This document discusses treatment options for high-risk prostate cancer. It defines high-risk as PSA >20, Gleason score >7, stage >T2b, or two or more intermediate risk factors. Treatment options discussed include radiation plus testosterone inactivating pharmaceuticals (TIP), which generally has better outcomes than surgery alone. The addition of seed implants to radiation can further boost radiation doses to the prostate. Studies show seed implants combined with radiation and TIP can achieve cure rates of 88-95% for high-risk prostate cancer patients.
1) The TAMARIS trial evaluated the efficacy and safety of NV1FGF gene therapy compared to placebo for treating critical limb ischemia in patients unsuitable for revascularization.
2) The primary endpoint of reducing major amputations or death within 12 months was not met. NV1FGF did not improve amputation-free survival compared to placebo.
3) No safety signals were identified over the course of the trial and long-term follow-up is ongoing. The results suggest NV1FGF is not an effective treatment for critical limb ischemia in this patient population.
1. Hematopoietic stem cell transplantation (HSCT) can provide long-term remission for some CML patients, but it carries risks of mortality and morbidity.
2. HSCT is best considered after failure of tyrosine kinase inhibitor (TKI) therapy or for accelerated/blast phase disease.
3. Directly after diagnosis, HSCT may be too risky due to transplant-related risks outweighing potential benefits. In blast crisis phase, HSCT may be too late due to disease progression.
Gioffrè Gaetano. Le Statine nella Chirurgia non Cardiaca. ASMaD 2012Gianfranco Tammaro
The document discusses the cardioprotective effects of statins through cholesterol-dependent and independent mechanisms. It summarizes evidence that statins reduce peri-procedural myocardial injury following percutaneous coronary interventions (PCI) through several pleiotropic effects, including reducing inflammation, improving endothelial function, and providing ischemic preconditioning. It recommends starting high-dose statins such as atorvastatin before elective PCI to maximize these benefits. The cardioprotective effects of statins may also be useful in reducing myocardial injury and ischemia during non-cardiac surgery.
Improving Patient Safety Outcomes: Impact of Bar-code Technologyhospira2010
This document summarizes research on the impact of bar-code medication administration (BCMA) technology in reducing medication errors. Studies show BCMA reduced dispensing errors by 36-63% and potential adverse drug events by 63%. BCMA also reduced medication administration errors in intensive care units by 19.7% to 8.7%. While BCMA's impact varied between ICUs and general wards, it reduced clinically important error types. 9% of intercepted errors using BCMA were considered moderate or severe risks. BCMA has potential to reduce errors but continued improvements are still needed given medication errors can still occur.
Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms.
Presented at AHA by: Faiez Zannad, M.D., Ph.D., John J.V. McMurray, M.D., Henry Krum, M.B., PhD., Dirk J. van Veldhuisen, M.D.,Ph.D., Karl Swedberg, M.D., Ph.D, Harry Shi, M.S., John Vincent, M.B., PhD., Stuart J Pocock, Ph.D. and Bertram Pitt, M.D. for the EMPHASIS-HF Study Group * Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure
Courtesy of http://www.cardiovascularbusiness.com
1) Acromegaly is caused by excess growth hormone production, usually from a pituitary tumor. The goals of treatment are to control symptoms, suppress hormone levels, decrease tumor size, and preserve normal pituitary function.
2) Surgical removal of the tumor via transsphenoidal surgery often results in remission, with higher rates for microadenomas versus macroadenomas. Pre-operative factors like tumor size and invasiveness affect outcomes.
3) Medical therapies like somatostatin analogs and GH receptor antagonists can help control hormone levels and symptoms in cases where surgery is not effective or possible. These medications provide alternatives or adjuncts to surgery in treating acromegaly.
The document outlines the procedures for activating different emergency codes at Bhumibol Adulyadej Hospital, including trauma codes A, B, C, and M and non-trauma codes for stroke, childbirth before admission, CPR, and myocardial infarction. It then evaluates the efficacy of the trauma code activation system based on 199 patients transferred by emergency services, finding high accuracy in code identification and improved outcomes for activated code M patients.
The document summarizes a clinical trial comparing the treatments erlotinib and gefitinib for non-small cell lung cancer. It found that erlotinib improved overall survival compared to standard chemotherapy, with a median survival of 6.7 months for erlotinib versus 4.7 months for chemotherapy. Erlotinib also prolonged progression-free survival compared to chemotherapy. The study provides support for using erlotinib or gefitinib as treatments for non-small cell lung cancer.
1) The TAMARIS trial evaluated the efficacy and safety of NV1FGF gene therapy compared to placebo for treating critical limb ischemia in patients unsuitable for revascularization.
2) The primary endpoint of reducing major amputations or death within 12 months was not met. NV1FGF did not improve amputation-free survival compared to placebo.
3) No safety signals were identified over the course of the trial and long-term follow-up is ongoing. The results suggest NV1FGF is not an effective treatment for critical limb ischemia in this patient population.
1. Hematopoietic stem cell transplantation (HSCT) can provide long-term remission for some CML patients, but it carries risks of mortality and morbidity.
2. HSCT is best considered after failure of tyrosine kinase inhibitor (TKI) therapy or for accelerated/blast phase disease.
3. Directly after diagnosis, HSCT may be too risky due to transplant-related risks outweighing potential benefits. In blast crisis phase, HSCT may be too late due to disease progression.
Gioffrè Gaetano. Le Statine nella Chirurgia non Cardiaca. ASMaD 2012Gianfranco Tammaro
The document discusses the cardioprotective effects of statins through cholesterol-dependent and independent mechanisms. It summarizes evidence that statins reduce peri-procedural myocardial injury following percutaneous coronary interventions (PCI) through several pleiotropic effects, including reducing inflammation, improving endothelial function, and providing ischemic preconditioning. It recommends starting high-dose statins such as atorvastatin before elective PCI to maximize these benefits. The cardioprotective effects of statins may also be useful in reducing myocardial injury and ischemia during non-cardiac surgery.
Improving Patient Safety Outcomes: Impact of Bar-code Technologyhospira2010
This document summarizes research on the impact of bar-code medication administration (BCMA) technology in reducing medication errors. Studies show BCMA reduced dispensing errors by 36-63% and potential adverse drug events by 63%. BCMA also reduced medication administration errors in intensive care units by 19.7% to 8.7%. While BCMA's impact varied between ICUs and general wards, it reduced clinically important error types. 9% of intercepted errors using BCMA were considered moderate or severe risks. BCMA has potential to reduce errors but continued improvements are still needed given medication errors can still occur.
Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms.
Presented at AHA by: Faiez Zannad, M.D., Ph.D., John J.V. McMurray, M.D., Henry Krum, M.B., PhD., Dirk J. van Veldhuisen, M.D.,Ph.D., Karl Swedberg, M.D., Ph.D, Harry Shi, M.S., John Vincent, M.B., PhD., Stuart J Pocock, Ph.D. and Bertram Pitt, M.D. for the EMPHASIS-HF Study Group * Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure
Courtesy of http://www.cardiovascularbusiness.com
1) Acromegaly is caused by excess growth hormone production, usually from a pituitary tumor. The goals of treatment are to control symptoms, suppress hormone levels, decrease tumor size, and preserve normal pituitary function.
2) Surgical removal of the tumor via transsphenoidal surgery often results in remission, with higher rates for microadenomas versus macroadenomas. Pre-operative factors like tumor size and invasiveness affect outcomes.
3) Medical therapies like somatostatin analogs and GH receptor antagonists can help control hormone levels and symptoms in cases where surgery is not effective or possible. These medications provide alternatives or adjuncts to surgery in treating acromegaly.
The document outlines the procedures for activating different emergency codes at Bhumibol Adulyadej Hospital, including trauma codes A, B, C, and M and non-trauma codes for stroke, childbirth before admission, CPR, and myocardial infarction. It then evaluates the efficacy of the trauma code activation system based on 199 patients transferred by emergency services, finding high accuracy in code identification and improved outcomes for activated code M patients.
The document summarizes a clinical trial comparing the treatments erlotinib and gefitinib for non-small cell lung cancer. It found that erlotinib improved overall survival compared to standard chemotherapy, with a median survival of 6.7 months for erlotinib versus 4.7 months for chemotherapy. Erlotinib also prolonged progression-free survival compared to chemotherapy. The study provides support for using erlotinib or gefitinib as treatments for non-small cell lung cancer.
This document discusses new frontiers in viral hepatitis, specifically considerations for patients with HIV/HCV co-infection. It provides information on historical and current treatment approaches for hepatitis C, including cure rates of different treatment regimens. It also addresses factors to consider when making treatment decisions, such as genotype, duration of infection, and comorbidities. Upcoming interferon-free treatment options and drug-drug interactions with antiretrovirals are briefly touched upon.
WASHINGTON, D.C.—Use of certain doses of atopaxar in acute coronary syndrome patients can reduce rates of bleeding, cardiovascular events and better achieve platelet inhibition, according to the results of the LANCELOT-ACS trial presented Sept. 23 as a late-breaking clinical trial during the 2010 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting.
www.cardiovascularbusiness.com/topics/coronary-intervention-surgery/tct-lancelot-acs-says-certain-doses-atopaxar-can-reduce-bleeding-cv-events
1) The study examined outcomes in patients with heart failure who were at high risk, finding that at 6 months their risk was approximately 3.8 times higher.
