Problem: Patients, physicians and carriers need a simple, unbiased means to compare the cancer control rates of modern prostate cancer treatment methods. To solve this problem, we have assembled experts from key treating disciplines: Surgery, External Radiation, Internal (or Brachytherapy), High Frequency Ultrasound, and Proton Therapy to do a complete review study of the current literature on prostate cancer treatment.
There appears to be a higher cancer control success rate for Brachy over EBRT and Surgery for all groups. Patients are encouraged to look at graphs and determine for themselves
This document summarizes a study comparing the results of different treatments for prostate cancer. A group of experts assembled to conduct a comprehensive review of over 25,000 prostate studies published between 2000-2012. They identified 218 studies that met their criteria for comparing cancer control rates of treatments including surgery, radiation therapy, brachytherapy, high intensity focused ultrasound, and proton beam therapy. The group analyzed success rates for each treatment based on patients' prostate-specific antigen levels as an indicator of cancer progression over time.
This document summarizes a review study comparing treatment results for prostate cancer. Over 21,000 prostate studies published between 2000-2011 were reviewed, with 145 meeting criteria for inclusion. Experts from various treatment disciplines (e.g. surgery, radiation) assembled to conduct a complete literature review on prostate cancer treatment success rates based on PSA levels. Results are presented separating patients into low, intermediate, and high risk groups.
The document summarizes the results of the CABANA Pilot Study, which compared catheter ablation to antiarrhythmic drug therapy for atrial fibrillation. The study found that ablation was more effective than drugs at preventing recurrent symptomatic atrial fibrillation over 12 months of follow-up. However, the pilot study had some limitations due to its small sample size and short follow-up duration. It established the feasibility of conducting a larger pivotal trial to determine long-term outcomes of ablation versus drug therapy for atrial fibrillation.
The document summarizes the results of the CABANA Pilot Study, which compared catheter ablation to antiarrhythmic drug therapy for atrial fibrillation. The study found that ablation was more effective than drugs at preventing recurrent symptomatic atrial fibrillation over 12 months of follow-up. However, the pilot study had some limitations due to its small sample size and short follow-up duration. It established the feasibility of conducting a larger pivotal trial to determine long-term outcomes of ablation versus drug therapy for atrial fibrillation.
POC Breast 1 | 2007 - Adjuvant Endocrine Therapyrtp
- The document discusses treatment recommendations and patterns of care for adjuvant endocrine therapy in postmenopausal women with breast cancer based on surveys of clinical investigators and practicing oncologists from 2007-2005.
- It presents results on recommended endocrine therapies for different patient profiles including aromatase inhibitors, tamoxifen, ovarian suppression, and considerations for managing side effects.
The document discusses survey results from clinical investigators and practicing oncologists on their use of adjuvant chemotherapy regimens for breast cancer patients. The most common regimens used were anthracycline-containing regimens like AC for node-negative patients and TAC for node-positive patients. More clinicians were using taxane-containing regimens like AC followed by paclitaxel or docetaxel-cyclophosphamide over time. Many clinicians had information on or used gene expression assays like Oncotype DX or MammaPrint to guide chemotherapy decisions.
There appears to be a higher cancer control success rate for Brachy over EBRT and Surgery for all groups. Patients are encouraged to look at graphs and determine for themselves
This document summarizes a study comparing the results of different treatments for prostate cancer. A group of experts assembled to conduct a comprehensive review of over 25,000 prostate studies published between 2000-2012. They identified 218 studies that met their criteria for comparing cancer control rates of treatments including surgery, radiation therapy, brachytherapy, high intensity focused ultrasound, and proton beam therapy. The group analyzed success rates for each treatment based on patients' prostate-specific antigen levels as an indicator of cancer progression over time.
This document summarizes a review study comparing treatment results for prostate cancer. Over 21,000 prostate studies published between 2000-2011 were reviewed, with 145 meeting criteria for inclusion. Experts from various treatment disciplines (e.g. surgery, radiation) assembled to conduct a complete literature review on prostate cancer treatment success rates based on PSA levels. Results are presented separating patients into low, intermediate, and high risk groups.
The document summarizes the results of the CABANA Pilot Study, which compared catheter ablation to antiarrhythmic drug therapy for atrial fibrillation. The study found that ablation was more effective than drugs at preventing recurrent symptomatic atrial fibrillation over 12 months of follow-up. However, the pilot study had some limitations due to its small sample size and short follow-up duration. It established the feasibility of conducting a larger pivotal trial to determine long-term outcomes of ablation versus drug therapy for atrial fibrillation.
The document summarizes the results of the CABANA Pilot Study, which compared catheter ablation to antiarrhythmic drug therapy for atrial fibrillation. The study found that ablation was more effective than drugs at preventing recurrent symptomatic atrial fibrillation over 12 months of follow-up. However, the pilot study had some limitations due to its small sample size and short follow-up duration. It established the feasibility of conducting a larger pivotal trial to determine long-term outcomes of ablation versus drug therapy for atrial fibrillation.
POC Breast 1 | 2007 - Adjuvant Endocrine Therapyrtp
- The document discusses treatment recommendations and patterns of care for adjuvant endocrine therapy in postmenopausal women with breast cancer based on surveys of clinical investigators and practicing oncologists from 2007-2005.
- It presents results on recommended endocrine therapies for different patient profiles including aromatase inhibitors, tamoxifen, ovarian suppression, and considerations for managing side effects.
The document discusses survey results from clinical investigators and practicing oncologists on their use of adjuvant chemotherapy regimens for breast cancer patients. The most common regimens used were anthracycline-containing regimens like AC for node-negative patients and TAC for node-positive patients. More clinicians were using taxane-containing regimens like AC followed by paclitaxel or docetaxel-cyclophosphamide over time. Many clinicians had information on or used gene expression assays like Oncotype DX or MammaPrint to guide chemotherapy decisions.
This document summarizes evidence from clinical trials on systemic treatments for high-risk prostate cancer, including androgen deprivation therapy and chemotherapy. Long-term androgen deprivation therapy for 2-3 years is shown to improve outcomes compared to short-term therapy based on trials. The addition of docetaxel to radiation therapy and androgen deprivation is being investigated in ongoing phase III trials to improve survival for high-risk localized prostate cancer.
