Re: Grimm: treatment outcomes

[Guest guest]

In the absence of any large-scale published randomized study comparing

prostate cancer treatments, perhaps the most thorough and objective

literature review attempting such a comparison was the one done by the

Prostate Cancer Results Study Group. A summary is on Dr. Grimm's web site:

http://www.prostatecancertreatmentcenter.com/ProstateCancer/ProstateCancerResult\

sStudyGroup.aspx

I find it a bit bemusing that this study is often criticized as being

'biased' towards brachytherapy when the results are presented by Drs. Grimm

or Blasko, or shown on a brachytherapy web site. The actual study group was

composed of 25 highly respected doctors including surgeons, radiologists,

oncologists, and medical researchers. The study group had very restrictive

conditions for inclusion of the studies reviewed-- only those providing

stratification of treatment results by risk group, only studies published in

peer reviewed journals, only studies meeting a minimum number of patients.

The graphical summaries showing treatment results by risk group are fully

documented with references and are rather eye-opening in the range of actual

treatment outcomes for each treatment type and risk group.

As a prostate cancer patient yet to be treated (6 years into Active

Surveillance), and thus as yet having no bias towards MY treatment choice, I

am following the continuing study by this group with great interest. I can

highly recommend that any man facing the tough issue of chosing treatment

for prostate cancer take a look at the above web site.

I can provide additional slides from presentations on this review if anyone

wishes.

The Best to You and Yours!

Jon in Nevada

------------------------------

Date: Wed, 1 Feb 2012 14:20:02 -0500

Subject: Re: Surgery Next Week!

Marty, if Grimm really has evidence that " Brachy +IMRT yields lower

incidence of sexual dysfunction and lower incidence of incontinence, " then

he should have published his findings in a peer reviewed journal article,

not just on his website. I'm sure that the Dr. knows this, so, the only

conclusion I can draw is that he probably did submit an article and the

reviewers rejected it.........................

[Guest guest]

Thanks Excellent study. Sort of a scandal at the VA Hospital near the Hospital of the Univ of Penn several years ago. Seems the radiologist implanting seeds was doing a bad job, and many seeds dislodged, or moved, causing radiation burns in unwanted places, and other adverse effects. The program was shut down while all patients were contacted and sreevaluated. Meanwhile the new proton beam machine went on line next door at HUP. So, in Philadelphia, it is my impression that brachytherapy is not getting all the support it deserves. Obviously, in selecting a surgeon, you want one with experience and lots of it. T In the absence of any large-scale published randomized study comparing prostate cancer treatments, perhaps the most thorough and objective literature review attempting such a comparison was the one done by the Prostate Cancer Results Study Group. A summary is on Dr. Grimm's web site:http://www.prostatecancertreatmentcenter.com/ProstateCancer/ProstateCancerResultsStudyGroup.aspxI find it a bit bemusing that this study is often criticized as being 'biased' towards brachytherapy when the results are presented by Drs. Grimm or Blasko, or shown on a brachytherapy web site. The actual study group was composed of 25 highly respected doctors including surgeons, radiologists, oncologists, and medical researchers. The study group had very restrictive conditions for inclusion of the studies reviewed-- only those providing stratification of treatment results by risk group, only studies published in peer reviewed journals, only studies meeting a minimum number of patients. The graphical summaries showing treatment results by risk group are fully documented with references and are rather eye-opening in the range of actual treatment outcomes for each treatment type and risk group.As a prostate cancer patient yet to be treated (6 years into Active Surveillance), and thus as yet having no bias towards MY treatment choice, I am following the continuing study by this group with great interest. I can highly recommend that any man facing the tough issue of chosing treatment for prostate cancer take a look at the above web site.I can provide additional slides from presentations on this review if anyone wishes.The Best to You and Yours!Jon in Nevada------------------------------Date: Wed, 1 Feb 2012 14:20:02 -0500Subject: Re: Surgery Next Week!Marty, if Grimm really has evidence that " Brachy +IMRT yields lowerincidence of sexual dysfunction and lower incidence of incontinence," thenhe should have published his findings in a peer reviewed journal article,not just on his website. I'm sure that the Dr. knows this, so, the onlyconclusion I can draw is that he probably did submit an article and thereviewers rejected it.........................

[Guest guest]

Just to be clear, the study group (the group of 25 doctors, not just Dr.

Grimm) used published studies in compiling their review. They reviewed over

18,000 papers and based their findings on over 800 selected by very

restrictive criteria.

The Study Group's findings were also published in the PCRI Insights, May

2011:

http://prostate-cancer.org/pcricms/sites/default/files/PDFs/Is14-2_p3-11.pdf

This included the comparison (with references) of side effects by treatment

type that was questioned in a previous post.

