peter grimm do seattle prostate institute l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Comparative Effectiveness Prostate Cancer Results Study Group 2009 PowerPoint Presentation
Download Presentation
Comparative Effectiveness Prostate Cancer Results Study Group 2009

Loading in 2 Seconds...

play fullscreen
1 / 24

Comparative Effectiveness Prostate Cancer Results Study Group 2009 - PowerPoint PPT Presentation


  • 172 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Comparative Effectiveness Prostate Cancer Results Study Group 2009' - matty


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
peter grimm do seattle prostate institute
Peter Grimm, DO

Seattle Prostate Institute

Comparative Effectiveness Prostate Cancer Results Study Group 2009

Latest update 4/23/09

prostate cancer results study group
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
expert panel
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
expert panel4
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
study
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

criteria for inclusion
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
criteria for inclusion7
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
articles meeting criteria
% Articles Meeting Criteria

Total 603 Treatment Articles. Some articles addressed several treatments

low risk pcsg criteria
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
low risk pcsg criteria10
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

low risk 40 mo med f u or 100 pts
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
low risk 40 mo med f u or 100 pts13
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
intermediate risk pcrsg criteria
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
intermediate risk pcrsg criteria15
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
intermediate comparison 40 mo med f u or 100 pts
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
intermediate comparison 40 mo med f u or 100 pts17
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
high risk pcrsg criteria
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
high risk pcrsg criteria19
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
high risk 40 mo med f u or 50 pts
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
high risk 40 mo med f u or 50 pts21
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
conclusions
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
special thanks to
Special Thanks To…

1-877-773-0622

www.studymanager.com