1) A study examined the effect of warfarin genotyping on outcomes in patients initiating warfarin therapy, comparing an intervention group that received genotyping to historical controls.
2) The intervention group had significantly lower rates of hospitalization for all causes (28% decrease) and for bleeding/thromboembolism (27% decrease) over 6 months.
3) Physicians changed warfarin prescriptions according to genotype results, suggesting genotyping helped improve dosing and reduce adverse events during initial warfarin treatment.
This document summarizes a journal club discussion on a clinical trial comparing active monitoring, surgery, and radiotherapy for treating clinically localized prostate cancer. The trial included over 2,600 men randomized to one of the three treatment groups or choosing their own treatment. Results found no difference in prostate cancer deaths between groups after 10 years. Exploratory analyses combining randomized and non-randomized cohorts found a lower risk of cancer death with radical treatment versus active monitoring. However, radical treatments were associated with higher rates of urinary incontinence, erectile dysfunction, and bowel issues compared to active monitoring. Limitations included potential for bias in the analyses and unknown long-term outcomes beyond 10 years.
POC Breast 1 | 2007 - Systemic Therapy for Metastatic Diseasertp
The document discusses survey results from clinical investigators and practicing oncologists on their treatment recommendations and preferences for various cases of metastatic breast cancer. Key findings include:
- For premenopausal patients with metastatic breast cancer, most recommend monthly injections of leuprolide or goserelin rather than every 3 months.
- For patients progressing after 4+ years of adjuvant anastrozole, fulvestrant and exemestane were the most preferred first-line endocrine therapies.
- Most felt nab-paclitaxel has similar or better efficacy and safety compared to docetaxel-based regimens for metastatic disease.
- Options like bevacizumab, ca
Nomograms provide more accurate predictions of patient outcomes than alternative approaches and should be used to inform treatment decisions. Nomograms discriminate better than risk groups by accounting for individual patient characteristics. Studies show nomograms make more accurate predictions than clinicians. Not using nomograms risks inferior decision making and can be unethical by not providing patients with personalized outcome estimates.
- A study analyzed data from the DIG trial to examine the effect of digoxin on 30-day hospital admissions in older adults with heart failure.
- The study found that digoxin reduced the absolute risk of all-cause hospital admission within 30 days by 2.7% and the relative risk by 34% compared to placebo. Digoxin also reduced the risk of cardiovascular hospital admissions at 30 days by 47%.
- The beneficial effect of digoxin on reducing 30-day hospital admissions persisted out to 60 and 90 days with no signs of harm, suggesting digoxin provides early benefits without increasing later risks.
This document summarizes guidelines from the Lugano Classification for assessing response in lymphoma patients using computed tomography (CT) scans and positron emission tomography (PET) scans. It describes how to measure baseline tumor burden, defines response categories of complete response, partial response, stable disease, and progressive disease based on CT and PET findings. It also explains the five-point Deauville scoring system for interpreting PET scans and provides examples of patient scans and scores.
The document summarizes research on active surveillance for prostate cancer. It discusses definitions of clinically significant prostate cancer, criteria for active surveillance candidacy, biomarkers like PSA kinetics and PCA3, and outcomes of patients on surveillance like cancer-specific survival rates and rates of remaining free from intervention. It concludes that active surveillance appears safe in the intermediate term but challenges remain in identifying higher risk disease and validating triggers for intervention.
Olaparib is an oral PARP inhibitor that has shown efficacy in the treatment of breast and ovarian cancers associated with BRCA mutations. In breast cancer, phase III trials OlympiA and OlympiAD demonstrated that olaparib improves invasive disease-free survival and progression-free survival, respectively, in patients with germline BRCA mutations. In ovarian cancer, phase III trials SOLO-1, PAOLA-1, and PRIMA found that olaparib improves progression-free survival when used as maintenance therapy or in combination with chemotherapy in patients with BRCA mutations. Olaparib is now approved for several indications based on these trials and provides an important targeted treatment option for cancers associated
The document discusses key aspects of study design in oncology research. It emphasizes that study design is crucial to answering research questions correctly. It identifies six key aspects: 1) defining a clear research question, 2) selecting an appropriate study population, 3) choosing an appropriate study type such as observational or experimental, 4) determining the unit of analysis such as individual patients, 5) using valid measurement techniques, and 6) properly calculating sample size to achieve sufficient statistical power. Poor study design can introduce errors that cannot be corrected, so these aspects are important to consider from the start of a research study.
Primary Care direct access to thyroid ultrasound: Audit of clinical efficienc...u.surgery
This document describes an audit of primary care referrals for thyroid ultrasound (TUS) before and after the implementation of a one stop thyroid diagnostic clinic. The audit found that primary care access to TUS did not improve detection of thyroid pathology and led to inefficiencies. After establishing a one stop clinic with standardized referral criteria and risk assessment, more suspicious nodules were biopsied, detection of neoplasms increased, and follow-up of inconclusive results improved. The audit concluded that limiting primary care access to TUS and routing patients through a specialized one stop clinic enhances efficiency and quality in evaluating thyroid nodules.
1) The Spanish GEICAM study found that after using the Oncotype DX test, the treatment recommendation changed in 31.8% of early-stage breast cancer patients, with the most common change being a switch from chemotherapy plus hormone therapy to hormone therapy alone (20.6% of cases).
2) Factors like higher tumor grade, high Ki-67, and positive progesterone receptor status were associated with an increased likelihood of changing the treatment recommendation.
3) Medical oncologists reported increased confidence in their treatment recommendations after receiving the Oncotype DX results.
Clinically localized prostate cancer requires risk stratification and shared decision making between doctors and patients regarding treatment options. The document compares guidelines from ASCO and EAU on active surveillance, radical prostatectomy, radiotherapy, focal therapies, and whole gland cryosurgery. It notes side effects like erectile dysfunction and urinary incontinence vary depending on the treatment and should be discussed.
Hydrogel use in prostate cancer radiation therapyMatthew Katz
Hydrogel use represents a technical advance in trying to decrease the risk of treatment toxicity in prostate cancer radiation therapy. I presented this talk at the Fall Conference of the Southern NH chapter of Oncology Nursing Society yesterday.