2) Baseline characteristics were similar between the eplerenone and placebo groups, including average age of 64, 72% males, mean ejection fraction of 33%, and 32% with diabetes.
3) For the primary endpoints of total mortality and cardiovascular mortality or hospitalization, eplerenone demonstrated a 15% and 13% reduced risk respectively compared to placebo.
West egfr mutation acquired resistanceH. Jack West
Review by Dr. H. Jack West of current understanding of mechanisms behind and emerging treatment options for patients with advanced NSCLC with acquired resistance to EGFR tyrosine kinase inhibitors after a good initial response.
The document summarizes clinical experience using the Bio Active Stent (BAS), which is coated with titanium-nitride-oxide, compared to paclitaxel-eluting stents (PES) and bare-metal stents (BMS). It finds that over 3 years of follow-up, the BAS had lower rates of major adverse cardiac events, myocardial infarction, and target lesion revascularization compared to PES and BMS. In the year following clopidogrel discontinuation, PES had higher rates of myocardial infarction and stent thrombosis than BAS or BMS.
The study analyzed data from 688 pediatric patients under 18 years of age visiting an outpatient clinic over one year to determine the utilization of fixed dose combinations (FDCs) for respiratory tract infections. The results showed that 32% of patients were toddlers aged 1-3 years. The most common diagnoses were upper respiratory tract infection (URTI) at 25% and influenza-like illness (ILI) at 18%. FDCs with 2 drugs were most frequently prescribed at 72%. Herbal combinations accounted for 28% of FDCs. The study recommends physicians be aware of ingredient strengths in different FDC brands to avoid dosing errors in children.
This corporate presentation by Roberto Bellini, President and CEO of BELLUS Health Inc., provides an overview of the company and its pipeline. BELLUS is focused on developing products for amyloid-related diseases, including their late-stage product KIACTA for AA amyloidosis, a rare and fatal kidney disease with no existing treatment. The presentation outlines the positive Phase II/III results for KIACTA, their partnership with Celtic Therapeutics to fund the confirmatory Phase III trial, and plans to complete recruitment in 2013 and report results in 2015. In addition, the presentation discusses their nutraceutical product VIVIMIND for memory protection and early-stage asset NRM8499 for Alzheimer's disease
The study compared the efficacy and safety of sorafenib versus sunitinib in treating advanced hepatocellular carcinoma (HCC). The study was stopped early after an interim analysis found that sunitinib was associated with a higher rate of serious adverse events compared to sorafenib. Sorafenib showed superior overall survival compared to sunitinib, with median overall survival of 10.2 months versus 7.9 months. Subgroup analyses found sorafenib also had longer median overall survival than sunitinib in both Asian and non-Asian patient populations.
Rivaroxaban was compared to warfarin for the prevention of stroke and embolism in atrial fibrillation patients. Over 14,000 patients were randomly assigned to once-daily rivaroxaban or warfarin with INR monitoring. The primary endpoint of stroke or embolism occurred less frequently with rivaroxaban compared to warfarin. Major bleeding occurred at similar rates while critical organ bleeding and death occurred less often with rivaroxaban.
This document summarizes interim analysis results from a randomized phase 3 study of abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer. The study showed a statistically significant improvement in radiographic progression-free survival with a median of not reached for abiraterone acetate versus 8.3 months for placebo. There was also a strong trend towards improved overall survival with a median of not reached for abiraterone acetate versus 27.2 months for placebo and a 25% reduction in risk of death. Benefits were seen across patient subgroups.
Susan O'Brien, M.D., Professor, Dept. of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center: Newest Strategies in the Treatment of CML/CLL presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center.
This document discusses compliance with narcotics guidelines for managing prescription drug abuse. It describes how managed care programs, employers, healthcare providers and insurers are susceptible to increased workers' compensation costs due to prescription drug abuse. It identifies strategies to help drug-dependent employees return to work, and describes how Washington State has addressed overuse of opioids in workers' compensation through dosing guidelines and a prescription drug monitoring program. The agenda includes discussing the problem of prescription drug abuse, efforts to prevent problems, and the cost of addiction.
Montecucco Carlo Murizio Torino 13° Convegno Patologia Immune E Malattie Orfa...cmid
This document summarizes safety data from the LORHEN registry on anti-TNF-α treatments in rheumatoid arthritis patients. It found that 18.2% of patients discontinued treatment due to adverse events, with serious infections occurring in 6.9% of patients. Risk of discontinuation due to adverse events increased with age and higher corticosteroid doses. The risk of serious infections was highest for infliximab. The study provides valuable real-world safety data on anti-TNF-α treatments from a large observational registry.
Resuscitation what works what doesnt and whats coming down the tube persoffRiver City Symposium
The document summarizes recent evidence on resuscitation techniques for cardiac arrest, finding that high quality chest compressions are essential but often lacking, and that delays in defibrillation, poor coordination of care, and excessive ventilation can reduce survival rates; it also reviews promising new approaches like continuous chest compressions and therapeutic hypothermia. Overall survival remains low but targeted improvements to the resuscitation process may help increase the percentage of patients who survive cardiac arrest with good neurological outcomes.
This corporate presentation by Roberto Bellini, President and CEO of BELLUS Health Inc., provides an overview of the company. BELLUS is focused on developing products for amyloid-related diseases, including their late-stage product KIACTA for AA amyloidosis, a rare kidney disease. The presentation summarizes the positive Phase II/III results for KIACTA, the confirmatory Phase III trial funded through a partnership with Celtic Therapeutics, and the potential market opportunity. It also provides an overview of their nutraceutical product VIVIMIND and early-stage asset NRM8499 for Alzheimer's disease, as well as the company's financial position and key milestones for 2012.
Missile Defense and the Islamic Republic of Iran: Contribution to Deterrence...Scott Rogers
On February 14, 2013, Washington Institute senior fellow Michael Eisenstadt presented a briefing on missile defense and Iran at a conference on missile defense organized by the Polish Institute of International Affairs in Warsaw.
As presented at the Western PD Conference, Feb 2013 in Vancouver, BC. An argument to avoid suboptimal hemodialysis starts with a central venous catheter by pursuing urgent start peritoneal dialysis.
this is very good ppt. for make in India. it will give you the brief introduction about beautiful initiative taken by the Indian government to make India a manufacturing hub.
fbx-t radar element of global defence system thaadHossam Zein
fbx-t radar element of global defence system
for more:
Terminal High Altitude Area Defense THAAD
http://www.slideshare.net/hossamzein/mfc-thaadpc-14751556
BAE Systems provides clean technology solutions for transit vehicles. They discuss benefits like improved energy efficiency and performance from electric drive components in hybrids, plug-in hybrids, and electric vehicles. They have experience with over 3,800 hybrid bus systems globally. Testing shows their hybrid buses achieve up to 40% better fuel economy and reduce emissions. London testing of hybrid double deckers and single deckers showed up to 30% fuel savings. However, issues like costs, subsidies, and technology reliability need consideration for clean transit to be viable long-term.
This document discusses new frontiers in viral hepatitis, specifically considerations for patients with HIV/HCV co-infection. It provides information on historical and current treatment approaches for hepatitis C, including cure rates of different treatment regimens. It also addresses factors to consider when making treatment decisions, such as genotype, duration of infection, and comorbidities. Upcoming interferon-free treatment options and drug-drug interactions with antiretrovirals are briefly touched upon.
WASHINGTON, D.C.—Use of certain doses of atopaxar in acute coronary syndrome patients can reduce rates of bleeding, cardiovascular events and better achieve platelet inhibition, according to the results of the LANCELOT-ACS trial presented Sept. 23 as a late-breaking clinical trial during the 2010 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting.
www.cardiovascularbusiness.com/topics/coronary-intervention-surgery/tct-lancelot-acs-says-certain-doses-atopaxar-can-reduce-bleeding-cv-events
1) The study examined outcomes in patients with heart failure who were at high risk, finding that at 6 months their risk was approximately 3.8 times higher.
2) Baseline characteristics were similar between the eplerenone and placebo groups, including average age of 64, 72% males, mean ejection fraction of 33%, and 32% with diabetes.
3) For the primary endpoints of total mortality and cardiovascular mortality or hospitalization, eplerenone demonstrated a 15% and 13% reduced risk respectively compared to placebo.
West egfr mutation acquired resistanceH. Jack West
Review by Dr. H. Jack West of current understanding of mechanisms behind and emerging treatment options for patients with advanced NSCLC with acquired resistance to EGFR tyrosine kinase inhibitors after a good initial response.
The document summarizes clinical experience using the Bio Active Stent (BAS), which is coated with titanium-nitride-oxide, compared to paclitaxel-eluting stents (PES) and bare-metal stents (BMS). It finds that over 3 years of follow-up, the BAS had lower rates of major adverse cardiac events, myocardial infarction, and target lesion revascularization compared to PES and BMS. In the year following clopidogrel discontinuation, PES had higher rates of myocardial infarction and stent thrombosis than BAS or BMS.
The study analyzed data from 688 pediatric patients under 18 years of age visiting an outpatient clinic over one year to determine the utilization of fixed dose combinations (FDCs) for respiratory tract infections. The results showed that 32% of patients were toddlers aged 1-3 years. The most common diagnoses were upper respiratory tract infection (URTI) at 25% and influenza-like illness (ILI) at 18%. FDCs with 2 drugs were most frequently prescribed at 72%. Herbal combinations accounted for 28% of FDCs. The study recommends physicians be aware of ingredient strengths in different FDC brands to avoid dosing errors in children.
