comparative effectiveness - prostate cancer results, study group - 2009
TRANSCRIPT
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 11/4/2014 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
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>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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7
60
70
80
90
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Brachy
Surgery
EBRT
5
22
16
← Years →
CRYO
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references
3
13
12
24
14 8
No TX
2
23
HIFU
% P
SA
Pro
gre
ssio
n F
ree
20
1115
Protons
21
4
18
17 19
9
10
EBRT &
Seeds
13
25
Robot RP
26
11/4/2014 9
7
60
70
80
90
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Brachy
Surgery
EBRT
5
22
16
← Years →
CRYO
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references
3
13
12
24
14 8
No TX
2
23
HIFU
% P
SA
Pro
gre
ssio
n F
ree
20
1115
Protons
21
4
18
17 19
9
10
EBRT &
Seeds
13
25
Robot RP
26
11/4/2014 10
Brachy
Surgery
EBRT
11/4/2014 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
41
49
4316 52
50
51
3
13 12
1
45
7
47
45
14
23
8
2
22
% P
rogre
ssio
n F
ree
46
1115
58
57 46
4
59
60
48 21
18
17
54
19
9
1044
4755
63 62
24
56
61
6526
66
67
CRYO
No TX
HIFU
Protons
EBRT &
Seeds
Robot RP
62
← Years →
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references 11/4/2014 12
25
60
70
80
90
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Brachy
Surgery
EBRT
5
41
49
4316 52
50
51
3
13 12
1
45
7
47
45
14
23
8
2
22
% P
rogre
ssio
n F
ree
46
1115
58
57 46
4
59
60
48 21
18
17
54
19
9
1044
4755
63 62
24
56
61
6526
66
67
CRYO
No TX
HIFU
Protons
EBRT &
Seeds
Robot RP
62
← Years →
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references
Brachy
EBRT
Surgery
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25
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
30
23
16
21
5
26
27 19
31
6
% P
SA
Pro
gre
ssio
n F
ree
18
12
28
3
17
7
32 14
33
9
8
2
25
35
34 1
13
Protons
EBRT &
Seeds
HDR← Years →
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references 11/4/2014 14
15
4 36
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
30
23
16
21
5
26
27 19
31
6
% P
SA
Pro
gre
ssio
n F
ree
18
12
28
3
17
7
32 14
33
9
8
2
25
35
34 1
13
Protons
EBRT &
Seeds
HDR← Years →
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references 11/4/2014 15
15
4 36
Brachy
EBRT
Surgery
5533
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
30
23
16
21
5
51
26
27 19
72
13
67
31
6
1
%P
SA
Pro
gre
ssio
n F
ree
12
61
28
3
5317
60
7
59
56
57
73
14
54
9
8
2
25
4
15
52
58
62
63
3 32
65
4
68 69
70
71
64
34
35
48
74
75
76
77
36
80
78
Protons
EBRT &
Seeds
HDR
79
← Years →
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references 11/4/2014 16
18
5533
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
30
23
16
21
5
51
26
27 19
72
13
67
31
6
1
%P
SA
Pro
gre
ssio
n F
ree
18
12
61
28
3
5317
60
7
59
56
57
73
14
54
9
8
2
25
4
15
52
58
62
63
3 32
65
4
68 69
70
71
64
34
35
48
75
76
77
36
80
78
Protons
EBRT &
Seeds
HDR
79
← Years →
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references 11/4/2014 17
Brachy
EBRT
Surgery
74
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
6
11
36
13
3
25
15
5
31
EBRT
Seeds +
ADT
19 23
30
16
10
20
18
33
29
7
% P
SA
Pro
gre
ssio
n F
ree
4 17
32
14
21
8
2
1
9
22
24
26
27
28
34
37
38
39
41
37
41
12
Protons
EBRT &
Seeds
HDR
EBRT &
ADT
← Years →
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references 11/4/2014 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
Cryo
6
11
36
3
25
15
31
EBRT
Seeds +
ADT
19
30
16
10
18
33
29
7
% P
SA
Pro
gre
ssio
n F
ree
4 17
14
21
8
2
1
9
22
24
28
34
37
38
39
41
37
41
12
Protons
EBRT &
Seeds
HDR
EBRT &
ADT
← Years →
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references 11/4/2014 19
Brachy
EBRT
Surgery
13
32
5
26
20
23
27
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
64
6
11
36
13 57
3
25
15
5
56
31
60
16 23
30
55 59
18 20
19
33
29
7
% P
SA
Pro
gre
ssio
n F
ree
4
17
32
72
50
61
14
21
8
62
12
58
2
1
9
22
24
26
27
28
34
37
38
39
51
52
54
63
65
6667
68
69
70
Seeds + HT
40 76
73
74
75
71
7778
79
80
81
82
83
84
41
85
37
41
10
EBRT
Seeds +
ADT
EBRT &
Seeds
HDR
EBRT &
ADT
← Years →
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references 11/4/2014 20
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
64
6
11
36
13 57
3
25
15
5
56
31
60
16 23
30
55 59
18 20
19
33
29
7
% P
SA
Pro
gre
ssio
n F
ree
4
17
32
72
50
61
14
21
8
62
12
58
2
1
9
22
26
27
28
34
37
39
51
52
54
63
65
6667
68
69
70
Seeds + HT
40 76
74
75
71
78
79
80
81
82
83
84
41
85
41
10
EBRT
Seeds +
ADT
EBRT &
Seeds
HDR
EBRT &
ADT
← Years →
• Prostate Cancer Results Study Group 3/31/09
• Numbers within symbols refer to references 11/4/2014 21
Brachy
EBRT
Surgery
24
37
38
73
77
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
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1-877-773-0622www.studymanager.com
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Anne Grilley
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