peter grimm, do seattle prostate institute latest update 4/23/09
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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
04/10/23 2
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
04/10/23 3
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
04/10/23 6
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
04/10/23 7
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
04/10/23 8
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
1-877-773-0622www.studymanager.com
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04/10/23 24
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