This corporate presentation by Roberto Bellini, President and CEO of BELLUS Health Inc., provides an overview of the company and its pipeline. BELLUS is focused on developing products for amyloid-related diseases, including their late-stage product KIACTA for AA amyloidosis, a rare and fatal kidney disease with no existing treatment. The presentation outlines the positive Phase II/III results for KIACTA, their partnership with Celtic Therapeutics to fund the confirmatory Phase III trial, and plans to complete recruitment in 2013 and report results in 2015. In addition, the presentation discusses their nutraceutical product VIVIMIND for memory protection and early-stage asset NRM8499 for Alzheimer's disease
The study compared the efficacy and safety of sorafenib versus sunitinib in treating advanced hepatocellular carcinoma (HCC). The study was stopped early after an interim analysis found that sunitinib was associated with a higher rate of serious adverse events compared to sorafenib. Sorafenib showed superior overall survival compared to sunitinib, with median overall survival of 10.2 months versus 7.9 months. Subgroup analyses found sorafenib also had longer median overall survival than sunitinib in both Asian and non-Asian patient populations.
Rivaroxaban was compared to warfarin for the prevention of stroke and embolism in atrial fibrillation patients. Over 14,000 patients were randomly assigned to once-daily rivaroxaban or warfarin with INR monitoring. The primary endpoint of stroke or embolism occurred less frequently with rivaroxaban compared to warfarin. Major bleeding occurred at similar rates while critical organ bleeding and death occurred less often with rivaroxaban.
This document summarizes interim analysis results from a randomized phase 3 study of abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naïve patients with metastatic castration-resistant prostate cancer. The study showed a statistically significant improvement in radiographic progression-free survival with a median of not reached for abiraterone acetate versus 8.3 months for placebo. There was also a strong trend towards improved overall survival with a median of not reached for abiraterone acetate versus 27.2 months for placebo and a 25% reduction in risk of death. Benefits were seen across patient subgroups.
Susan O'Brien, M.D., Professor, Dept. of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center: Newest Strategies in the Treatment of CML/CLL presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center.
This document discusses compliance with narcotics guidelines for managing prescription drug abuse. It describes how managed care programs, employers, healthcare providers and insurers are susceptible to increased workers' compensation costs due to prescription drug abuse. It identifies strategies to help drug-dependent employees return to work, and describes how Washington State has addressed overuse of opioids in workers' compensation through dosing guidelines and a prescription drug monitoring program. The agenda includes discussing the problem of prescription drug abuse, efforts to prevent problems, and the cost of addiction.
Montecucco Carlo Murizio Torino 13° Convegno Patologia Immune E Malattie Orfa...cmid
This document summarizes safety data from the LORHEN registry on anti-TNF-α treatments in rheumatoid arthritis patients. It found that 18.2% of patients discontinued treatment due to adverse events, with serious infections occurring in 6.9% of patients. Risk of discontinuation due to adverse events increased with age and higher corticosteroid doses. The risk of serious infections was highest for infliximab. The study provides valuable real-world safety data on anti-TNF-α treatments from a large observational registry.
Resuscitation what works what doesnt and whats coming down the tube persoffRiver City Symposium
The document summarizes recent evidence on resuscitation techniques for cardiac arrest, finding that high quality chest compressions are essential but often lacking, and that delays in defibrillation, poor coordination of care, and excessive ventilation can reduce survival rates; it also reviews promising new approaches like continuous chest compressions and therapeutic hypothermia. Overall survival remains low but targeted improvements to the resuscitation process may help increase the percentage of patients who survive cardiac arrest with good neurological outcomes.
This corporate presentation by Roberto Bellini, President and CEO of BELLUS Health Inc., provides an overview of the company. BELLUS is focused on developing products for amyloid-related diseases, including their late-stage product KIACTA for AA amyloidosis, a rare kidney disease. The presentation summarizes the positive Phase II/III results for KIACTA, the confirmatory Phase III trial funded through a partnership with Celtic Therapeutics, and the potential market opportunity. It also provides an overview of their nutraceutical product VIVIMIND and early-stage asset NRM8499 for Alzheimer's disease, as well as the company's financial position and key milestones for 2012.
Missile Defense and the Islamic Republic of Iran: Contribution to Deterrence...Scott Rogers
On February 14, 2013, Washington Institute senior fellow Michael Eisenstadt presented a briefing on missile defense and Iran at a conference on missile defense organized by the Polish Institute of International Affairs in Warsaw.
As presented at the Western PD Conference, Feb 2013 in Vancouver, BC. An argument to avoid suboptimal hemodialysis starts with a central venous catheter by pursuing urgent start peritoneal dialysis.
this is very good ppt. for make in India. it will give you the brief introduction about beautiful initiative taken by the Indian government to make India a manufacturing hub.
fbx-t radar element of global defence system thaadHossam Zein
fbx-t radar element of global defence system
for more:
Terminal High Altitude Area Defense THAAD
http://www.slideshare.net/hossamzein/mfc-thaadpc-14751556
BAE Systems provides clean technology solutions for transit vehicles. They discuss benefits like improved energy efficiency and performance from electric drive components in hybrids, plug-in hybrids, and electric vehicles. They have experience with over 3,800 hybrid bus systems globally. Testing shows their hybrid buses achieve up to 40% better fuel economy and reduce emissions. London testing of hybrid double deckers and single deckers showed up to 30% fuel savings. However, issues like costs, subsidies, and technology reliability need consideration for clean transit to be viable long-term.
The Aegis Ballistic Missile Defense System Martin Milita
Martin Milita is a consultant who lobbies on behalf of defense contractors like Lockheed Martin to continue contracts, including for the Aegis Combat System installed on US naval vessels. The Aegis system was developed in the 1970s to defend against incoming missiles and now includes ballistic missile defense capabilities as well, intercepting intercontinental missiles. It is also used to destroy short and medium-range missiles and has even intercepted a failing satellite. The Aegis system is being adapted to ground-based sites through the Aegis Ashore program, which will maintain sites in Poland and Romania to defend against threats from the Middle East.
The document discusses the evolution of science and technology (S&T) capabilities and funding sources over time. It shows that government sponsorship of S&T was higher than commercial sponsorship from 1945 to 2015. It also shows the breakdown of UK defense S&T programs between research, applied research, and development, with the vast majority (97.5%) going to acquisition programs rather than research. This ratio is lower than recommended models, which could mean the UK's technological advantage may not be driven as much by S&T.
This document discusses technology investments and contributions to the Ballistic Missile Defense System (BMDS). It outlines several key technology areas like discrimination sensors, common kill vehicle technology, and advanced systems engineering capabilities using simulation tools. It also discusses engaging universities for research in areas like data fusion and tracking algorithms. The goal is to assess new concepts, address capability gaps, and hedge future threats through exploratory technology development. Past investments are said to have helped shape today's BMDS capabilities.
[Military] [article] [armada international] land based air defencezerliz3
The document provides information on various medium-range surface-to-air missile systems, including the Raytheon MIM-23 Hawk, Russian 9K12 Kub and 9K37 Buk systems, and the Eurosam Samp-T system. It discusses the capabilities and upgrades of the Hawk system, used by the US and other nations. It then describes the Russian Kub and its successor, the Buk system, and upgrades available for older Kub systems. It concludes by outlining the Franco-Italian Eurosam Samp-T system, which uses MBDA Aster 30 missiles.
The document discusses missile defense capabilities in the Baltic region. It analyzes the current defense systems and threats from Russia. It recommends improving defenses by modifying Aegis ship schedules, integrating missile defense into naval groups, diversifying control of systems, purchasing Patriot systems, and upgrading aircraft. NATO is addressing gaps but the Baltic States should still invest in their own defenses like Patriot systems while NATO completes an Aegis Ashore site in Poland and improves other capabilities in the region.
Although typically not thought of as a major medical concern, hormone imbalances affect millions of people all over the world and can dramatically hinder the daily lives of both men and women. As we age, hormone levels such as Testosterone, Estrogen and Thyroid, Progesterone, DHEA, Pregnenolone, Melatonin and Cortisol drop or become imbalanced.
Aegis bmd overview_mac_capt shipman 23 jan 12_ distro a_12-mda-6517_11 januar...Lsquirrel
This document provides an overview of the Aegis Ballistic Missile Defense (BMD) program for the Military Affairs Council. It summarizes Aegis BMD's role in intercepting short, medium, and intermediate range ballistic missiles. It also outlines the U.S. Phased Adaptive Approach for European missile defense and the current status of Aegis BMD ships. The overview discusses Aegis BMD's engagement capabilities at different ranges and its contributions to the Ballistic Missile Defense System over time with upgrades to sensors, weapons, and command and control systems.
The document provides details on the history of US ballistic missile defense programs from 1944 to present day. It discusses early programs like Project Nike and Safeguard that tracked missiles. It then covers the Strategic Defense Initiative from the 1980s which conducted tests like Homing Overlay Experiments demonstrating intercepts. Subsequent programs tested interceptors like the ERIS, HEDI, and Ground Based Interceptor. The document also provides information on various radars used for detection and tracking like Cobra Dane, PAVE PAWS, and Sea-Based X-Band Radar.
RADAR - RAdio Detection And Ranging
This is the Part 1 of 2 of RADAR Introduction.
For comments please contact me at solo.hermelin@gmail.com.
For more presentation on different subjects visit my website at http://www.solohermelin.com.
