Treatment of Prostate Cancer
About Prostate Seed Institute
Facts About Prostate Cancer
What Is The Prostate?
Risk Factors for Prostate Cancer
Symptoms of Prostate Cancer
Test for Prostate Cancer
Diagnosis of Prostate Cancer
Grading & Staging Prostate Cancer
Frequently Asked Questions
Resources
Resources
Glossary of Cancer Terms
Contact Us
Prostate Seed Institute
7415 Las Colinas Blvd. Suite100
Irving , Texas , 75063
214.379.2700

Competitive Effectiveness of Prostate Cancer Treatment
Prostate Cancer Results, Study Group 2010

Peter Grimm, DO, John Sylvester, MD
Prostate Cancer Treatment Center Seattle
9730 3rd Ave NE
Seattle Wa, 98115
Prostatecancertreatmentcenter.com

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

  • Ignace Billiet,MD Europe
  • David Bostwick, MD Bostwick Laboratories
  • David Crawford, MD Univ Colorado
  • Adam Dicker, MD Thomas Jefferson
  • Peter Grimm, DO Prostate Cancer Treatment Center
  • Netherlands
  • Mira Keyes, MD BC Cancer Agency
  • Kupelian, Patrick, MD MD Anderson Orlando
  • Robert Lee Duke University Medical Center
  • Stefan Machtens,MD Europe
  • 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
  • Katsuto Shinohara, MD UCSF
  • John Sylvester, MD Prostate Cancer Treatment Center
  • Mark Scholz, MD Prostate Cancer Research Institute
  • Ed Weber, MD Prostate Cancer Treatment Center
  • Anthony Zietman, MD Harvard Joint Center
  • Michael Zelefsky, MD Memorial Sloan Kettering
  • Fellows Jason Wong, MD
  • Jyoti Mayadev, UC Davis MD
  • Stacy Wentworth, MD Winston NC
  • Robyn Vera, DO Medical College of Virginia

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

  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
  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

% Articles Meeting Criteria

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

Reason for Article rejection
  Strat BR FS Exc <72Gy <100pt <5yr f/u other
RP 68% 4 9 - 3 13 3
EBRT 31% 3 3 31 12 23 4
Brachy 29% 2 7 - 15 40 5
Cyro 10% 0 0 - 32 57 14
RobRP 64% 2 2 - 8 20 6
Proton 45% 0 0 - 18 36  


 

Low Risk PCRSG Criteria
 
Question
Would changing the median f/u to 40 months, or relax # pts change the overall outcome?
 
Low Risk
> 40 mo Med F/U or < 100 pts
 
 
Immediate Risk PCRSG Criteria
 
 
Intermediate Comparison
>40 mo Med F/U or < 100 pts
 
 
High Risk PCRSG Criteria
 
 
High Risk
>40 mo Med F/U or < 50 pts
 
 
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
 
For More Information

 
Special Thanks To...