Drug Information Association Clinical Forum Presentationdneasha
Pharmacoepidemiology studies were performed on YASMIN and CRESTOR to better understand safety risks in real-world use. For YASMIN, a large database study found no increased risks of hyperkalemia or blood clots compared to other oral contraceptives. For CRESTOR, a global program using multiple databases evaluated safety outcomes like rhabdomyolysis. Future directions may include using health databases and electronic records in large simple trials to efficiently answer safety questions.
This document summarizes evidence from several randomized controlled trials investigating hypofractionated radiotherapy schedules for early breast cancer. It discusses the START trials which established 40 Gy in 15 fractions over 3 weeks as a standard schedule. It then summarizes the recent FAST Forward trial which investigated a shorter 1-week schedule of 26 Gy in 5 fractions. While FAST Forward found this ultra-hypofractionated schedule non-inferior to 40 Gy in terms of tumor control and toxicity based on 5-year follow-up, it notes limitations like the lack of subgroup analyses, longer follow-up, and smaller number of centers compared to START trials. The document concludes that 26 Gy in 5 fractions may be adopted as a new standard but that further evidence
CRYOTHERAPY SALVAGE OF RADIATED PROSTATEGil Lederman
Cryotherapy, or freezing treatment, can be used as a salvage therapy for prostate cancer patients whose disease recurs after radiation treatment. The analysis found that patients who underwent cryotherapy after radiation had better outcomes if they had a pre-cryotherapy PSA level below 10 and a Gleason score less than or equal to 8. There was a 74% two-year disease-free survival rate for patients meeting these criteria compared to lower rates for patients with higher PSA levels or Gleason scores. Additionally, patients who only received radiation prior to cryotherapy had better outcomes than those who also received hormonal therapy. Cryotherapy may cure a subset of patients with locally recurrent prostate cancer after radiation, but is associated with significant side effects.
Surgery vs IMRT for High Risk Prostate Cancer Debate - ACRO 2015drewzer
This document summarizes key points about treatment options for high risk prostate cancer. It discusses controversies around using androgen deprivation therapy alone versus tri-modality treatment with surgery, radiotherapy and ADT. Clinical trial data is presented showing improved survival with radiotherapy alone or with ADT compared to ADT alone. Challenges with surgery are noted along with long term functional outcomes data with radiotherapy. The importance of a multi-disciplinary approach and shared decision making is emphasized. While further randomized controlled trial data is still needed, the document argues against avoiding radiotherapy in high risk prostate cancer treatment.
This document reviews treatments for neuroendocrine tumors (NETs), including peptide receptor radionuclide therapy (PRRT). It summarizes the evidence for various NET treatment options such as surgery, somatostatin analogs, PRRT, chemotherapy, and targeted therapies. It also provides an overview of a PRRT treatment day and integrates PRRT with other NET therapies. Clinical trial data is presented demonstrating the efficacy of PRRT and targeted therapies such as everolimus and sunitinib in extending progression-free survival for NETs. The conclusion emphasizes treating NETs only when necessary and considering surgery first followed by somatostatin analogs, PRRT, intra-arterial therapies,
1) The AURELIA trial evaluated bevacizumab combined with chemotherapy versus chemotherapy alone for platinum-resistant recurrent ovarian cancer.
2) The trial found that progression-free survival was significantly longer in the bevacizumab combination group compared to the chemotherapy alone group (median 6.7 months vs 3.4 months).
3) Rates of objective response were also significantly higher in the bevacizumab combination group compared to chemotherapy alone (30.9% vs 12.6%).
Bridging Evidence Based Medicine and Patient Centered Care: The Case of Local...Zackary Berger
This document discusses bridging evidence-based medicine and patient-centered care in the context of localized prostate cancer treatment decisions. Around 90% of men diagnosed with localized prostate cancer receive immediate treatment, while 10% opt for active surveillance which involves regular monitoring without initial treatment. However, some men eventually choose to leave active surveillance due to disease reclassification or personal preference. The document examines factors influencing men's decisions regarding active surveillance versus treatment and explores how addressing patients' anxieties, concerns, and partnering with primary care providers could help bridge evidence-based medicine and patient-centered approaches.
O documento lista várias características humanas determinadas geneticamente, como a habilidade de enrolar a língua em "U" e a presença de sardas, e discute os genes dominantes e recessivos associados. Também aborda doenças genéticas como a coreia de Huntington e a construção de heredogramas.
This document summarizes evidence from clinical trials on systemic treatments for high-risk prostate cancer, including androgen deprivation therapy and chemotherapy. Long-term androgen deprivation therapy for 2-3 years is shown to improve outcomes compared to short-term therapy based on trials. The addition of docetaxel to radiation therapy and androgen deprivation is being investigated in ongoing phase III trials to improve survival for high-risk localized prostate cancer.
1) A study examined the effect of warfarin genotyping on outcomes in patients initiating warfarin therapy, comparing an intervention group that received genotyping to historical controls.
2) The intervention group had significantly lower rates of hospitalization for all causes (28% decrease) and for bleeding/thromboembolism (27% decrease) over 6 months.
3) Physicians changed warfarin prescriptions according to genotype results, suggesting genotyping helped improve dosing and reduce adverse events during initial warfarin treatment.
This document summarizes a journal club discussion on a clinical trial comparing active monitoring, surgery, and radiotherapy for treating clinically localized prostate cancer. The trial included over 2,600 men randomized to one of the three treatment groups or choosing their own treatment. Results found no difference in prostate cancer deaths between groups after 10 years. Exploratory analyses combining randomized and non-randomized cohorts found a lower risk of cancer death with radical treatment versus active monitoring. However, radical treatments were associated with higher rates of urinary incontinence, erectile dysfunction, and bowel issues compared to active monitoring. Limitations included potential for bias in the analyses and unknown long-term outcomes beyond 10 years.
POC Breast 1 | 2007 - Systemic Therapy for Metastatic Diseasertp
The document discusses survey results from clinical investigators and practicing oncologists on their treatment recommendations and preferences for various cases of metastatic breast cancer. Key findings include:
- For premenopausal patients with metastatic breast cancer, most recommend monthly injections of leuprolide or goserelin rather than every 3 months.