Part of the Figures were not properly downloaded. I recommend viewing the presentation on my website under RADAR Folder.
RADAR stands for Radio Detection and Ranging. It uses radio waves to determine the range, altitude, direction or speed of objects. The document discusses the basic principles and components of radar systems. It describes how pulsed radar works by transmitting pulses and calculating distance based on time of flight. Continuous wave radar is also covered, which can determine velocity using Doppler shift. Applications discussed include navigation, weather monitoring, air traffic control and military uses such as early warning systems and missile guidance.
This document provides an overview of radar systems. It discusses what radar is, the evolution of radar from its initial uses detecting objects with radio waves in the late 1800s. It then explains the basic principles of how radar works to detect objects using radio signal transmission and reflection. Key components of radar systems like transmitters, receivers, antennas and signal processing are described. Applications of radar systems include military, remote sensing, air traffic control, and navigation. The document also discusses radar modulators and antenna design considerations for radar.
The document summarizes the Missile Defense Agency's efforts to improve ballistic missile defense capabilities. It discusses the history and increasing threats posed by ballistic missiles. The agency is working to enhance the Ground Based Interceptor program through improved reliability and discrimination capabilities. It is also developing new sensor technologies and exploring options like boost phase intercept and space-based interceptors. International partnerships remain important for a globally integrated missile defense system.
1) The document provides an overview of ballistic missile defense and summarizes accomplishments from the past year.
2) It discusses the growing ballistic missile threat and proliferation trends. Over 5,500 ballistic missiles are estimated to be in the arsenals of countries other than the US, China, Russia or NATO as of 2010.
3) It summarizes key ballistic missile defense tests conducted in the past year including successful intercepts using the Aegis/SM-3 system and hit-to-kill technology. International cooperation agreements with countries like Poland, Turkey and Spain were also highlighted.
The document discusses the increasing ballistic missile threats from North Korea and Iran and outlines the United States' national priorities to strengthen homeland defense and maintain regional defense commitments. It provides details on enhancements to the Ground-Based Midcourse Defense system and the deployment of Aegis Ballistic Missile Defense and Terminal High Altitude Area Defense (THAAD) systems. The document also summarizes international cooperation efforts and outlines an integrated approach to developing missile defense capabilities.
Cytori Cell Therapy aims to improve quality and length of life through innovative cell therapy. The company has treated over 4,000 patients for conditions like cardiovascular disease and soft tissue disorders. Recent clinical trials show promise for treating chronic myocardial ischemia and acute heart attack. For chronic heart failure, cell therapy may help improve heart condition, activity, and reduce mortality for "no option" patients, representing a large potential market.
Dose Escalation By Imrt And Organ Trackingin Prostate Cancerfondas vakalis
1) This study assessed toxicity in 18 patients treated with dose-escalated IMRT to 80 Gy for prostate cancer while using organ tracking of the prostate.
2) Acute and early late toxicity was minimal, with limited urinary toxicity and minimal rectal toxicity observed.
3) Dose volume histograms showed dose constraints for organs at risk were met.
4) Further follow-up is still needed to fully assess long-term toxicity and efficacy of this aggressive dose escalation approach.
This document summarizes the state of the art in permanent prostate brachytherapy (PPB) based on literature and a large single-institution series. Key findings include:
1) PPB monotherapy provides excellent long-term cancer control for low-intermediate risk prostate cancer, with 10-year biochemical no evidence of disease rates of 88-96%.
2) For all risk groups, PPB monotherapy results in similar long-term outcomes as radical prostatectomy or external beam radiation in terms of cancer control and survival. However, PPB may have fewer side effects.
3) Salvage treatments after PPB fail provide limited cancer control due to high toxicity, but focal therapy aimed at the
Future Developments In Radiation Therapy For Prostate Cancerfondas vakalis
This document discusses future developments in radiation therapy for prostate cancer. It summarizes that dose escalation improves disease control but can increase toxicity risks. Newer radiation techniques like IMRT, fiducial markers, on-board imaging, and protons may allow safer dose escalation by better sparing nearby organs. Further refinements include selective dose painting within the prostate using MRI/MRS imaging fusion to guide treatment. The document also reviews the history and ongoing improvements in brachytherapy techniques for localized prostate treatments.
1) Intensity modulated radiation therapy (IMRT) is a technique that uses computer software to conform the radiation dose to the shape of the tumor, reducing dose to surrounding normal tissues and decreasing toxicity.
2) Numerous studies have shown IMRT provides better sparing of the small bowel, bladder, and rectum compared to conventional radiation for gynecologic cancers.
3) IMRT may allow dose escalation to high risk sites or involved nodes while maintaining normal tissue doses. Some studies have also investigated using IMRT as an alternative to brachytherapy boosts.
4) Clinical studies suggest IMRT results in low rates of acute gastrointestinal and genitourinary toxicity compared to conventional radiation for
Soft tissue sarcomas are rare mesenchymal tumors that can arise in various soft tissues of the body. They are classified based on their cell of origin and differentiation. Treatment involves surgical excision with negative margins, with adjuvant radiation therapy sometimes used to improve local control. Prognosis depends on tumor size, grade, depth and margins of resection, with retroperitoneal and high grade tumors having a worse prognosis due to difficulty obtaining clear margins. Metastatic disease typically spreads to the lungs and has a poor median survival of 8-12 months.
Cytori CEO Chris Calhoun presents as part of the "Cardiovascular, AMI & PAD" panel on the Regenerative Medicine Insight Track at the Biotech Showcase on January 10, 2012
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- Ewing's Sarcoma is identified by the translocation t(11;22) in 90-95% of cases.
- Metastases most commonly spread to the lungs, bones, and bone marrow. Nearly all patients have micrometastases at diagnosis.
- Treatment involves induction chemotherapy followed by local control with surgery or radiotherapy and maintenance chemotherapy.
- Several clinical trials have evaluated chemotherapy regimens and dosing schedules, with INT-0099 establishing VDC/IE as the standard of care and AEWS-0031 showing improved outcomes with interval-compressed chemotherapy.
Radiation therapy for early stage hodgkin’s lymphomaSandip Sarkar
This document discusses radiation therapy for early stage Hodgkin's lymphoma. It provides a brief history of treatment and developments. Key points include:
- Combined modality therapy with chemotherapy and radiation therapy is now the standard of care for early stage disease based on improved outcomes compared to radiation alone.
- For early stage favorable disease, the consensus is multi-agent chemotherapy for 2-4 cycles with involved field radiation therapy. For early stage unfavorable disease, 4 cycles of chemotherapy and radiation is recommended.
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The document discusses different treatment options for prostate cancer based on risk categories and disease stage, emphasizing the importance of accurate risk assessment and monitoring disease progression to initiate appropriate treatment early. It also stresses maintaining physical fitness during treatment and combining therapies when possible to achieve the best outcomes.
This document discusses the numerous variables involved in prostate cancer treatment decisions. It covers factors like risk level, treatment options for newly diagnosed, recurrent, and advanced prostate cancer. It also addresses how patient characteristics, relationships, personality, and understanding of statistics can influence decisions. Additionally, it outlines the many uncertainties in prostate cancer like rapid technology changes, limitations of studies and doctors, and potential profit motives. The conclusion is that prostate cancer requires considering a man's overall health, relationships, and quality of life when determining the often complex management options.
Prostate cancer deaths have decreased 40% over the past 20 years due to early detection and treatment, earlier use of hormone blockade therapy, and new agents. Screening and treatment have improved 10-year survival rates for prostate cancer patients. Prostate cancer screening starts important discussions about health, but increased screening may lead to overdiagnosis and overtreatment. Other leading causes of death in men include heart disease, lung cancer, and infections like pneumonia. Preventive measures like vaccines, screening tests, exercise, and diet can reduce mortality from cancer and heart disease.
This document discusses screening and biopsy for prostate cancer. It provides information on:
1. The imperfect nature of PSA screening and the risks of overdiagnosing low-grade prostate cancer through unnecessary biopsies and overtreatment.
2. Factors that can help determine the likelihood of finding cancer on biopsy for men with elevated PSA levels, such as prostate size, family history, and PCA3 urine tests.
3. Imaging options like MRI that may improve accuracy and allow targeted biopsies to avoid unnecessary procedures.
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This document discusses various imaging modalities for prostate cancer including ultrasound, MRI, CT, bone scans, and PET scans. It provides details on what each modality images, its benefits and limitations. Key applications discussed include biopsy guidance, active surveillance, therapy planning, and follow-up of rising PSA levels. While each modality has advantages, the best option depends on a patient's individual clinical factors and risk level.
This document discusses the management of low risk prostate cancer. It outlines the natural history of untreated low risk prostate cancer and the problems of overdiagnosis and overtreatment. Active surveillance is presented as a management option for low risk prostate cancer, with the rationale being to avoid unnecessary treatment and preserve quality of life. Results from active surveillance studies show low rates of cancer progression and metastasis, with 62% free from intervention at 10 years in one study. Triggers for intervention on active surveillance like rising PSA, grade progression, or tumor volume increase are discussed.
The document discusses various treatment options for prostate cancer including brachytherapy, IMRT, proton therapy, and surgery. It provides details on complications and side effects for each option as well as 5-year cure rates from various studies. It also discusses active surveillance versus immediate treatment and compares the results of the PIVOT and Bill-Axelson trials that studied intermediate risk prostate cancer patients.
