SLIDES EXTRACTED FROM PRESENTATION

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

SLIDES EXTRACTED FROM PRESENTATION“COMPARING TREATMENT RESULTS OF PROSTATE

CANCER”, DATED 15_01_2013(3)

1

2

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. (*1st & 2nd group)

Some treatment methods are under-represented due to failure to meet criteria

ABOUT THIS REVIEW STUDY

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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

3

Criteria for Inclusion of Article*

* Expert panel consensus

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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]

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5

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.

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“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

EXPLANATORY NOTES FOR FOLLOWING SELECTED CHARTS

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Each treatment is given a symbol. For example Seed implant alone (Brachy) is given a blue dot with a number in it.

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

27 27

How to Interpret the Results -1

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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.

How to Interpret the Results - 2

*Next Slide

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Intermediate Risk Intermediate Risk Stage T1 or T1-2 Stage T1-Stage T1 or T1-2 Stage T1-2 2

Gleason Score 7 or Gleason 6Gleason Score 7 or Gleason 6PSA < 10 PSA PSA < 10 PSA

10-2010-20High Risk High Risk Stage T2c or T3 Gleason score ≥ 8 PSA > 20 ng/mL

Low Risk Low Risk Stage: T1 or T2a,b Stage: T1 or T2a,b Gleason Sum Gleason Sum << 6 6 PSA PSA << 10 ng/ml 10 ng/ml

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10

77

5 5

22 22

← Years from Treatment →

CRYO

• Prostate Cancer Results Study Group • Numbers within symbols refer to references

