25-year survival data on men treated with ProstRCision

You are likely to see or hear media reports of data from a paper by Critz et al. published in the March issue of the Journal of Urology. We would merely comment that we reported on this paper last October when it first became available on line. Please click here to see our detailed report.

9 Responses

  1. This is all about making money.


    There is good news here: the Critz RCOG group has obviously been tracking a large group of its patients over many years with sufficient diligence to meet peer review standards for the Journal of Urology, a major respected journal of course.

    Many of us had been disappointed that the RCOG group had not published any long-term update, other than the “10 year” update published in 2004, nearly a decade ago, based on median follow-up of 6 years. (This absence of follow-up, after fairly vigorous publication previously, was on my mind when I was reviewing my radiation therapy options last year. I had my second of 39 TOMOtherapy treatments today.)

    As Sitemaster points out, the abstract lumps patients into a large, homogenous group that is not stratified by risk, but with a high proportion of apparently low-risk patients. To me, given the high rate of success under active surveillance for low-risk patients, as Sitemaster noted, that greatly reduces the value of this study as indicated by the abstract.

    I’m hoping RCOG will give us updates by risk group. They have done so several times in the past. Their 2004 report, with a somewhat different slice (more recent 1992-1998 treatments) of their patient population, indicated “10 year” (but likely with a median of about 6 years for the higher-risk groups based on the overall median) recurrence-free success rates of 93% for low-risk, 80% for intermediate-risk, and 61% for high-risk. An earlier paper in 2000 showed a total of 188 patients with PSAs greater than 10 ng/ml (144 with PSA > 10-20 and 44 with PSA > 20), so RCOG should have visibility into long-term success for a substantial number of higher risk patients.

    Sitemaster: Were any risk group statistics reported in the full paper? I’m thinking they would have been featured in the abstract, so I’m thinking not. I’m suspicious that RCOG is trying to put the best spin on their results, which, lacking solid success with the higher risk groups, would not be impressive.

    Thanks very much for posting this.

  3. Dear Jim:

    Yes … The paper does give the actuarial 10- and 15-year rates for biochemical freedom from recurrence by risk group, as follows:

    — Low risk at 10 years, 93% (range, 91-94%)
    — Low risk at 15 years, 92% (range, 90 -93%)
    — Intermediate risk at 10 years, 74% (range, 71-77%)
    — Intermediate risk at 15 years, 73% (range, 69-76%)
    — High risk at 10 years, 44% (range, 39-50%)
    — High risk at 15 years, 42% (range, 36-49%)

    In other words, the results for the men who were most likely not to have needed aggressive treatment (if they even needed treatment at all) were excellent. The results for the men who had the greatest possible potential for benefit from aggressive treatment weren’t too good. And the results for the men in between were … in-between.

    However, … as I pointed out in October when we originally commented on this paper … it includes absolutely no information whatsoever about the risk for complications and side effects of treatment.

  4. This might be useful for comparison. This study is known here in Sweden, and an attempt to improve on this kind of trimodal treatment by use of a somewhat higher dose escalation and 3 years of adjuvant ADT was, eh, tried out on me, from February 2009 until May 2012. (However, I did have Gleason 8 as opposed to Gleason 7 disease.) I haven’t read the full paper yet, but have downloaded it.

  5. Thanks very much for the details of the Critz RCOG study by risk group!

    While there are issues in comparing studies, from a patient’s perspective I’m eager to compare results when credible comparative data are available. In this case, it looks to me that the RCOG results for 10 years, which are virtually the same at 15 years for each risk group, are comparable to the results published by Dr. Michael Dattoli and colleagues in 2007 based on review of 282 consecutive patients, the vast majority with higher risk features per NCCN criteria, treated from 1992-1996.

    The Dattoli team approach was similar to the RCOG approach in that all men got both seeds (iodine-125 for RCOG, palladium-103 for Dattoli) and EBRT, but the seeds were implanted first in the RCOG approach, vice versa under the Dattoli approach, and 103 men in the Dattoli study received a few months of androgen deprivation therapy, which did not happen in the RCOG study.

    As a patient, I feel the Dattoli results are clearly superior. Though I have looked for artificial differences that might account for the superior Dattoli results, I have not found anything significant. Here’s what I’m seeing, using the RCOG 10-year results and the Dattoli actuarial 14-year results, based on median follow-up for non-failing patients of 9.5 years.

    • RCOG
    • Low-risk group, 93%
    • Intermediate-risk group, 74%
    • High-risk group, 44%
  6. Dattoli
    • Low-risk group, not specified
    • Intermediate-risk group, 87% (n = 119)
    • High-risk group, 72% (n = 124)

    The difference for the high risk group is striking!

    The Dattoli team also reports side effects, summarizing as follows: “Treatment morbidity was limited to temporary RTOG grade 1–2 urinary and gastrointestinal symptoms.”

    I have been aware of the Dattoli study from shortly after it was published. At that point I was about 8 years along with my own challenging, high-risk case, and I found the study most encouraging. It helped me begin seriously considering radiation. Of course technology has improved greatly since both groups were treated. For instance, the Dattoli group was using 3D conformal pelvic radiation as contrasted with the sophisticated versions of IMRT plus advanced imaging that the group is using today. (My own treatment is being done at a local TOMOtherapy center.)

  • Jim:

    As you stated at the beginning … you don’t know if you are comparing apples to apples, so this is a very dangerous way to make any sort of comparison.

  • Hi George,

    As Sitemaster noted, comparisons are tricky, but the success result of the Swedish study you cited for high-risk men at the 9-year point, 75.7% freedom from biochemical recurrence, is remarkably close to the Dattoli figure of 72%, though with a considerably higher occurrence of significant side effects. Both figures are well above the success rate of 44% for the high-risk group treated by RCOG.

  • Hi Jim,

    Thanks for the heads up and the comparison. I have to admit, that due to a sudden increase in my workload, I haven’t been able to look at your post yet. I shall do so later this afternoon.

  • I read the article I posted 2 days ago. It does cover people like myself, with Gleason 8 disease. My error.

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