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This document discusses treatments for advanced prostate cancer. It begins by describing androgen deprivation therapy as the first line treatment. It then discusses newer FDA-approved treatments since 2010 like cabazitaxel, abiraterone, and immunotherapy drug Provenge. The rest of the document focuses on chemotherapy drug Taxotere/docetaxel, providing details on its efficacy compared to other drugs in clinical trials, side effects, and promising combinations with other treatments like Avastin, carboplatin, and thalidomide. It also discusses other emerging treatments like cabazitaxel, curcustersin, and immunotherapy drug Provenge.
2. Definition: High-Risk
Standard definition of High-Risk (any one of the
below)
PSA > 20
Gleason > 7
Stage > T2b
Two or three Intermediate-Risk Factors
An even more serious form of High-Risk:
Any Gleason grade 5 (Gleason score 9 or 10)
Seminal vesicle invasion
Pelvic lymph node metastases
3. High Risk Group is Heterogeneous
Big difference between a T1c, Gleason 8, PSA 6
and a T3, Gleason 7, PSA 40.
The differing profile of High Risk disease in
research studies is highly era dependant and
continues to be a problem in comparing
treatment outcomes today.
Trend for High Risk category today is lower
volume disease but high grade
4. High Risk
Approximately 15% of the 220,000 men who are
diagnosed annually (33,000 men) are High-Risk
Cancer specific mortality at 10 years for High-Risk
disease averages between 5% and 15%
There is some consensus among experts about
treatment:
1. Treat, don’t observe (except the very elderly or infirm)
2. Radiation plus testosterone inactivating
pharmaceuticals (TIP) is generally a better treatment
than surgery (except perhaps in men who have a high
Gleason but very low volume disease)
5. Staging Studies: High Risk
Considered standard:
Bone Scan to evaluate for possible bone metastasis
CT scan (or MRI ) of abdomen and pelvis to evaluate for
possible pelvic node metastases
Logical but still not considered standard: Endorectal
MRI to evaluate for possible seminal vesicle invasion
(scan quality varies depending on equipment and
physician experience )
6. What to Do with Scan Results that
Are Considered Ambiguous?
Suspicious bone scan findings can be further
evaluated with MRI or with CT directed biopsy
Suspicious pelvic node findings can be evaluated
with ProstaScint, experimental PET scans, CT
directed needle biopsy or laparoscopic surgery
Suspicious endorectal MRI findings suggesting
seminal vesicle invasion can be evaluated with
color doppler or endorectal MRI directed biopsy
7. Surgery for Gleason 8-10?
Epstein, Urology 76:715, 2010
9300 men with median:
PSA of 7.5 and stage T2
80% recurrence rate at 15 years
70% had extra capsular disease
An even worse outcome was associated with any:
Gleason grade 5
Seminal vesicle invasion
Positive lymph nodes
Take home message: Surgical cure rates are low with
high Gleason score when there is a palpable
abnormality on digital rectal examination
9. Outcome after Surgery in Men
with
High-Risk is Improved with TIP
Men with High-Risk:
Two years of TIP consisting of Zoladex plus Casodex
resulted in surprisingly low relapse rate in 481 men with
High-Risk disease (Dorff, JCO 29:2040, 2011)
Relapse rate @ five years was only 7.5%
Men with Positive Nodes:
Immediate TIP was better than TIP started at relapse in
men with positive nodes at surgery (Messing, NEJM, 341:1781,
1999)
Mortality @ 7 years: 15% vs. 40%
10. Pelvic XRT after Surgery in Men
Found Node Positive from Surgery
Briganti, Eur Urol 2011
364 men node positive after surgery
117 men had TIP plus pelvic radiation vs.
247 men had TIP without radiation
10-year cancer specific survival
86% with TIP plus XRT to pelvic nodes
70% with TIP alone
11. Is Surgery Appropriate for High Risk?
Please consider the following:
If cure rates with surgery alone are poor…
If men do better after surgery with the addition
of TIP….
If men do better after surgery with pelvic node
radiation…..
Why not proceed straight to radiation and skip
the surgery ?
12. Surgery Vs. Radiation for High-Risk
Arcangeli, IJROBP 75:975, 2009
162 men treated with EBRT plus TIP
9 months of testosterone deprivation started 2 months
before xrt
80 gy without node treatment
122 men treated with radical prostatectomy
Radiation patients had higher Gleason scores and
clinical stage that surgery patients
3-year relapse rate was 13% for the radiation patients
and 30% for the surgery patients
13. Rationale for seed implant boost
Higher dose, more conformal radiation treatment is
attained with seed implant compared to external
beam radiation alone
Studies incorporating seed implant boost show
excellent relapse free survival rates
15. Radiation Dose From Seeds in EBRT
Equivalent Doses
Prostate
Typical IMRT ≈ 100 Gy EBRT
high dose equivalent
78 – 81 Gy
Area of
Prostate
Receiving
150+ Gy
EBRT
equivalent
16. Seeds + EBRT
Dose vs. Risk Grouping
Low Risk Disease High Risk Disease
(standard)
(seeds + EBRT)
(inadequate)
(standard for
seeds alone)
552 patients
2,188 patients
p < 0.0001
(inadequate)
Achieving high dose more important for *Stone NN et al, IJROBP
High Risk disease than for Low risk Vol. 69, #5, 1472, 2007
17. Cure Rates: Seeds for High-Risk
# TIP Cure Follow Reference
Pts. Rate Up
190 6 mo. 95% 8 yr. Merrick, IJROBP 61:32, 2005
243 ½ 6 m0. 88% 10 yr. Bittner, IJROBP 72:433, 2008
107 no 63% 10 yr Demanes, AJCO 32:342, 2009
18. Very High Risk Treated with
Seeds + EBRT + TIP*
131 patients, median age 68 yr.
T3
PSA > 40
Gleason 10
Gleason 8-9 with >50% + bx cores,
Gleason 8-9 with PSA > 20
12 year results
Overall survival 61%
Cause-specific survival 88%
PSA progression free 71%
Cause of death
Prostate cancer 8.3%
Heart disease 22.2%
*Bittner N, Merrick GS, Butler WM, et al.
Brachytherapy 11(2012) 250-255
19. Relapse Rates: High-Risk
EBRT, Seeds & ADT
20
20 16
16 45
45
109
109
Brachy
19 18
19 18 4
4
38 22
22
108
108 EBRT & ADT
17
EBRT & Seeds
Treatment Success
43 32
43 32 37
37
34
34
44
47
47 Hypo EBRT
44
9 41
9 41 22 104
48 104
36
36 48 10
10 42
11 12 42 24
12 8 24
25
25 8
101
101
106
106 33 21
33 21 5
5
39
39
EBRT
103
103
35
35
11
11
7 6 26
7 6 26 Surgery
31 30
Protons
46 31 30
46 107
107
102 15
102 15 HDR
105
105
EBRT Seeds +
r g or P AS P %
23 29
29
← Years from 23
Treatment 49
49 ADT
→ Robot RP
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
19
Prostate Cancer Center of Seattle
20. Relapse Rates: High-Risk
>40 months follow-up or less than 100 patients
65
81 20
20 16
16 45 109
109
Brachy
19 18 45
80 19 18 4
74 4 108
108 EBRT & ADT
78 38 22
22
67
67 17
55 75 EBRT & Seeds
72 54 85 43 76
43 37
37
72 54 34
34 44 32
32
47
47 Hypo EBRT
66 9 41
66 9 41 68 44
2 57 104
71 6436 68
71 6436
79 48 59
48 59
2
10
104
10 42
42
50
50 56 11
56 12
12 24
24
53 25 8 61
8 61
25 89
89
101
101
EBRT 62 106
62 106
70
70
33 21
33 21 5
39
5
39
11
11 60
60
103
103 83 7 82 26
83 7 82 26
35
35 63 66
Protons
ss ecc uS t ne maer T
52 63
52 84
84
73 31 30 58
77 46 73
46
31 30 58
88
88
86 87
86 87
107
107
102 15
102 15
HDR
t
51
51 105
105
EBRT Seeds +
r g or P AS P %
23 29
Surgery
29
← Years from 23 Treatment
69
69 49
49
ADT
→ Robot RP
• Prostate Cancer Results Study Group HIFU
• Numbers within symbols refer to references
02/23/13 20
Prostate Cancer Center of Seattle
21.
22. Rationale for Pelvic Radiation
Metastatic disease represents the most dangerous
component of the cancer
Historically, pelvic radiation is incorporated as standard in
all randomized prospective trials of High-Risk disease
One randomized study by Mack Roach showed improved
disease free survival at 5 years with pelvic xrt
Another randomized study by Pascal Pommier showed no
benefit
Modern IMRT radiation is far less toxic that older
radiation technology
23. Hormones Plus Node Radiation
Roach, IJROBP 69:646, 2007
1500 patients randomized between no node radiation
and 50 Gy of node radiation. Dose to prostate was 70
Gy. Men were also randomized between TIP starting
two months before radiation and continuing for four
months vs. starting TIP at the end of radiation (also
for four months)
Patients: Median PSA was 22, 73% of men had
Gleason 7 or more, 2/3 of men were stage T2c, T3 or
T4
Conclusion: Node radiation improved cure rates.