- For patients progressing after 4+ years of adjuvant anastrozole, fulvestrant and exemestane were the most preferred first-line endocrine therapies.
- Most felt nab-paclitaxel has similar or better efficacy and safety compared to docetaxel-based regimens for metastatic disease.
- Options like bevacizumab, ca
Nomograms provide more accurate predictions of patient outcomes than alternative approaches and should be used to inform treatment decisions. Nomograms discriminate better than risk groups by accounting for individual patient characteristics. Studies show nomograms make more accurate predictions than clinicians. Not using nomograms risks inferior decision making and can be unethical by not providing patients with personalized outcome estimates.
- A study analyzed data from the DIG trial to examine the effect of digoxin on 30-day hospital admissions in older adults with heart failure.
- The study found that digoxin reduced the absolute risk of all-cause hospital admission within 30 days by 2.7% and the relative risk by 34% compared to placebo. Digoxin also reduced the risk of cardiovascular hospital admissions at 30 days by 47%.
- The beneficial effect of digoxin on reducing 30-day hospital admissions persisted out to 60 and 90 days with no signs of harm, suggesting digoxin provides early benefits without increasing later risks.
This document summarizes guidelines from the Lugano Classification for assessing response in lymphoma patients using computed tomography (CT) scans and positron emission tomography (PET) scans. It describes how to measure baseline tumor burden, defines response categories of complete response, partial response, stable disease, and progressive disease based on CT and PET findings. It also explains the five-point Deauville scoring system for interpreting PET scans and provides examples of patient scans and scores.
The document summarizes research on active surveillance for prostate cancer. It discusses definitions of clinically significant prostate cancer, criteria for active surveillance candidacy, biomarkers like PSA kinetics and PCA3, and outcomes of patients on surveillance like cancer-specific survival rates and rates of remaining free from intervention. It concludes that active surveillance appears safe in the intermediate term but challenges remain in identifying higher risk disease and validating triggers for intervention.
Olaparib is an oral PARP inhibitor that has shown efficacy in the treatment of breast and ovarian cancers associated with BRCA mutations. In breast cancer, phase III trials OlympiA and OlympiAD demonstrated that olaparib improves invasive disease-free survival and progression-free survival, respectively, in patients with germline BRCA mutations. In ovarian cancer, phase III trials SOLO-1, PAOLA-1, and PRIMA found that olaparib improves progression-free survival when used as maintenance therapy or in combination with chemotherapy in patients with BRCA mutations. Olaparib is now approved for several indications based on these trials and provides an important targeted treatment option for cancers associated
The document discusses key aspects of study design in oncology research. It emphasizes that study design is crucial to answering research questions correctly. It identifies six key aspects: 1) defining a clear research question, 2) selecting an appropriate study population, 3) choosing an appropriate study type such as observational or experimental, 4) determining the unit of analysis such as individual patients, 5) using valid measurement techniques, and 6) properly calculating sample size to achieve sufficient statistical power. Poor study design can introduce errors that cannot be corrected, so these aspects are important to consider from the start of a research study.
Primary Care direct access to thyroid ultrasound: Audit of clinical efficienc...u.surgery
This document describes an audit of primary care referrals for thyroid ultrasound (TUS) before and after the implementation of a one stop thyroid diagnostic clinic. The audit found that primary care access to TUS did not improve detection of thyroid pathology and led to inefficiencies. After establishing a one stop clinic with standardized referral criteria and risk assessment, more suspicious nodules were biopsied, detection of neoplasms increased, and follow-up of inconclusive results improved. The audit concluded that limiting primary care access to TUS and routing patients through a specialized one stop clinic enhances efficiency and quality in evaluating thyroid nodules.
1) The Spanish GEICAM study found that after using the Oncotype DX test, the treatment recommendation changed in 31.8% of early-stage breast cancer patients, with the most common change being a switch from chemotherapy plus hormone therapy to hormone therapy alone (20.6% of cases).
2) Factors like higher tumor grade, high Ki-67, and positive progesterone receptor status were associated with an increased likelihood of changing the treatment recommendation.
3) Medical oncologists reported increased confidence in their treatment recommendations after receiving the Oncotype DX results.
Clinically localized prostate cancer requires risk stratification and shared decision making between doctors and patients regarding treatment options. The document compares guidelines from ASCO and EAU on active surveillance, radical prostatectomy, radiotherapy, focal therapies, and whole gland cryosurgery. It notes side effects like erectile dysfunction and urinary incontinence vary depending on the treatment and should be discussed.
Hydrogel use in prostate cancer radiation therapyMatthew Katz
Hydrogel use represents a technical advance in trying to decrease the risk of treatment toxicity in prostate cancer radiation therapy. I presented this talk at the Fall Conference of the Southern NH chapter of Oncology Nursing Society yesterday.
Drug Information Association Clinical Forum Presentationdneasha
Pharmacoepidemiology studies were performed on YASMIN and CRESTOR to better understand safety risks in real-world use. For YASMIN, a large database study found no increased risks of hyperkalemia or blood clots compared to other oral contraceptives. For CRESTOR, a global program using multiple databases evaluated safety outcomes like rhabdomyolysis. Future directions may include using health databases and electronic records in large simple trials to efficiently answer safety questions.
This document summarizes evidence from several randomized controlled trials investigating hypofractionated radiotherapy schedules for early breast cancer. It discusses the START trials which established 40 Gy in 15 fractions over 3 weeks as a standard schedule. It then summarizes the recent FAST Forward trial which investigated a shorter 1-week schedule of 26 Gy in 5 fractions. While FAST Forward found this ultra-hypofractionated schedule non-inferior to 40 Gy in terms of tumor control and toxicity based on 5-year follow-up, it notes limitations like the lack of subgroup analyses, longer follow-up, and smaller number of centers compared to START trials. The document concludes that 26 Gy in 5 fractions may be adopted as a new standard but that further evidence
CRYOTHERAPY SALVAGE OF RADIATED PROSTATEGil Lederman
Cryotherapy, or freezing treatment, can be used as a salvage therapy for prostate cancer patients whose disease recurs after radiation treatment. The analysis found that patients who underwent cryotherapy after radiation had better outcomes if they had a pre-cryotherapy PSA level below 10 and a Gleason score less than or equal to 8. There was a 74% two-year disease-free survival rate for patients meeting these criteria compared to lower rates for patients with higher PSA levels or Gleason scores. Additionally, patients who only received radiation prior to cryotherapy had better outcomes than those who also received hormonal therapy. Cryotherapy may cure a subset of patients with locally recurrent prostate cancer after radiation, but is associated with significant side effects.
