Download Prostate Cancer Results Study Group 2014 – Results Comparing

Prostate Cancer Results Study Group 2014 – Results Comparing Treatment of Prostate Cancer
Prostate Cancer
Peter Grimm, DO
Prostate Cancer Center of Seattle
Seattle, WA About This Review Study
• 28,000+ prostate studies were published between 2000 and June 2013
• 1,127 of those studies featured treatment results
• 233 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
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Prostate Cancer Results Study Group
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David Bostwick, MD – Bostwick Laboratories David Crawford, MD – University of Colorado, Denver, CO
Brian Davis, MD – Mayo Clinic, Rochester, MN
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 – Prostate Cancer Center of Seattle, WA
Jos Immerzeel, MD – De Prostaat Kliniek, the Netherlands Stephen Langley, MD – St Luke's Cancer Centre, Guildford, England Al
Alvaro Martinez, MD –
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MD William Beaumont, Royal Oak, MI
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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
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Prostate Cancer Results Study Group
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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 –
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Schiffler Cancer Center, Wheeling, WV h ffl
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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 Weber, MD –
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Prostate Cancer Center of Seattle, Seattle, WA
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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
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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 5
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
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Criteria for Inclusion of Article* 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 (cryotherapy), protons, HDR lt
d) CRYO (
th
)
t
HDR
(high‐dose‐rate brachytherapy)
4.Article must be in a peer‐reviewed journal
* Expert panel consensus
Criteria for Inclusion of Article (Cont’d) 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
9.For additional criteria information, contact [email protected]
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% Articles Meeting Criteria RP
EBRT/ IMRT
Cryo
Brachy/ HDR
Robot RP
Proton
HIFU
9%
13%
5.4%
21%
5.3% 24%
8%
28/320
40/302
2/37
64/306
4/76
4/17
3/38
Total of 1,127 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: T1 or T2a,b
• Gleason score: ≤6
• PSA: ≤10 ng/mL
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%P
PSA Progression Free
Treatment Success
Low‐Risk Results 25 8
4
22
6
3
31
19 105 24
11314
110
27
13
37
114 35
33
32
10
28
39103
29 101
18
112
102
2 26
40
1100
16
111
115
12
7
15
109
5
36
107
106
104
9
108
EBRT &
Seeds
Robot RP
20
17
7
CRYO
HIFU
34
Protons
HDR
← Years from Treatment →
11109
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
Prostate Cancer Center of Seattle
6/27/2014 Update of BJU Int, 2012, Vol. 109(Supp. 1)
% PSA
A Progression Fre
ee
Treatment Success
Low‐Risk Results – Weighted
25
4
22
3 6
31
19 105 24
110
37
11314
114 35
33
29 101
39103
18
102
2 26
40
1 100
7
EBRT/IMRT
LDR Brachy
27
13 8
32
10
112 28
36
12
107
106
111
16
5
Surgery
9
15
109
115
104
EBRT &
Seeds
Robot RP
108
20
17
7
CRYO
HIFU
34
← Years from Treatment →
Protons