However, the improvement was only seen when TIP
was started 2 months before radiation
24. Pelvic Node Radiation Ineffective?
Pommier, JCO 25:5366, 2007
444 patients
Pelvic node radiation 46 Gy (instead of 50Gy)
Small radiation field than the Roach study
Initial dose to prostate only 66 Gy
50% of study participants had calculated risk of node
metastases of less than 15%
Patients: Median PSA 16, 50% Gleason 6 or less, 25% stage
T3 (the rest were T1 or T2)
Conclusion: No difference in cure rates at 5 years but
study was seriously underpowered to detect a difference
25. Toxicity from Node Radiation?
Deville, IJROBP 78:763, 2010
30 patients treated with IMRT 79 Gy
30 patient treated IMRT 79 Gy and 45 Gy to pelvis
At 24 months no “late” GI or GU toxicity
Deville, IJROBP 82:1389, 2012
31 patients IMRT 70.2 Gy (to fossa after surgery)
36 patients IMRT 70.2 to fossa & 45 Gy to pelvis
No significant difference in “late” toxicity at 25 months
26. Calculating Risk of Nodes
Yu, IJROBP 80:69, 2011
Mack Roach has proposed that only men with more
than a 15% risk of node metastases should be
considered candidates for node radiation
The % risk of nodes involvement can be calculated as:
(Gleason score minus 5) x (PSA/3 +1.5 x T stage)
where T = 0, 1 or 2 for T1c, T2a, and T2b or T2c.
This is the so called Yale formula which has
supplanted the Roach formula and the Nguyen
formula due to enhanced accuracy
Note: Formula does not incorporate other important
prognostic info such as % biopsy or imaging results
27. Not All Node Radiation Equal
Lawton, IJROBP 74:377, 2009
Two different clinical cases distributed to 14 radiation
oncologists with expertise in genitourinary oncology
Conclusion, “Significant disagreement exists in the
definition of…. pelvic nodal radiation therapy among
GU radiation oncology specialists”
Consensus meeting October 2007 to develop a
clinical target volume (CTV) for node radiation by 10
GU radiation specialists.
Access to their conclusions was published in the same
journal (Lawton, IJROB 74:383, 2009)
28.
29. Longer Duration of TIP is Clearly Better
1. 4 months Zoladex/Flutamide vs. none (Pilepich, IJROBP 50:1243, 2001)
Cancer death @ 8 years: 23% vs. 31%
2. 36 months of Zoladex vs. none (Bolla, Lancet 2010)
Cancer death @ 10 years: 10% vs. 30%
3. 24 months of Zoladex vs. 4 months of Zoladex plus
Flutamide: (Horwitz, JCO 26:2497, 2008)
Cancer death @ 10 years: 11% vs. 16%
30. Rationale for Casodex or Flutamide
Nanda, IJROBP 76: 1439,2010
628 High-Risk men treated with:
Beam radiation
Brachytherapy boost
Average of 4 months hormone blockade
401 men received Lupron alone whereas 227 men were
treated with a combination of Lupron plus antiandrogen
Outcome at 5 years: Men receiving Lupron plus
antiandrogen had a significantly lower rate of prostate
cancer mortality
31. Adjuvant Chemotherapy
Rationale: Treat micro-metastatic disease while still
vulnerable to eradication
Proven benefit in other tumor types such as breast,
colon and lung cancer
Chemotherapy options limited to two drugs: Taxotere
or Mitoxantrone
Preliminary trials in prostate cancer suggest a
possible benefit
32. Adjuvant Mitoxantrone
Wang, BJU 86:675, 2000
38 men with locally advanced disease
All given with Lupron / Flutamide indefinitely
19 men randomly allocated to 4 cycles of
mitoxantrone (this is the only randomized trial of
adjuvant chemotherapy in existance)
Kaplan-Meier survival curve shows significantly
prolonged survival in the men administered
mitoxantrone (next slide)
34. Adjuvant Taxotere
Kibel, J Urol 177:1777, 2007
77 men treated with surgery most who had seminal vesicle
invasion and high Gleason scores
The median time to relapse for this group of patients based
on their stage, Gleason score and PSA was predicted to be
10 months by a Kattan Nomogram
All 77 men were administered weekly Taxotere for 6 mo.
Actual median time to relapse was improved by 50% (to
15.7 months)
35. Radiation + Hormones + Taxotere
DiBiase IJROP 81:732,2011
42 patients
75 % grade 4 + 3 or higher
Median PSA 17.8
Treatment
Pelvic radiation
Brachytherapy boost
Lupron for two years
Weekly Taxotere for 3 months
Outcome: 70% disease free after 7 years
36. Conclusion: The Best Treatment
for High-Risk is Multimodality
Therapy
TIP for two years, to be started a couple
months before XRT
IMRT to prostate and pelvic nodes when
calculated risk of nodes is > 15%
Seed implant boost to prostate
Palladium or Iodine permanent seeds
HDR temporary seeds (for SV invasion?)
Adjuvant chemotherapy is still considered
investigational
Editor's Notes
This sets the theme for this talk which is multimodality therapy is standard and that surgery is an inferior approac
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Radical Prostatectomy for Clinically Advanced (cT3) Prostate Cancer since the advent of PSA testing: 15 year outcome. BJU Int 2005; 95:751-6. 31. Zelefsky, M et al. Multi-Institutional Analysis of Long-Term Outcome for T1-T2 Prostate Cancer Treated with Permanent Seed Implantation. Int J Radiat Oncol Bio Phys 2007;67(2):327-333. 32. Zelefsky, M et al. Long Term Outcome of High Dose Intensity Modulated Radiation Therapy for Patients With Clinically Localized Prostate Cancer. J Urology 2006;176:1415-19. (81 Gy) 33. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol Bio Phys 2008;71(4):1028-33. (81 Gy) 34. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor Control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol bio Phys 2008;71(4):1028-33. (86 Gy) 35. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166:876-881. (75 Gy) 36. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166:876-881. (81 Gy) 37. Dattoli, M et al. Long-term Outcomes After Treatment with Brachytherapy and Supplemental Conformal Radiation for Prostate Cancer Patients Having Intermediate and High-Risk Features. Cancer 2007;110(3):551-555. 38. Moyad, M et al. Statins, especially Atorvastatin, may Favorable Influence Clinical Presentation and Biochemical Progression-free Survival after Brachytherapy for Clinically Localized Prostate Cancer. Urology 2005;66(6):1150-1154. 39. Zelefsky, M et al . Long Term Outcome Following Three dimensional Conformal/IMRT for Clinical Stage T3 Prostate Cancer. Eurr Urol 2008; 53:1172-79. 40. (Open) 41. Galalae R et al. Hypofractionated Conformal HDR Brachytherapy in Hormone Naïve Men with Localized Prostate Cancer . Strahlenther Onkol 2006;182(3):135-141. 42. Demanes, DJ et al. Excellent Results from High Dose Rate Brachytherapy and External Beam Radiation Therapy for Prostate Cancer are Not Imroved by Androgen Deprivation. Amer J Clin Oncol 2009;32(4):342-347. 43. Stock, R et al. Outcomes for patients with High-Grade Prostate Cancer Treated with a Combination of Brachytherapy, EBRT and Hormone therapy. BJU Int 2009;104:1631-1636. 44. Stone, N et al . Local Control following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes. Int J Radiat Oncol Bio Phys 2010;7 6(2):355-360. 45. Bittner, N et al. Whole Pelvis Radiotherapy in Combination with Interstitial Brachytherapy: Does Coverage of the Pelvic Lymph Nodes Improve Treatment Outcome in High Risk Prostate Cancer? Int J Radiat Oncol Bio Phys 2010;76(4):1078-1084. 46. Rubio-Briones, J et al . Metastatic Progression, Cancer Specific Mortality and Need for Secondary Treatments in Patients with Clinically High Risk Prostate Cancer Treated Initially with Radical Prostatectomy. Actas Urologicas Esanolas 2010; 34(7):610-617. 47. Dattoli, M et al . Long Term Outcomes for Patients with Prostate Cancer Having Intermediate and High Risk Disease, Treated with Combination External Beam Irradiation and Brachytherapy. J Oncology 2010;2010(Article Id 471375):6 pages. 48. Menon, M et al . Biochemical Recurrence Following Robot Assisted Radical Prostatectomy: Analysis of 1384 patients with a median 5 year follow-up. Eurr Urol 2010;58:838-46. 49. Pierorazio, P et al. Long Term Survival after Radical Prostatectomy for Men with High Gleason Sum in Pathologic Specimen. Urology 2010;76(3):715-21. 101. Deger, S et al . (Germany) High Dose Rate (HDR) Brachytherapy with Conformal Radiation Therapy for Localized Prostate Cancer. Eurr Urology 2005;47:441-448. 102. Magheli A et al . (Johns Hopkins) Importance of Tumor Location in Patients with High Preoperative PSA Levels ( greater than 20 ng/ml treated with Radical Prostatectomy . J Urology 2007;178:1311-15. 103. Kupelian P, et al. Improved Biochemical Relapse-Free Survival With Increased Radiation Doses in Patients With Localized Prostate Cancer: The Combined Experience of Nine Institutions in 1994 and 1995. Int J Radiat Oncol Bio Phys 2005;61(2):415-419. 104. Sylvester, J et al. 15-Year Biochemical Relapse Free Survival in Clinical Stage T1-T3 Prostate Cancer Following Combined External Beam Radiotherapy and Brachytherapy: Seattle Experience. Int J Radiat Oncol Bio Phys 2007;67(1):57-64. 105. Hinnen, K et al. (Netherlands) Long Term Biochemical and Survival Outcome of 921 Patients Treated with I-125 Permanent Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010; 76(5):1433-1438. 106. Hsu, C et al . Comparing Results After Surgery in Patients with Clinical Unilateral T3a Prostate Cnacer Treated with or without neoadjuvent Androgen-Deprivation Therapy . BJU Int 2006;99:311-314. 107. Roehl, K et al. Cancer Progression and Survival Rates Following Anatomical Radical Prostatectomy in 3,478 Consecutive Patients: Long Term Results. J Urology 2004;172:910-914. 108. Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107:226-233. (No ADT) 109. Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107:226-233. (Plus ADT)