Among the 11 criteria the study group used in selecting publications to

include in their review was that the selected papers had to use these

criteria for biochemical failure:

" A PSA based, standardized endpoint for treatment failure had to be

used. (Biologic Relapse

Free Survival – BRFS). Note: Radiation, Cryotherapy, and HIFU use the

ASTRO or

Phoenix definition of PSA failure. Surgery uses PSA >= 0.2 ng/ml as an

indicator failure. "

I don't know what definition Grimm uses for his patients. The Study Group

Report was not referring to Grimm's practice

The two links I provided do not include the keys linking the plotted data

points to the publication references. However, I do have a 2011 PowerPoint

presentation of the Study Groups slides that does show the source

publication for every point in each slide.

As I indicated originally, this is the most objective and comprehensive

review comparing prostate cancer treatment results that I have found in the

past 6 years. The Study Group reportedly intends to provide updates

annually.

You know guys, there is no way to summarize valid information dealing with

our disease in 25 words or less on an Internet post... There are excellent

information sources available, but, it does take a bit of effort to read and

digest them.... ;-)

The Best to You and Yours!

Jon in Nevada

------------------------------

Date: Wed, 1 Feb 2012 18:20:32 -0500

Subject: Re: Grimm: treatment outcomes

Jon...Do you have Grimm's list of references used to identify the various

studies used to create his graphs (e.g. the references that identify the

numbers in the graphical symbols)? Can anyone tell me what definition of

biochemical failure Grimm uses for his patients?..Thanks, Ron

>In the absence of any large-scale published randomized study comparing

>prostate cancer treatments, perhaps the most thorough and objective

>literature review attempting such a comparison was the one done by the

>Prostate Cancer Results Study Group. A summary is on Dr. Grimm's web site:

>http://www.prostatecancertreatmentcenter.com/ProstateCancer/ProstateCancerResul\

tsStudyGroup.aspx

>

>I find it a bit bemusing that this study is often criticized as being

>'biased' towards brachytherapy when the results are presented by Drs. Grimm

>or Blasko, or shown on a brachytherapy web site. The actual study group

>was

>composed of 25 highly respected doctors including surgeons, radiologists,

>oncologists, and medical researchers. The study group had very restrictive

>conditions for inclusion of the studies reviewed-- only those providing

>stratification of treatment results by risk group, only studies published

>in

>peer reviewed journals, only studies meeting a minimum number of patients.

>The graphical summaries showing treatment results by risk group are fully

>documented with references and are rather eye-opening in the range of

>actual

>treatment outcomes for each treatment type and risk group.

>

>As a prostate cancer patient yet to be treated (6 years into Active

>Surveillance), and thus as yet having no bias towards MY treatment choice,

>I

>am following the continuing study by this group with great interest. I can

>highly recommend that any man facing the tough issue of chosing treatment

>for prostate cancer take a look at the above web site.

>

>I can provide additional slides from presentations on this review if anyone

>wishes.

>

>The Best to You and Yours!

>Jon in Nevada

>

[Guest guest]

Date: Sat, 4 Feb 2012 20:45:13 -0500

Subject: Re: Grimm: treatment outcomes

The Prostate Cancer Results Study Group evaluated over 18,000 papers and

ended up selecting 848 that met their selection criteria, which are fully

documented in the three references provided thus far to this work in past

posts.

Historically there have been no consistent definitions of biochemical

failure (based on PSA) among or even within treatment types. To go through

the 848 publications used in ths review and obtain the necessary raw data to

back calculate a consistent definition of biochemical failure would be a

rather absurd task. Yes, the fact that historical studies have used

different definitions of biochemical failure is among the many challenges in

trying to conduct such a review.

There have been no long-term large-scale random clinical trials comparing

prostate cancer treatments, and, given the costs of such a long-term trial

and the challenge of having men agree to have randomized treatment, there

probably never will be such trials in the future.

Available retrospective studies vary greatly in scope and rigor. At one

narrow extreme are rather small single-practitioner results comparing

robotic to open surgery, which are subject to the bias of selection criteria

and surgical techniques of that particular surgeon. How does one translate

such results to the local availability of community doctors? The same

issues apply to a single doctor or single institution study reporting

outcomes of any type of treatment. The Study Group reported by Grimm et al

attempted to present a wider review of the range of results from major types

of treatment, using well-defined selection criteria, and, importantly in my

own view of our disease, stratified by cancer risk. If there are other

studies of similar scope and documentation, let's share them.

They presented the results in a graphical format which is rather easy to

comprehend. Each data point in the graphs represents an entire study, which

in an available PowerPoint file is fully referenced in the 'notes' section

below each graph. I have posted the PowerPoint file in the Yahoo prostate

cancer support group files:

http://health.groups.yahoo.com/group/ProstateCancerSupport/files/

with the file name:

Grimm.2011.TreatmentComparisonSlides.ppt

If there is an alternative site where posting this file would be more

inclusive, let me know.

The Best to You and Yours!

Jon in Nevada