11

12 12 24 24

14 14

8 8

22

23 23

HIFU

% P

SA

Pro

gres

sion

Fre

e

1111

1515

Protons

21 21

4 4

1818

9 9

10 10

EBRT & Seeds

2525

Robot RP

26 26

Prostate Cancer Center of Seattle

27 27

HDR

28282929

3030

313132323333

34 34

1919 36 36

37 37

3838

LOW RISK RESULTS – STRICT CRITERIA Weighted

3 3 3939

35

4040

100100

101101

1313EBRT

Brachy

Surgery

Tre

atm

ent

Suc

cess

103103

102 102

66

16 16

104104106106107107

108 108

17 17

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11

77

5 5

22 22


CRYO


11 12 12

24 24

14 14 8 8

22

23 23

HIFU

% P

SA

Pro

gres

sion

Fre

e

1111

1515

Protons

21 21

4 4

1818

9 9

10 10

EBRT & Seeds

2525

Robot RP 26 26


27 27

HDR

28282929

3030

31 3132323333

34 34

1919 36 36

37 37

3838

LOW RISK RESULTS – RELAXED CRITERIA Weighted

Tre

atm

ent

Suc

cess

3 3 3939

35

4040

4141

100100

101101

1313

6565

4949

7676

8080

5656

59 59

63 63

4141

75 75

51 51

71717272

90 90

7373

7474

7070

4242

5757

85 858484

6666

43436464

44 44EBRT & ADT

5353

82828181 6262

5454

7979

86 86

8787

8888

4545

5858

6969

78787878

77 77

46464646

48484848

91 91

++ Seeds & ADT

9393

9292

8989

5050

6767

68 68

95959494

555552525252

83838383

47476161

BrachyEBRT

Surgery

Hypo EBRT

96 96

103103

102 102

97 97

9898

60 60 66

16 16

104104106106

9999

107107

108 108

17 17

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12

29 29

2222

2121

5 5 1919

% P

SA

Pro

gres

sion

F

ree

1818

12 12

2828

3 3 17 17

10 10

32 32

99

88 2 2

2525

1 1

13 13

Protons

HDR



1515

443636

37 37

3838

++

Seeds Alone

Seeds + ADT40 40

Robot RP

4141

42 42

44 44

4343

4545

46 46

INTERMEDIATE RISK RESULTS – STRICT CRITERIA

Weighted

77

11 11

14 14

2020

35 35

34 34

39 39

23232424

1616

66

2626

3333

EBRT & Seeds

EBRT Surgery

Brachy

EBRT & Seeds

Hypo EBRT

EBRT, Seeds + ADT

Tre

atm

ent

Suc

cess


3030

27 27

48 48

49 49

150150

151151

31 31

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13

29 29

2222

2121

5 5 1919

% P

SA

Pro

gres

sion

F

ree

1818

12 12

2828

3 3 17 17

10 10

32 32

99

88 2 2

2525

1 1

13 13

Protons

HDR



151544

3636


37 37

3838

++

Seeds Alone

Seeds + ADT40 40

Robot RP

4141

42 42

44 44

4343

4545

46 46

INTERMEDIATE RISK RESULTS – RELAXED CRITERIA

WEIGHTED

77

11 11

14 14

2020

35 35

34 34

39 39

23232424

1616

6 6

2626

3333

8282

6666

8888

6767

7070

9797

6363

6565

102102103103

101 101

8686

87878585

58586868

717181815050

EBRT + ADT

9494

9393

9292

7777

919151

6969

Hypo EBRT99 99

7575

9090

8989

5656

5555

5454

8080

5757

8383

60 60

7373

7272

9898

5353

5252

7979

95956464

100100

8484

7878

5959

62 62

7474

9696

7676

EBRT

Brachy

Surgery

EBRT & Seeds

EBRT, Seeds +ADT

Tre

atm

ent

Suc

cess

104104

1051053030

27 27

48 48

49 49

150150

151151

106106 107 107 31 31

109109

108108

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14

66 11 11

3636

25 25

15 15

55

EBRT Seeds +ADT

19 19

3030

16 16 20 20

18 18

2929% P

SA

Pro

gres

sion

Fre

e

17

21 21

88

99

22 22

24 24

26 26

37 37

4141

1212

Protons

HDR




4242

43 43

4444

45 45

4646

47 47

Robot RP

48 48

4949

101101

102102

103103

104 104

105 105

106106

107 107

109 109

HIGH RISK RESULTS – STRICT CRITERIAWeighted

2323

3535

108 108 44

22

3131

3939

3232

3333

3434

38

EBRT, Seeds & ADTEBRT, Seeds & ADTBrachy

EBRT Surgery

EBRT & ADT

EBRT & Seeds

Hypo EBRT

Tre

atm

ent

Suc

cess

11

77

110110

2727

33

1313

1414

28 28

4040

10 10

111 111

112112

112112

113113

114 114

115115

116 116

Surg & ADT

118118

117 117 119 119 121121

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15

66

11 11

3636

25 25

15 15

55

19 19

3030

16 16 20 20

18 18

2929% P

SA

Pro

gres

sion

Fre

e

17

21 21

88

99

22 22

24 24

26 26

37 37

4141

1212

Protons



4242

43 43

4444

4646

47 47

48 48

4949

101101

102102

103103

104 104

105 105

106106

107 107

109 109

HIGH RISK RESULTS – RELAXED CRITERIA

WEIGHTED

Tre

atm

ent

Suc

cess

10 10

2323

3535

108 108 44

22

3131

3939

3232

3333

3434

38

5050

5151

5252

53

5454

55

HIFU

5656

8686 8787

57

5858

5959

6161

6262

6363

6464

65

6666

6767

6868

6969

7070

7171

7272

7373

74

7576

77

78

8888

79

80

81

8989

8484

8383 8282

85

Surgery

Brachy

EBRT

EBRT & ADT

EBRT & Seeds

Hypo EBRT

HDR

EBRT Seeds +ADT

Robot RP


11

77

9090

9191

110110

2727

33

1313

1414

28 28

4040

9292

45 45

111 111

112112

112112

113113

114 114

115115

116 116

Surg & ADT

118118119 119

6060

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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

16

OBSERVATIONS

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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)

Documents

SLIDES EXTRACTED FROM PRESENTATION