1 st Group References: 1. Bahn, D et al. Targeted Cryoablation of the Prostate:7-year Outcomes in the Primary Treatment of Prostate Cancer. Urology 2002;60(Supp 2A):3-11. 2. Burri, R et al. Young Men have Equivalent Biochemical Outcomes Compared with Older Men After Treatment with Brachytherapy for Prostate Cancer. Int J Radiat Oncol Bio Phys 2010;77(5):1315-21. 3. (Open) 4. Bittner, N et al. Primary Causes of Death After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2008;72(2):433-440. 5. Boorjian, S et al. Mayo Clinic Validation of the D'Amico Risk Group Classification for Predicting Survival Following Radical Prostatectomy. J Urology 2008;179:1354-1361. 6. Carver, B et al. Long Term Outcome following Radical Prostatectomy in Men with Clinical T3 Prostate Cancer. J Urology 2006;176:564-568. 7. Cohen, J et al. Ten-Year Biochemical Disease Control in Patients with Prostate Cancer Treated with Cryosurgery as Primary Therapy. Urology 2008;71(3):515-518. 8. Critz, F et al. 10-year Disease Survival Rates After Simultaneous Irradiation for Prostate Cancer with a Focus on Calculation Methodology. J Urology 2004;172:2232-2238. 9. Galalae, R et al. Long-term Outcome by Risk Factors Using Conformal High-Dose-Rate Brachytherapy (HDR-BT) Boost with or without Neoadjuvant Androgen Suppression for Localized Prostate Cancer . Int J Radiat Oncol Bio Phys 2004;58(4):1048-1055. 10. Kollmeier, M et al. Biochemical Outcomes After Prostate Brachytherapy with 5-year Minimal follow-up: Importance of patient Selection and implant Quality. Int J Radiat Oncol Bio Phys 2003;57(3):645-653. 11. Kuban, D et al. Long-Term Multi-Institutional Analysis of Stage T1-T2 Prostate Cancer Treated with Radiotherapy in the PSA Era. Int J Radiat Oncol Biol Phys 2003;57(4):915-928.(PSA:4-10,GS:2-6,>70 Gy) 12. Kuban, D et al. Long-Term Results of the MD Anderson Randomized Dose-Escalation Trial for Prostate Cancer. Int J Radiat Oncol Bio Phys 2008;70(1):67-74. 13. (Open) 14. (Open) 15. Loeb, S et al. Intermediate-term potency, continence & survival outcomes of radical prostatectomy for clinically high-risk or locally advanced prostate cancer . Urology 2007;69(6):1170-1175. 16. Merrick, G et al. A ndrogen deprivation therapy does not impact cause specific overall survival after permanent prostate brachytherapy. Int J Radiat Oncol Bio Phys 2006;65(3):669-77. (EBRT, Seeds, ADT) 17. Merrick, G et al. Androgen deprivation therapy does not impact cause specific overall survival after permanent prostate brachytherapy. Int j Radiat Oncol Bio Phys 2006;65(3):669-77. (EBRT & Seeds) 18. Merrick, G et al. Prognostic Significance of Perineural Invasion on Biochemical Progression-free Survival after Prostate Brachytherapy . Urology 2005;66(5):1048-1053. 19. Merrick, G et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2005;61(1):32-43. (EBRT & Seeds) 20. Merrick, G et al. Impact of Supplemental External Beam Radiotherapy and/or Androgen Deprivation Therapy on Biochemical Outcome After Permanent Prostate Brachytherapy. Int J Radiat Oncol Bio Phys 2005;61(1):32-43. (EBRT, Seeds, ADT) 21. Mian, B et al . Outcome of Patients w/ Gleason score 8 or Higher Prostate Cancer following Radical Prostatectomy alone . J Urology 2002;167:1675-1680. 22. Pellizzon, A et al . The Relationship Between the Biochemical Control Outcomes and the Quality of Planning of HDR as a Boost to External Beam Radiotherapy for locally and locally advanced Prostate Cancer using the RTOG-ASTRO Phoenix definition. Int J Med Sci 2008;5:113-120. 23. Stokes, S et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000;47(1):129-136. (EBRT) 24. Potters, L et al. 12-Year Outcomes Following Permanent Prostate Brachytherapy in Patients With Clinically Localized Prostate Cancer. J Urology 2005;173:1562-1566. 25. Stokes, S et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation Int J Radiat Oncol Bio Phys 2000;47(1):129-136. (RP) 26. Sylvester, J et al. Ten Year Biochemical Relapse Free Survival After External Beam Radiation and Brachytherapy for Localized Prostate Cancer: The Seattle Experience. Int J Radiat Oncol Bio Phys 2003;57(4):944-952. 27. (Open) 28. (Open) 29. Thames, H et al. Increasing External Beam Dose for T1-T2 Prostate Cancer: Effect on Risk Groups. Int J Radiat Oncol Bio Phys 2006; 65(4):975-981. 30. Ward, J et al. Radical Prostatectomy for Clinically Advanced (cT3) Prostate Cancer since the advent of PSA testing: 15 year outcome. BJU Int 2005; 95:751-6. 31. Zelefsky, M et al. Multi-Institutional Analysis of Long-Term Outcome for T1-T2 Prostate Cancer Treated with Permanent Seed Implantation. Int J Radiat Oncol Bio Phys 2007;67(2):327-333. 32. Zelefsky, M et al. Long Term Outcome of High Dose Intensity Modulated Radiation Therapy for Patients With Clinically Localized Prostate Cancer. J Urology 2006;176:1415-19. (81 Gy) 33. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol Bio Phys 2008;71(4):1028-33. (81 Gy) 34. Zelefsky, M et al. Long-term Results of Conformal Radiotherapy for prostate Cancer: Impact of Dose Escalation in Biochemical Tumor Control and distant Metastases-free Survival Outcomes. Int j Radiat Oncol bio Phys 2008;71(4):1028-33. (86 Gy) 35. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166:876-881. (75 Gy) 36. Zelefsky, M et al. High Dose Radiation Delivered by Intensity Modulated Conformal Radiotherapy Improves the Outcome of Localized Prostate Cancer. J Urology 2001;166:876-881. (81 Gy) 37. Dattoli, M et al. Long-term Outcomes After Treatment with Brachytherapy and Supplemental Conformal Radiation for Prostate Cancer Patients Having Intermediate and High-Risk Features. Cancer 2007;110(3):551-555. 38. Moyad, M et al. Statins, especially Atorvastatin, may Favorable Influence Clinical Presentation and Biochemical Progression-free Survival after Brachytherapy for Clinically Localized Prostate Cancer. Urology 2005;66(6):1150-1154. 39. Zelefsky, M et al . Long Term Outcome Following Three dimensional Conformal/IMRT for Clinical Stage T3 Prostate Cancer. Eurr Urol 2008; 53:1172-79. 40. (Open) 41. Galalae R et al. Hypofractionated Conformal HDR Brachytherapy in Hormone Naïve Men with Localized Prostate Cancer . Strahlenther Onkol 2006;182(3):135-141. 42. Demanes, DJ et al. Excellent Results from High Dose Rate Brachytherapy and External Beam Radiation Therapy for Prostate Cancer are Not Imroved by Androgen Deprivation. Amer J Clin Oncol 2009;32(4):342-347. 43. Stock, R et al. Outcomes for patients with High-Grade Prostate Cancer Treated with a Combination of Brachytherapy, EBRT and Hormone therapy. BJU Int 2009;104:1631-1636. 44. Stone, N et al . Local Control following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes. Int J Radiat Oncol Bio Phys 2010;7 6(2):355-360. 45. Bittner, N et al. Whole Pelvis Radiotherapy in Combination with Interstitial Brachytherapy: Does Coverage of the Pelvic Lymph Nodes Improve Treatment Outcome in High Risk Prostate Cancer? Int J Radiat Oncol Bio Phys 2010;76(4):1078-1084. 46. Rubio-Briones, J et al . Metastatic Progression, Cancer Specific Mortality and Need for Secondary Treatments in Patients with Clinically High Risk Prostate Cancer Treated Initially with Radical Prostatectomy. Actas Urologicas Esanolas 2010; 34(7):610-617. 47. Dattoli, M et al . Long Term Outcomes for Patients with Prostate Cancer Having Intermediate and High Risk Disease, Treated with Combination External Beam Irradiation and Brachytherapy. J Oncology 2010;2010(Article Id 471375):6 pages. 48. Menon, M et al . Biochemical Recurrence Following Robot Assisted Radical Prostatectomy: Analysis of 1384 patients with a median 5 year follow-up. Eurr Urol 2010;58:838-46. 49. Pierorazio, P et al. Long Term Survival after Radical Prostatectomy for Men with High Gleason Sum in Pathologic Specimen. Urology 2010;76(3):715-21. 