04/10/23 18

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surg

EBRT

Cryo66

1111

3636

33

25 25

15 15 31 31

EBRT Seeds + ADT

19 19

3030

16 16

10 10

18 18

33 33

2929

7 7

% P

SA

Pro

gres

sion

Fre

e

4 4 17

14 14

21 21

88

22

1 1

99

2222

24 24

28 28

34 34

3737

38 38

3939

4141

37 37

4141

1212

Protons

EBRT & Seeds

HDR

EBRT & ADT

← Years →

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

04/10/23 19

Brachy

EBRT

Surgery

1313

32 32

55

26 26

20 20

23 23

27 27

53 53

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surg

EBRT

Cryo

6464

66

1111

3636

1313 57 57

3 3

25 25

15 15

5 5

5656

31 31

60 60

16 16 23 23

30 30

55 55 59 59

18 18 20 20

19 19

33 33

2929

77

% P

SA

Pro

gres

sion

Fre

e

4 4

17 17

32 32

7272

50 50

61 61

14 14

21 21

8 8

6262

1212

58 58

2 2

11

99

2222

24 24

26 26

27 27

28 28

34 34

37 37

38 38

39 39

5151

52 52

5454

63 63

65 65

66666767

6868

69 69

70 70

Seeds + HT

40 40 76 76

73 73

74 74

75 75

7171

777778 78

7979

80 80

81 81

82 82

8383

84 84

41 41

8585

37 37

4141

10 10

EBRT Seeds + ADT

EBRT & Seeds

HDR

EBRT & ADT

← Years →

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

04/10/23 20

53 53

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Brachy

Surg

EBRT

Cryo

6464

66

1111

3636

1313 57 57

3 3

25 25

15 15

5 5

5656

31 31

60 60

16 16 23 23

30 30

55 55 59 59

18 18 20 20

19 19

33 33

2929

77

% P

SA

Pro

gres

sion

Fre

e

4 4

17 17

32 32

7272

50 50

61 61

14 14

21 21

8 8

6262

1212

58 58

2 2

11

99

2222

26 26

27 27

28 28

34 34

37 37

39 39

5151

52 52

5454

63 63

65 65

66666767

6868

69 69

70 70

Seeds + HT

40 40 76 76

74 74

75 75

7171

78 78

7979

80 80

81 81

8282

8383

84 84

41 41

8585

4141

10 10

EBRT Seeds + ADT

EBRT & Seeds

HDR

EBRT & ADT

← Years →

• Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

04/10/23 21

Brachy

EBRT

Surgery

24 24

37 37

38 38

73 73

7777

No Randomized studies to date By BRFS control criteria

Brachytherapy alone or Comb appears superior in all risk groups

Prostate studies to date rarely include Pre-treatment Risk Group stratification, confounding comparisons

Only a small % of studies to date conform to basic reporting criteria

04/10/23 22

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