HDR
11109
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
Prostate Cancer Center of Seattle
6/27/2014 Update of BJU Int, 2012, Vol. 109(Supp. 1)
6
Low‐Risk Results – Weighted
% PSA Progression Free
Treatment Successs
>40 months’ follow‐up or <100 patients
HDR
Proton
1 50
68 51
92
46 11314
96
110
97 66 25
22
13 8
75
48
37
2014 816 6286
11435
44
3
60
41 82
33
32
203 6985
71
6584 3172 99 29 101 39103 11228 1067
98 89
42 94 95
61 93
18 88102
38
54
36
105 24
73
1947
43 55
78
2 26
64
12 83
40
20258
1 100 7 87
106
76 56
107
77
9
70 80
41
15 45
57 74 79
20
10959
17
90
53
27
+
LDR Brachy
111
5
EBRT/IMRT
16
52
104
108
Surgery
63
7
34
← Years from Treatment →
91
115
Seeds &
ADT
EBRT &
ADT
EBRT &
Seeds
Robot RP
49
CRYO
HIFU
Protons
Hypo EBRT
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HDR
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
Prostate Cancer Center of Seattle
6/27/2014 Update of BJU Int, 2012, Vol. 109(Supp. 1)
Intermediate‐Risk Patient Definition
• Zelefsky definition - Only 1 factor
- Clinical stage: T2c
- Gleason score: >7
- PSA: >10 ng/mL
• D’Amico definition - PSA 10
PSA 10–20
20 ng/mL, Gleason score 7, or Stage T2b
ng/mL, Gleason score 7, or Stage T2b
7
% PSA Progression Free
Treatment Success
Intermediate‐Risk Results – Weighted
24 2313
35
14
49
151
161
15 44
160 30 36 45 25
152 6 12
160
43 47
5
7 155
41
28
10 11
Seeds + ADT
EBRT & Seeds
Hypo EBRT
17
Seeds Alone
150
157
29
1
EBRT/IMRT
40
27
42
32 3
Robot RP
+
EBRT & Seeds
38
39
156 31
9 26
Seeds Alone
34
16 4
18
152
37
158
156
153
154
48
8
33
159
2
32
19
Surgery
46
20
HDR
155
← Years from Treatment
→
21
22
EBRT, Seeds +
ADT
Protons
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
Prostate Cancer Center of Seattle
6/27/2014 Update of BJU Int, 2012, Vol. 109(Supp. 1)
Favorable vs Unfavorable* Intermediate Risk Favorable g
• Single feature • Gleason 3+4=7
• <50% 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 64 p 895‐902 2013 Favorable vs Unfavorable
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% PSA Progression Free
Treatment Successs
Intermediate‐Risk Results – Weighted
Favorable vs Unfavorable* EBRT & Seeds
Brachy
24 2313
35
14
49
151
160 30 36 45 25
152 6 12
160
16 4
F33
39
5
7 155
152
9 26
41
1
10 11
EBRT
40
38
28
17 27
Seeds Alone
150
157
29 U33
154
48
8
159
2
32
19
46
Surgery
20
HDR
155
← Years from Treatment
→
Seeds + ADT
EBRT & Seeds
Hypo EBRT
42
32 3
156 31
43 47
18
Robot RP
+
34
153
15 44
37
158
156
EBRT, Seeds +
ADT
21
Protons
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• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
Prostate Cancer Center of Seattle
6/27/2014 Update of BJU Int, 2012, Vol. 109(Supp. 1)
Intermediate‐Risk Results
% PSA Progression Free
10459
EBRT + ADT
54 56
59 55
66
24 23 13
14
35
79
49
59
158
92
156
98
151
34
153
161 1544 96
57
16 4
38 58
68 69
1093036 45
5 25
160
10599 77 12
39
83
152
107
82
97 6106
42 73
31
108
156 91
51
160
32 3 72
62 18 6393 4347
86
71
81 95
28
74 67 50
150
90 92652
5
65
152 78 70 7 155
103
29
76 102
154
41
1
60100
48
32
8 87
85 88 53
2
19
1010111 33
75
46
84
Robot RP
37
+
40
27
17
110
Treatment Successs
>40 months’ follow‐up or <100 patients
89 94
64
Seeds + ADT
EBRT & Seeds
Hypo EBRT
Seeds Alone
157
159
20
HDR
155
← Years from Treatment
→
80
21
22
EBRT, Seeds +
ADT
Protons
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
Prostate Cancer Center of Seattle
6/27/2014 Update of BJU Int, 2012, Vol. 109(Supp. 1)
9
Intermediate‐Risk Results – Weighted
Treatment Successs
LDR SEEDS ALONE
54
10459 56
111
66 55
49
111 9279