100. (Open) 101. Deger, S et al . (Germany) High Dose Rate (HDR) Brachytherapy with Conformal Radiation Therapy for Localized Prostate Cancer. Eurr Urology 2005;47:441-448. 102. Magheli A et al . (Johns Hopkins) Importance of Tumor Location in Patients with High Preoperative PSA Levels ( greater than 20 ng/ml treated with Radical Prostatectomy . J Urology 2007;178:1311-15. 103. Kupelian P, et al. Improved Biochemical Relapse-Free Survival With Increased Radiation Doses in Patients With Localized Prostate Cancer: The Combined Experience of Nine Institutions in 1994 and 1995. Int J Radiat Oncol Bio Phys 2005;61(2):415-419. 104. Sylvester, J et al. 15-Year Biochemical Relapse Free Survival in Clinical Stage T1-T3 Prostate Cancer Following Combined External Beam Radiotherapy and Brachytherapy: Seattle Experience. Int J Radiat Oncol Bio Phys 2007;67(1):57-64. 105. Hinnen, K et al. (Netherlands) Long Term Biochemical and Survival Outcome of 921 Patients Treated with I-125 Permanent Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010; 76(5):1433-1438. 106. Hsu, C et al . Comparing Results After Surgery in Patients with Clinical Unilateral T3a Prostate Cnacer Treated with or without neoadjuvent Androgen-Deprivation Therapy . BJU Int 2006;99:311-314. 107. Roehl, K et al. Cancer Progression and Survival Rates Following Anatomical Radical Prostatectomy in 3,478 Consecutive Patients: Long Term Results. J Urology 2004;172:910-914. 108. Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107:226-233. (No ADT) 109. Merrick, G et al. Prostate Cancer Death is Unlikely in High Risk Patients Following Quality Permanent Seed Implantation. BJU Int 2010;107:226-233. (Plus ADT) 2 nd Group References: 50. Aizer A, et al. Radical Prostatectomy vs Intensity-Modulated Radiation Therapy in the Management of Localized Prostate Adenocarcinoma. Radiotherapy and Oncology 2009;93:185-191. 51. Battermann J , et al . Results of permanent prostate brachytherapy, 13 years of experience at a single institution. Radiotherapy & Oncology 2004;71:23-28. 52. Berglund R, et al. Limited Pelvic Lymph Node Dissection at the Time of Radical Prostatectomy Does Not Affect 5-Year Failure Rates for Low, Intermediate and High Risk Prostate Cancer: Results From CaPSURE. J Urology 2007;177:526-530. 53. Beyer D, et al. Relative influence of gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer . Brachytherapy 2003;2:77-84. 54. Cahlon O, et al. Ultra high dose (86.4Gy) IMRT for localized prostate cancer: toxicity and biochemical outcomes. Int J Radiat Oncol Bio Phys 2008;71(2):330-337. 55. Copp H, et al. Tumor Control Outcomes of Patients Treated With Trimodality Therapy For Locally Advanced Prostate Cancer . Urology 2005;65(6):1146-1151. 56. Crouzet S , et al . Multicentric Oncologic Outcomes of High-Intensity Focused Ultrasound for Localized Prostate Cancer in 803 patients. Eurr Urol 2010;58:559-566. 57. Demanes D, et al. High-Dose-Rate Intensity Modulated Brachytherapy With External Beam Radiotherapy for Prostate Cancer: California Endocurietherapy's 10-Year Results. Int J Radiat Oncol Bio Phys 2005;61(5):1306-1316. 58. Donohue J, et al. Poorly Differentiated Prostate Cancer Treated With Radical Prostatectomy: Long-Term Outcome and Incidence of Pathological Downgrading. J Urology 2006;176(3):991-995. 59. Ellis R, et al. Biochemical disease free survival rates following definitive low-dose-rate prostate brachytherapy with dose escalation to biologic target volumes identified with SPECT/CT capromab pendetide. Brachytherapy 2007;6:16-25. 60. Freedland S, et al. Radical Prostatectomy for Clinical Stage T3a Disease . Cancer 2007;109(7):1273-1278. 61. Henry A, et al. Outcomes Following Iodine-125 Monotherapy for localized Prostate Cancer: The results of Leeds 10-year single-center brachytherapy experience . Int J Radiat Oncol Bio Phys 2010;76(1):50-56. 62. Hernandez D, et al . Contemporary Evaluation of the D’Amico risk classification of Prostate Cancer. J Urol 2007;70(5):931-935. 63. Hong S, et al . Predictions of Outcomes after Radical Prostatectomy in Patients Diagnosed with Prostate Cancer of Biopsy GS > 8 via Contemporary multi ( > 12)-core prostate biopsy. BJU Int 2011;108(2):217-222. 64. Hull G, et al. Cancer control with radical prostatectomy alone in 1000 consecutive patients. J Urology 2002;167:528-534. 65. Khaksar S, et al. Interstitial low dose rate brachytherapy for prostate cancer-a focus on intermediate & high risk disease. Clinical Oncology 2006;18:513-518. 66. Khuntia D, et al. Recurrence-free survival rates after external-beam radiotherapy for patients with clinical T1-T3 prostate carcinoma in prostate specific antigen era . Cancer 2004;100(6):1283-1292. 67. Koontz B, et al. Morbidity and Prostate Specific Antigen Control of External Beam Radiation Therapy plus Low Dose Rate Brachytherapy Boost for Low ,Intermediate and High Risk Prostate Cancer. Brachytherapy 2009;8:191-196. 68. Kupelian P , et al . Hypofractionated Intensity-Modulated Radiotherapy (70Gy at 2.5Gy per fraction) for Localized Prostate Cancer: Cleveland Clinic Experience. Int J Radiat Oncol Bio Phys 2007; 68(5):1424-1430. 69. Kwok Y, et al. Risk Group stratification in patients undergoing permanent I-125 prostate brachytherapy as monotherapy. Int J Radiat Oncol Bio Phys 2002;53(3):588-594. 70. Lederman G, et al. Retrospective Stratification of a Consecutive Cohort of Prostate Cancer Patients Treated with a Combined Regimen of External-beam Radiotherapy and Brachytherapy. Int J Radiat Oncol Bio Phys 2001;49(5):1297-1303. 71. Lee L, et al. Role of Hormonal therapy in the management of intermediate to high risk prostate cancer treated with permanent radioactive seed implantation. Int J Radiat Oncol Bio Phys 2002;52(2):444-452. 72. Liauw S, et al. Dose-escalated radiotherapy for hight-risk prostate cancer: outcomes in modern ear with short termandrogen deprivation therapy. Int J Radiat Oncol Bio Phys 2010;77(1):125-130. 73. Livsey J, et al. Hypofractionated Conformal Radiotherapy in Carcinoma of the Prostate: five-Year Outcome Analysis. Int J Radiat Oncol Bio Phys 2003;57(5):1254-1259. 74. Nobes J, et al. Biochemical Relapse-Free Survival in 400 Patients Treated with I-125 Prostate Brachytherapy: the Guildford Experience. Prostate Ca & Prostatic Disease 2009;12:61-66. 75. Phan T, et al. High dose rate brachytherapy as a boost for the treatment of localized prostate cancer. J Urology 2007;177:123-127. Prada P, et al. High-dose-rate intensity modulated brachytherapy with external-beam radiotherapy improves local and biochemical control in patients with high risk prostate cancer. Clin Transl Oncol 2008;10:415-421. Sathya J, et al. Randomized Trial comparing Iridium implants plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 2005;23(5):1192-1199. Stock, R. et al. Combined Modality Treatment in the Management of High Risk Prostate Cancer . Int J Radiat Oncol Bio Phys 2004;59(5):1352-1359. Stone N, et al. Multicenter Analysis of Effect of High Biologic Effective dose on Biochemical Failure and Survival Outcomes in Patients with Gleason 7-10 Prostate cancer Treated with Permanent Prostate Bracyhhterapy. Int J Radiat Oncol Bio Phys 2009;73(2):341-346. Stone N, et al. Customized dose Prescription for Permanent Prostate Brachytherapy: Insights From a Multicenter Analysis of Dosimetry Outcomes. Int J Radiat Oncol Bio Phys 2007;69(5):1472-1477. Yamada Y, et al. Favorable Clinical Outcomes of 3-D Computer Optimized High Dose Rate Prostate Brachytherapy in the management of Localized Prostate cancer. Brachytherapy 2006;5:157-164. Yossepowitch O, et al . Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178:493-499. (Def. #1) Yossepowitch O, et al . Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178:493-499. (Def. #2) Yossepowitch O, et al . Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178:493-499. (Def. #3) Zwahlen D , et al. High Dose Rate Brachytherapy in Combination with Conformal External Beam Radiotherapy in the Treatment of Prostate Cancer. Brachytherapy 2010;9:27-35. D’Amico A, et al. Biochemical outcomes after Radical Prostatectomy or External Beam Radiation Therapy for patients with clinically localized prostate carcinoma in the Prostate Specific Antigen Era. Cancer 2002;95(2):281-286. (RP) D’Amico A, et al. Biochemical outcomes after Radical Prostatectomy or External Beam Radiation Therapy for patients with clinically localized prostate carcinoma in the Prostate Specific Antigen Era. Cancer 2002;95(2):281-286. (EBRT) Stokes S, et al. Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation. Int J Radiat Oncol Bio Phys 2000;47(1):129-136. (seeds) Yossepowitch O, et al . Radical Prostatectomy for Clinically Localized High Risk Prostate Cancer: Critical Analysis of Risk Assessment Methods. J Urology 2007;178:493-499. (Def. #4)