Surgery vs IMRT for High Risk Prostate Cancer Debate - ACRO 2015drewzer
This document summarizes key points about treatment options for high risk prostate cancer. It discusses controversies around using androgen deprivation therapy alone versus tri-modality treatment with surgery, radiotherapy and ADT. Clinical trial data is presented showing improved survival with radiotherapy alone or with ADT compared to ADT alone. Challenges with surgery are noted along with long term functional outcomes data with radiotherapy. The importance of a multi-disciplinary approach and shared decision making is emphasized. While further randomized controlled trial data is still needed, the document argues against avoiding radiotherapy in high risk prostate cancer treatment.
This document reviews treatments for neuroendocrine tumors (NETs), including peptide receptor radionuclide therapy (PRRT). It summarizes the evidence for various NET treatment options such as surgery, somatostatin analogs, PRRT, chemotherapy, and targeted therapies. It also provides an overview of a PRRT treatment day and integrates PRRT with other NET therapies. Clinical trial data is presented demonstrating the efficacy of PRRT and targeted therapies such as everolimus and sunitinib in extending progression-free survival for NETs. The conclusion emphasizes treating NETs only when necessary and considering surgery first followed by somatostatin analogs, PRRT, intra-arterial therapies,
1) The AURELIA trial evaluated bevacizumab combined with chemotherapy versus chemotherapy alone for platinum-resistant recurrent ovarian cancer.
2) The trial found that progression-free survival was significantly longer in the bevacizumab combination group compared to the chemotherapy alone group (median 6.7 months vs 3.4 months).
3) Rates of objective response were also significantly higher in the bevacizumab combination group compared to chemotherapy alone (30.9% vs 12.6%).
Bridging Evidence Based Medicine and Patient Centered Care: The Case of Local...Zackary Berger
This document discusses bridging evidence-based medicine and patient-centered care in the context of localized prostate cancer treatment decisions. Around 90% of men diagnosed with localized prostate cancer receive immediate treatment, while 10% opt for active surveillance which involves regular monitoring without initial treatment. However, some men eventually choose to leave active surveillance due to disease reclassification or personal preference. The document examines factors influencing men's decisions regarding active surveillance versus treatment and explores how addressing patients' anxieties, concerns, and partnering with primary care providers could help bridge evidence-based medicine and patient-centered approaches.
O documento lista várias características humanas determinadas geneticamente, como a habilidade de enrolar a língua em "U" e a presença de sardas, e discute os genes dominantes e recessivos associados. Também aborda doenças genéticas como a coreia de Huntington e a construção de heredogramas.
The Prostate Cancer Results Study Group was formed to compare and share results from modern prostate cancer treatments in the absence of randomized studies. The group reviewed over 15,000 articles from 2000-2009 and identified 603 treatment results articles that met their inclusion criteria. These articles were analyzed and the results were compiled into graphs showing PSA progression-free survival rates for different treatments over time, stratified by low, intermediate, and high risk patient groups. The analysis found that brachytherapy alone or in combination appeared superior to other treatments in all risk groups based on standard reporting criteria. However, few studies to date stratified patients into recognized risk groups or conformed to basic reporting requirements.
Laurence d. wesley characterisation and classification of tropical residual...scgcolombia
1. Residual soils are formed through the physical and chemical weathering of parent rock materials in place, resulting in heterogeneous soils with properties that differ from uniform sedimentary soils.
2. The behavior of residual soils cannot be fully characterized by traditional soil mechanics theories and concepts developed for sedimentary soils, which are more uniform.
3. Residual soils exhibit high variability and complex engineering properties that require understanding formation processes and considering field performance over laboratory tests.
Leonardo cascini landslides risk zoning and managementscgcolombia
The document discusses landslide risk zoning and management. It provides an overview of general frameworks and formulas for assessing landslide risk that take into account hazards, elements at risk, and vulnerability. It also describes different scales of landslide zoning and their applications. As an example, it then summarizes a case study of landslide risk zoning and management in Italy, where landslides commonly cause property damage and slow-moving landslides are an issue, as well as infrequent but high-impact fast landslides.
This document discusses radiotherapy techniques for early breast cancer, including:
1) Modern techniques like IMRT and 4D radiotherapy allow for better treatment planning and delivery while avoiding nearby organs.
2) Several randomized clinical trials found that a shorter, hypofractionated course of radiotherapy was not inferior to standard radiotherapy in terms of local recurrence or toxicity.
3) Partial breast irradiation techniques are being studied as a way to further reduce treatment volumes and time for selected low-risk patients.
Топ достижений лечения ВИЧ в 2017 г / Top Advances in ART for 2017hivlifeinfo
Top Advances in ART for 2017
In this downloadable slideset, Joel E. Gallant, MD, MPH, provides a comprehensive update on ART management.
Format: Microsoft PowerPoint (.ppt)
File size: 579 KB
Date posted: 3/29/2017
This document summarizes key findings from the EUPROMS study on the impact of prostate cancer treatments on patient-reported outcomes. Some highlights include:
- Radical prostatectomy (RP) and radiation therapy (RT) both significantly reduced sexual function scores compared to active surveillance (AS), with about 1/3 of AS scores. RP also significantly reduced urinary continence scores compared to healthy controls.
- About 30-40% of RP patients and 15-20% of RT patients reported urinary incontinence issues like pad usage. RP also saw greater issues with urinary, bowel and sexual dysfunction compared to RT.
- Shared decision making scores were generally in the moderate range (median 33-
Hypofractionated Radiation Therapy in Breast CancerDr.Ram Madhavan
This document discusses hypofractionation in breast cancer radiotherapy. It provides rationale for adjuvant whole breast irradiation after breast-conserving surgery based on evidence from clinical trials. It reviews current evidence from trials comparing conventional fractionation to hypofractionated schedules, which found no disadvantage to hypofractionation in terms of safety and efficacy. The document discusses implications of breast cancer's low alpha-beta ratio for sensitivity to high dose per fraction. It reviews patient factors, outcomes, and guidelines for suitable patients for hypofractionation based on the evidence. The author's own experience at their institution adopting hypofractionation is presented, showing comparable results to trials.