151
161 1544 96
57
30 36 45
109
99 77 5
111
105 152
107
82
97 612
108
51
160
62 18 6393 4347
74 67 50
25
HDR
14
98
153
68
16 4
69
39
156 31 91
86
28
150
90 92652
5
152 78 70 7 155
103
29
76 102
154
41
1
60100
48
8 87
85 88 53
1010111
75
EBRT
24 23 13
35
EBRT + ADT
Robot RP
37
158
156
110
% PSA Progression Free
>40 months’ follow‐up or <100 patients
84
89 94
+
34
40
38 58
83
42 73
3 72
71
81 95
65
2
32
19
46
27
17
64
157
EBRT & SEEDS
Surgery
Seeds + ADT
EBRT & Seeds
Hypo EBRT
Seeds Alone
159
20
HDR
155
← Years from Treatment
→
80
21
22
EBRT, Seeds +
ADT
Protons
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
Prostate Cancer Center of Seattle
6/27/2014 Update of BJU Int, 2012, Vol. 109(Supp. 1)
High‐Risk Patient Definition
• Zelefsky definition
- 2 or more factors - Gleason score: >7
- PSA: 10–20 ng/mL
- Clinical stage: T1c–2b
• D'Amico - Gleason score: 8–10
- PSA: >20 ng/mL
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Treatment Success
% PS
SA Progression F
Free
High‐Risk Results
20
19 18
32
136123
122
40
125 44
1243 34135
125
13
16
4
112
108
17
EBRT & Seeds
131
43
41
48 128
103
35
46
37
47
127
2
Hypo EBRT
104
10 114
42
13412
8 132136
32
110 9
36
33 111
5 120
21 129 45 126
120
120
14
121 39 119
115
11
31
7 6 26
36
3011627
107
102
0 15
105
24 28
1
25
101 113
106
118
Surg & EBRT
Surg & ADT
EBRT & ADT
109
133
117
130
Protons
HDR
Robot RP
23 29
← Years from Treatment
→
49
EBRT Seeds +
ADT
Hypo EBRT
+ADT
HDR + ADT
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
Prostate Cancer Center of Seattle
6/27/2014 Update of BJU Int, 2012, Vol. 109(Supp. 1)
% PSA Progression Free
Treatment Success
High‐Risk Results – Weighted
EBRT, Seeds & ADT
20
16
19 18
2
32 22
123
136 122
40
125 44
1243 34135
HDR
125
13
EBRT/IMRT
103
35
46
108
17
43
EBRT & Seeds
37
47
127
2
10
114
42
1 13412
8 132136
32
110 9
36
33 111
5 120120
21 129 45 126
14
12139 119
115 11 26
31
76
36
3011627
107
102
0 15
105
48 128
EBRT + ADT
109
112131
41
25
101 113
106
118
4
112
Surg & EBRT
Surg & ADT
EBRT & ADT
EBRT & Seeds
Hypo EBRT
104
24 28
133
Surgery
117
130
HDR
23 29
← Years from Treatment
→
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
Protons
49
EBRT Seeds +
ADT
Robot RP
HDR + ADT
Prostate Cancer Center of Seattle
6/27/2014 Update of BJU Int, 2012, Vol. 109(Supp. 1)
11
High‐Risk Results – Weighted
Treatment Success
% PSA Progression Free
>40 months’ follow‐up or <100 patients
EBRT, Seeds & ADT
EBRT + Seeds
92 65
20
16
99 94 81
109
4
19 18
80
74
112
108
32
22
2
78
123
67
136 122
17
123
55
131
112
4075
125 44 85
4376
3
72
60
127
12454
34 135
91 66 41
125
68
8
2
57
134
71 1364 79
128
48 59 10
114
42
50
56 1
24 28
12
8 61
132136
53 25
90
32
110 9 89
101 113 45
36
45
5 120
62 106 12933 111
21 93
126
118
14
39 119 95
70
98 31
11 96
115
103
83 7 8226
35
6
52 63
84
36
73
30116
58 27
77 46
107
87
86
88
102
0 15
105
51
23 29
Years from 69
Treatment
EBRT + ADT
EBRT & Seeds
37
47
Hypo EBRT
104
133
EBRT
←
→
Surg & EBRT
Surg & ADT
EBRT & ADT
130
Protons
HDR
Surgery
49
EBRT Seeds +
ADT
Robot RP
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
HIFU
HDR + ADT
Prostate Cancer Center of Seattle
6/27/2014 Update of BJU Int, 2012, Vol. 109(Supp. 1)
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 for S i
id ff t t
tb
id d f
any treatment
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For More Information/Slides
Peter Grimm, DO
[email protected]
Or contact PCRSG member Prostate Cancer Center of Seattle website
www.Prostatecancertreatmentcenter.com
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