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Comparative Effectiveness Prostate Cancer Results Study Group 2009

Peter Grimm, DO Seattle Prostate Institute. Comparative Effectiveness Prostate Cancer Results Study Group 2009. Latest update 4/23/09 . Prostate Cancer Results Study Group .

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Comparative Effectiveness Prostate Cancer Results Study Group 2009

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  1. Peter Grimm, DO Seattle Prostate Institute Comparative Effectiveness Prostate Cancer Results Study Group 2009 Latest update 4/23/09

  2. Prostate Cancer Results Study Group • 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

  3. Expert Panel • 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

  4. Expert Panel • 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

  5. 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

  6. Criteria for Inclusion • Patients must be stratified into recognizable Pre-Treatment Risk groups: Low, Intermediate, and High Risk by either D’Amico, Zelefsky or NCCN stratification • bRFS standard endpointASTRO, Phoenix, and PSA < 0.2 (surgery) • Clinical StagingNo exclusions: i.e. No Pathologic staging • EBRT must be minimum 72 Gy IMRT / conformal

  7. Criteria for Inclusion • All Treatment modalities considered: Seeds, Surgery, IMRT, HIFU, CRYO Protons, HDR • Accepted results: Peer Reviewed Journals Only • Low Risk Accepted minimum number 100 pts • Int Risk Accepted minimum number 100 pts • High Risk Accepted minimum number 50 pts • Minimum median F/U : 5 yr

  8. % Articles Meeting Criteria Total 603 Treatment Articles. Some articles addressed several treatments

  9. Low Risk PCSG Criteria % PSA Progression Free 21 25 8 14 23 20 4 17 10 19 EBRT & Seeds 16 5 26 12 24 Robot RP 7 22 3 9 18 15 13 11 13 2 CRYO HIFU Protons ← Years → No TX • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  10. Low Risk PCSG Criteria % PSA Progression Free 21 Brachy 25 8 14 23 20 4 17 10 19 EBRT & Seeds 16 5 26 12 24 Robot RP 7 22 Surgery 3 9 18 15 13 11 13 EBRT 2 CRYO HIFU Protons ← Years → No TX • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references 4/2/2014 10

  11. Would changing the median f/u to 40 months, or relax # pts change the overall outcome ? Question

  12. Low Risk > 40 mo Med F/U or < 100 pts % Progression Free 54 50 48 49 21 25 8 14 67 23 41 44 66 51 4 17 10 62 EBRT & Seeds 19 47 63 45 55 43 57 52 46 16 5 26 65 13 12 60 61 24 Robot RP 22 58 7 3 45 9 18 15 59 11 47 1 46 56 2 CRYO HIFU 62 Protons ← Years → No TX • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  13. Low Risk > 40 mo Med F/U or < 100 pts % Progression Free 54 50 48 49 21 25 Brachy 8 14 67 23 41 44 66 51 4 17 10 62 EBRT & Seeds 19 47 63 45 55 43 57 52 46 16 5 26 65 13 12 60 61 24 Robot RP Surgery 22 58 7 3 45 9 18 EBRT 15 59 11 47 1 46 56 2 CRYO HIFU 62 Protons ← Years → No TX • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  14. Intermediate Risk PCRSG Criteria % PSA Progression Free 33 13 31 35 15 14 32 EBRT & Seeds 4 36 1 34 12 16 3 18 17 27 19 28 26 6 9 29 7 8 2 5 30 25 21 Protons HDR 23 ← Years → • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  15. Intermediate Risk PCRSG Criteria % PSA Progression Free 33 Brachy 13 31 35 15 14 32 EBRT & Seeds 4 36 1 34 12 16 3 18 17 27 19 28 EBRT 26 6 9 29 7 8 2 5 30 25 Surgery 21 Protons HDR 23 ← Years → • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  16. Intermediate Comparison >40 mo Med F/U or < 100 pts %PSA Progression Free 33 4 80 13 55 56 31 35 15 61 58 14 3 32 57 59 4 36 1 EBRT & Seeds 71 68 34 48 69 73 65 12 16 51 3 64 54 72 74 18 17 63 53 27 19 28 67 52 26 6 9 29 77 62 7 8 75 70 2 76 78 5 30 25 21 60 Protons 79 HDR 23 ← Years → • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  17. Intermediate Comparison >40 mo Med F/U or < 100 pts %PSA Progression Free 33 4 80 13 55 Brachy 56 31 35 15 61 58 14 3 32 57 59 4 36 1 EBRT & Seeds 71 68 34 48 69 73 65 12 16 51 3 64 74 54 72 18 17 63 53 27 19 28 67 52 26 6 9 29 77 62 EBRT 7 8 75 70 2 76 78 5 30 25 21 60 Surgery Protons 79 HDR 23 ← Years → • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  18. High Risk PCRSG Criteria % PSA Progression Free 20 16 EBRT & ADT 39 19 4 17 23 1 18 EBRT & Seeds 41 33 37 22 32 37 34 9 10 24 8 36 12 38 27 21 5 25 26 28 41 Protons 6 13 7 HDR 31 30 11 14 15 EBRT Seeds + ADT ← Years → 3 2 29 • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  19. High Risk PCRSG Criteria % PSA Progression Free 20 16 EBRT & ADT Brachy 39 19 4 17 23 1 18 EBRT & Seeds 41 33 37 22 32 37 34 9 10 24 8 36 12 38 27 EBRT 21 5 25 26 28 41 Protons 6 13 7 HDR 31 30 11 14 Surgery 15 EBRT Seeds + ADT ← Years → 3 2 29 • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  20. High Risk > 40 mo Med F/U or < 50 pts % PSA Progression Free Seeds + HT 80 20 18 EBRT & ADT 54 39 84 16 4 19 23 1 17 41 EBRT & Seeds 52 65 75 70 67 33 37 22 32 66 62 37 69 64 85 34 71 9 10 61 24 82 8 36 79 12 38 27 58 21 5 78 77 81 68 25 60 26 28 41 63 74 HDR 6 55 56 13 72 7 57 59 EBRT Seeds + ADT 73 31 30 50 83 51 53 11 14 15 40 ← Years → 3 2 76 29 • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  21. High Risk > 40 mo Med F/U or < 50 pts % PSA Progression Free Seeds + HT 80 20 18 EBRT & ADT Brachy 54 39 84 16 4 19 23 1 17 41 EBRT & Seeds 52 65 75 70 67 33 37 22 32 66 62 37 69 64 85 34 71 9 10 61 24 82 8 36 79 12 38 27 58 EBRT 21 5 78 77 81 68 25 60 26 28 41 63 74 HDR 6 55 56 13 72 7 57 59 EBRT Seeds + ADT 73 31 30 50 83 51 53 11 14 Surgery 15 40 ← Years → 3 2 76 29 • Prostate Cancer Results Study Group 3/31/09 • Numbers within symbols refer to references

  22. Conclusions • 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

  23. Special Thanks To… 1-877-773-0622 www.studymanager.com

  24. Special Thanks To… Anne Grilley

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