This document provides a summary of a clinical presentation on advances in the treatment of head and neck cancer. The presentation was given by four experts and discussed topics such as the prognostic value of tumor-infiltrating lymphocytes in head and neck squamous cell carcinoma, PD-L1 expression and outcomes with PD-1/PD-L1 inhibitors, ongoing immunotherapy trials, immune-related adverse events, TRK fusions found across cancer types, methods for detecting TRK fusions, and efficacy of TRK inhibitors.
This document discusses factors to consider when determining treatment for prostate cancer, including the biology and extent of the cancer, patient health status and life expectancy. It outlines prostate cancer risk groups based on staging and tumor characteristics, and how newer genomic testing can better classify risk. Combining clinical and genomic data separates risk groups and more accurately predicts outcomes like metastasis and mortality risks over 10 years. Genomics may reclassify some patients originally in intermediate risk groups to lower or higher risk, influencing treatment decisions.
The document discusses pancreatic cancer treatment and survival data from several clinical trials. It finds that chemoradiation provides a survival benefit compared to observation or chemotherapy alone in both the adjuvant and locally advanced settings. For resectable pancreatic cancer, chemoradiation improves median survival compared to surgery alone. Prospective trials also demonstrated improved 2-year survival rates with adjuvant chemoradiation. For locally advanced or borderline resectable pancreatic cancer, chemoradiation provides better local control and progression-free survival compared to chemotherapy alone.
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
Prostate cancer updates were presented. Key points include:
1) The Gleason score is used to assess tumor aggressiveness and has shifted to include higher scores over time.
2) Screening results do not support widespread mass screening, but early detection may be offered to informed men with baseline PSA testing at age 40 and screening intervals of 8 years if initial PSA is low.
3) For localized disease, treatment options include active surveillance, radical prostatectomy, or radiation therapy depending on risk level and life expectancy. Deferred treatment may be appropriate for many cases.
Оптимизация лечения ВИЧ в 2018 году / HIV Treatment Optimization: 2018hivlifeinfo
HIV Treatment Optimization: 2018
In this downloadable slideset, Eric S. Daar, MD, provides a comprehensive update on ART management.
Format: Microsoft PowerPoint (.ppt)
File Size: 723 KB
Released: April 26, 2018
The document discusses the use of genomics in early stage breast cancer treatment. It describes how genomics can provide personalized treatment by understanding each tumor's biology and risk of recurrence. Two multi-gene assays, Mammaprint and Oncotype DX, are discussed. Oncotype DX has been clinically validated to predict recurrence risk and chemotherapy benefit in node-negative patients. Studies also show it can predict outcomes for node-positive patients treated with tamoxifen. The results from these assays often change treatment decisions by identifying patients unlikely to benefit from chemotherapy.
Leveraging the Growing Arsenal of Adjuvant Therapies for Early-Stage NSCLCi3 Health
3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by, Dr. Helena A. Yu, Associate Attending Physician at Memorial Sloan Kettering Cancer Center, will provide insights into strategies for leveraging the growing arsenal of adjuvant therapies for early-stage non–small cell lung cancer (NSCLC), including treatment selection and adverse event management.
STATEMENT OF NEED
Lung cancer is the second most commonly diagnosed cancer and the leading cause of death for men and women worldwide. In the United States, non–small cell lung cancer (NSCLC) accounts for 81% of all lung cancer diagnoses (Cancer.net, 2023). Therapeutic options, survival rates, and outcomes for NSCLC are dramatically impacted by disease stage. For patients with early-stage disease, radical surgery is the mainstay of treatment; however, patients have a significant risk of relapse following surgery and local treatment. Numerous novel therapeutic approaches, including the use of molecular biomarkers and the development of targeted agents and immune checkpoint inhibitors, are under investigation for early-stage NSCLC, contributing to a growing arsenal of treatment options for this disease (Indini et al, 2020). In this visiting faculty meeting series chaired by Helena A. Yu, MD, Associate Attending Physician at Memorial Sloan Kettering Cancer Center, speakers will provide expert perspectives on diagnosis, identification of biomarkers, and efficacy and safety data of novel adjuvant therapies to improve survival outcomes for patients with early-stage NSCLC.
TARGET AUDIENCE
Medical oncologists, radiation oncologists, surgical oncologists, pulmonologists, nurse practitioners, physician assistants, oncology nurses, and other health care professionals involved in the treatment of patients with non–small cell lung cancer (NSCLC).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to
Identify the correct tumor stage and appropriate management approach for NSCLC based on the latest evidence
Distinguish biomarkers for early-stage NSCLC that can inform individualized treatment strategies
Appraise efficacy and safety data of novel adjuvant therapies for patients with NSCLC as elucidated by recent clinical trials
Apply strategies to prevent and mitigate adverse events associated with novel adjuvant therapies for early-stage NSCLC
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Leveraging the Growing Arsenal of Adjuvant
Therapies for Early-Stage NSCLC
Helena A. Yu, MD
Associate Attending Physician
Memorial Sloan Kettering Cancer Center
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Disclosures
Advisory board/panel: AbbVie, AstraZeneca, Black Diamond,
Blueprint, C4 Therapeutics, Cullinan, Daiichi Sankyo, Janssen, Taiho,
Takeda
Grants/research support: AstraZeneca, Black Diamond, Blueprint,
Cullinan, Daiichi Sankyo, Erasca, Janssen, Novartis, Pfize
1. The document discusses various clinical and pathological factors that can help predict outcomes for prostate cancer patients undergoing surgery, such as cancer volume, Gleason grade, clinical stage, and PSA levels.
2. Nomograms and statistical models have been developed using these factors to predict chances of cancer recurrence, pathologic stage, and disease progression.
3. However, some factors like clinical stage may have limited predictive value. Ongoing research aims to improve predictive accuracy by addressing issues like PSA standardization and biopsy upgrading.
