San Francisco, CA—The expression “a picture is worth a thousand words” is certainly true when it comes to figures from a new literature review of prostate cancer (PCa) treatments.
In a presentation at the American Society of Clinical Oncology’s 2010 Genitourinary Cancers Symposium, Peter Grimm, DO, showed that brachytherapy is more effective than surgery or electron beam radiation therapy (EBRT) in preventing progression in low- and intermediate-risk PCa.
Dr Grimm, executive director of the Prostate Cancer Treatment Center, Seattle, Wash, helped put together a panel of 25 radiation oncologists, brachytherapists, urologists, and medical oncologists from North America and Europe. They developed and then applied a set of strict inclusion criteria to 603 PCa treatment-related articles published since 2000. Dr Grimm then marked on graphs the rate of progression-free survival from each of the 51 articles that met all the criteria.
The results show that, for most patients with low- or intermediate-risk PCa, brachytherapy provides better outcomes than either surgery or EBRT.
The average prostate-specific antigen (PSA) progression-free survival rate from the low-risk PCa studies was 98% for brachytherapy, 92% for surgery, and 80% for EBRT.
Moreover, this sequence of effectiveness remained when Dr Grimm widened the inclusion criteria to take in low-risk PCa studies that had a median follow-up of ≥40 months or enrolled <100 patients, and when he examined intermediate-risk PCa (Figure). “PCRSG” stands for Prostate Cancer Results Study Group, which is the 25-member panel. Each symbol indicates an individual study; the shapes of the symbols represent the types of treatments, and the large circles represent the range of results from all of the studies of each treatment modality. (A full list of the studies referenced in this figure is available from the author—contact This email address is being protected from spambots. You need JavaScript enabled to view it..)
“Dr Grimm’s work synthesizes and summarizes the best retrospective data available regarding the relative strengths and weaknesses of all the available treatment options for prostate cancer…he did not ‘cherry pick’ articles from the literature,” commented Mark Scholz, MD, medical director, Prostate Oncology Specialists, Marina del Ray, Calif, and clinical assistant professor, Department of Medical Oncology, University of Southern California, Los Angeles. “It is a significant accomplishment, because there presently are no prospective comparisons and nor are there likely to be any in the future.”
The PCRSG criteria were:
Only 13% of the brachytherapy articles, 7% of the radical prostatectomy articles, and 0% of the high-intensity–focused ultrasound articles met all of these criteria.
Dr Grimm has not yet completed the analyses for the high-risk PCa studies.
“What I hope this kind of data does is also highlight the lack of uniformity of reporting,” concluded Dr Grimm. “We hope to move the field towards journal editors saying, ‘If you want your studies to be comparable to other work in the literature, they will have to meet these basic criteria.”