Ginna Laport is a professor of medicine and director of clinical research and biostatistics at Stanford University's blood and marrow transplantation division. She has previously held faculty positions at the University of Pennsylvania and University of Chicago. Dr. Laport chairs the steering committee of the BMT Clinical Trials Network and is a member of lymphoma committees at the National Cancer Institute and CIBMTR. Her presentation discusses current trends in hematopoietic cell transplantation for multiple myeloma, including the optimal induction regimen prior to transplant, the role of transplant versus no transplant with maintenance therapy, and timing of transplant.
High Risk disease is defined as “apparent localized cancer that has a high propensity of micro-metastatic disease” (cancer that is not visible on convention radiography, such as bone and CT scans). These cancers, once removed via radiation or surgery, are likely to "return," but in fact, they were never removed in the first place because the cancer cells were outside the treated region.
Therefore, successful eradication of high risk disease requires both aggressive local control and systemic treatment with androgen deprivation therapy and extended field radiation. This lecture will review the most up-to-date data on dose-intensity radiation therapy, pelvic radiation, surgery with adjuvant radiation, and adjuvant hormone therapy. Finally, data on experimental chemotherapy and abiraterone (Zytiga) will be presented.
Brachytherapy temporary vs permanent seed placementGil Lederman
This document compares temporary and permanent prostate brachytherapy seed placement for treating prostate cancer. It finds that permanent seed placement has better outcomes than temporary seed placement using catheters. For high-risk patients, the author's institution achieves 5 and 7-year disease-free survival rates up to 25% higher than another institution using temporary seed placement via catheters. Permanent seed placement allows patients to leave the hospital quickly with minimal side effects and return to normal activities, while temporary seed placement requires multiple treatments and hospital stays with more pain and risk of complications.
Join Fight CRC and Dr. Scott Kopetz to learn about the latest breaking colorectal cancer research from the American Society of Clinical Oncology 2019 Annual Conference.
Confronting the Challenges of HIV Care in an Aging Population.2019hivlifeinfo
Еxpert faculty use case-based examples to examine considerations for aging patients with HIV. Topics include ART modification, bone loss, renal impairment, cardiovascular risk, and cognitive decline.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Peter Grimm, DO
Prostate Cancer Center of Seattle
Comparing Treatment Results Of PROSTATE CANCER
Prostate Cancer Results Study Group 2014
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Problem: Patients, physicians and carriers need a simple, unbiased means to compare the cancer control rates of modern prostate cancer treatment methods.
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To solve this problem, we have assembled experts from key treating disciplines: Surgery, External Radiation, Internal (or Brachytherapy), High Frequency Ultrasound, and Proton Therapy
The purpose of this work is to do a complete review study of the current literature on prostate cancer treatment
3
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Ignace Billiet, MD F.E.B.U., Urologist Kortrijk, Belgium
David Bostwick, MD Bostwick Laboratories
David Crawford, MD Univ Colorado, Denver
Brian Davis, MD Mayo Clinic Rochester, Minnesota
Adam Dicker, MD Thomas Jefferson U Philadelphia,PA
Steven Frank, MD MD Andersen, Houston Texas
Peter Grimm, DO Prostate Cancer Center of Seattle
Jos Immerzeel, MD De Prostaat Kliniek Netherlands
Stephen Langley, MD St Luke's Cancer Centre, Guildford England
Alvaro Martinez, MD William Beaumont , Royal Oak, Mi
Mira Keyes, MD BC Cancer Agency , Vancouver Canada
Patrick Kupelian, MD UCLA Med Center Los Angeles
Robert Lee , MD Duke University Medical Center
Stefan Machtens, MD University Bergisch, Gladbach Germany
Jyoti Mayadev, UC Davis Davis ,California
Brian Moran, MD Chicago Prostate Institute Chicago
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Gregory Merrick, MD Schiffler Cancer Center Wheeling West Virginia
Jeremy Millar, MD Alfred Health and Monash University, Melbourne Australia
Mack Roach, MD UCSF San Francisco California
Richard Stock, MD Mt. Sinai New York
Katsuto Shinohara, MD UCSF San Francisco California
Mark Scholz, MD Prostate Cancer Research Institute Marina del Ray California
Edward Weber, MD Prostate Cancer Center of Seattle
Anthony Zietman, MD Harvard Joint Center Boston Ma
Michael Zelefsky, MD Memorial Sloan Kettering New York
Jason Wong, MD UC Irvine California
Robyn Vera, DO Radiant Oncology Lacey Washington
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28,000+ prostate studies were published between 2000 and June 2013
1,127 of those studies featured treatment results
233 of those met the criteria to be included in this review study. (*1st & 2nd group)
Some treatment methods are under- represented due to failure to meet criteria
ABOUT THIS REVIEW STUDY
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“Will I be cured?” or “Will my treatment make me cancer free?” are valid patient questions. However, PSA values (our best measurement tool today) cannot answer this absolutely. The current state-of-the-art can only indicate that the treatment was “successful” if PSA numbers do not indicate cancer progression.
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After prostate removal, PSA numbers usually fall rapidly to very low numbers and stay low.
After radiation, PSA numbers usually come down slower, might increase then fall in the 1 to 3 year range (called a “PSA Bump”), and then usually level out at a higher number than the surgery patient.
These different PSA expectations result in dissimilar ways to review a man’s PSA history to judge treatment success.
This study makes no attempt to standardize those evaluation systems.
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Brachy = Seed implantation, either permanent or temporary seeds
EBRT= External Beam Radiation Therapy includes
IMRT = Intensity Modulated Radiation
RP = Standard open radical prostatectomy
Robot RP = Robotic Radical Prostatectomy
HIFU = High frequency Ultrasound
Cryo= Cryotherapy
Protons = form of External Radiation using Protons
ADT= Hormone Therapy
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1.Patients should be separated into Low, Intermediate, and High Risk
2.Success must be determined by PSA analysis
3.All Treatment types considered: Seeds (Brachy), Surgery (Standard or Robotic), IMRT (Intensity Modulated Radiation), HIFU (High Frequency Ultrasound), CRYO (Cryo Therapy), Protons, HDR (High dose Rate Brachytherapy)
4. Article must be in a Peer Reviewed Journal
Criteria for Inclusion of Article*
* Expert panel consensus
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5. Low Risk articles must have a minimum of 100 patients
6. Intermediate Risk articles must have a minimum of 100 patients
7. High Risk articles, because of fewer patients, need only 50 patients to meet criteria
8. Patients must have been followed for a median of 5 years
For additional criteria information contact: lisa@prostatecancertc.com
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RP
EBRT/ IMRT
Cryo
Brachy/ HDR
Robot RP
Proton
HIFU
9%
13%
5.4%
21%
5.3%
24%
8%
28/320
40/302
2/37
64/306
4/76
4/17
3/38
Total of 1,127 Treatment Articles. Some articles addressed several treatments and were counted as separate articles for each treatment. *A few articles evaluated other/minor treatments and are not listed here. These calculations only include primary accepted articles, and do not include secondary acceptance totals.
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Each treatment is given a symbol. For example Seed implant alone (Brachy) is given a blue dot with a number in it.
The number in the symbol refers to the article. The article can be found in the notes section below the slide ( go into “view” in up left corner of PowerPoint and click on note section, then click on this portion and scroll down to see all the references)
Treatment Success % = Percent of men, whose PSA numbers indicate no cancer progression. (progression free) at a specific point in time
The bottom line indicates the number years the study is out An example, the blue dot with 27 inside indicates that, as per article 27, 97% of the patients treated with seeds alone in low risk patients at 12 years were free of disease progression according to PSA numbers
27
How to Interpret the Results
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First Establish your clinical risk group* by looking at the definitions or ask your physician. Refer only to those slides for your risk group
Make your own judgment and then ask a doctor in each discipline ( Seeds, External Radiation Surgery, etc) to tell you where his/her own peer reviewed published Treatment Success % would fit on this plot.
How to Interpret the Results
*Next Slide
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Low Risk
Stage: T1 or T2a,b Gleason Sum < 6 PSA < 10 ng/ml
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BJU Int, 2012, Vol. 109(Supp. 1)
7
5
22
← Years from Treatment →
CRYO
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
1
12
24
14
8
2
HIFU
% PSA Progression Free
11
15
Protons
4
18
9
10
EBRT & Seeds
25
Robot RP
26
Prostate Cancer Center of Seattle
27
HDR
28
29
31
32
33
34
19
36
37
LOW RISK RESULTS
Treatment Success
39
35
40
100
101
13
16
103
102
6
16
104
105
106
107
108
Update of z
20
109
109
110
111
112
113
114
115
7
3
17
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BJU Int, 2012, Vol. 109(Supp. 1)
17
7
60
70
80
90
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Seeds
Surgery
EBRT
5
22
← Years from Treatment →
CRYO
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
1
12
24
14
8
2
HIFU
% PSA Progression Free
11
15
Protons
4
18
9
10
EBRT &
Seeds
25
Robot RP
26
Prostate Cancer Center of Seattle
27
HDR
31 29 28
33 32
34
19
36
37
LOW RISK RESULTS
Weighted
39
35
40
100
101
13 EBRT
Brachy
Surgery
Treatment Success
103
102
6
16
104
105
106
107
108
Update of
109 20
110
112 111
113
114
115
7
3
17
109
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“The PCRSG criteria is pretty strict and not a lot of studies fit. What happens if you include articles with only 40 months of follow up or have a long follow up but less than 100 patients?”
24. Favorable
▪Single feature
▪Gleason 3+4=7
▪< 50% of biopsy cores +
Unfavorable
All other Intermediate
4/15/2014
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*Zumsteg et al (MSKCC) New Risk Classification system for therapeutic decision making PCA pts undergoing dose escalated EBRT European Urology 64 p 895-902 2013 Favorable vs Unfavorable
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BJU Int, 2012, Vol. 109(Supp 1)
25
29
22
21
5
% PSA Progression Free
18
12
28
3
17
10
9
8
2
1
13
Protons
HDR
← Years from Treatment →
• Prostate Cancer Results Study Group
• Numbers within symbols refer to references
15
4
36
37
38
+
Seeds Alone
Seeds + ADT
40
Robot RP
41
42
44
43
45
46
INTERMEDIATE RISK
Favorable Vs Unfavorable* Weighted
7
11
14
20
35
34
39
23
24
16
6
26
EBRT & Seeds
EBRT
Surgery
Brachy
EBRT & Seeds
Hypo EBRT
EBRT, Seeds + ADT
Treatment Success
Prostate Cancer Center of Seattle
30
27
47
48
49
150
151
31
Update of
152
152
153
154
155
155
156
157
158
159
19
25
32
32
F33
U33
160
160
156
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For most low risk patients, most therapies will be successful.
There appears to be a higher cancer control success rate for Brachy over EBRT and Surgery for all groups. Patients are encouraged to look at graphs and determine for themselves
Serious side effect rates must be considered for any treatment
Relaxing the report selection criteria doesn’t seem to impact the results substantially
OBSERVATIONS
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= Seeds alone
= EBRT & Seeds
= Surgery = Standard Radical Prostatectomy
= “Robot” =Robotic Prostatectomy
= “HIFU” = High Frequency Ultrasound
= “HDR”= High Dose Rate Brachytherapy +/-EBRT
= EBRT alone
= Hypo EBRT
= Protons
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= “CRYO” Cryo Therapy
= EBRT, Seeds, & ADT
= Seeds & ADT
= EBRT & ADT
= Surgery & ADT
= “Brachy” = all seed implant treatments
= all Surgery treatments
= all EBRT treatments
= all EBRT & Seeds
= all EBRT, Seeds & ADT
+
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Intermediate Risk
Stage T1 or T1-2 Stage T1-2
Gleason Score 7 or Gleason 6
PSA < 10 PSA 10-20
High Risk
Stage T2c or T3
Gleason score ≥ 8
PSA > 20 ng/mL
Low Risk
Stage: T1 or T2a,b Gleason Sum < 6 PSA < 10 ng/ml
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Peter Grimm, DO
peter@grimm.com
Lisa Grimm, Research Coordinator
lisa@prostatecancertc.com
Or ProstateCancerTC.com
Or contact PCRSG member
Prostate Cancer Center of Seattle website
www.Prostatecancertreatmentcenter.com