 These slides were extracted from a larger set of comprising a presentation entitled “Comparing Treatment Results of PROSTATE CANCER” dated 15_01_2013(3).  That presentation reports the results of an ongoing meta-analysis being conducted by the Prostate Cancer Results Study Group (PCRSG), led by Peter Grimm DO, of the Prostate Cancer Treatment Center in Seattle  A description of the work of the PCRSG is available through this link to the Prostate Cancer Treatment Center.the Prostate Cancer Treatment Center  The work of the PCRSG is directed at providing patients with a simple means of comparing the cancer control rates of modern prostate cancer treatment methods  This short extract has been prepared by the Prostate Cancer Support Group – ACT Region SLIDES EXTRACTED FROM PRESENTATION “COMPARING TREATMENT RESULTS OF PROSTATE CANCER”, DATED 15_01_2013(3) 1

2  23,000+ prostate studies were published between 2000 and 2012  989 of those studies featured treatment results  195 of those met the criteria to be included in this review study. (*1 st & 2 nd group)  Some treatment methods are under- represented due to failure to meet criteria ABOUT THIS REVIEW STUDY 15_01_2013(3)

3 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 3 Criteria for Inclusion of Article* * Expert panel consensus 15_01_2013(3)

4 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: 415_01_2013(3)

5 RP EBRT/ IMRT CryoBrachy/ HDR Robot RP ProtonHIFU 8.7%10.6%6%19%6%23%3% 25/28528/2632/3351/2754/653/131/33 Total of 989 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. 515_01_2013(3)

6  “Strict criteria” = studies that meet the criteria specified in earlier charts  “Relaxed criteria” = studies that met the strict criteria PLUS studies which:  (a) relate to to patients for whom there is only 40 to 59 months of follow- up (instead of 5 years or more), or  (b) relate to low risk or intermediate risk patients with 5 years or more of follow-up but with less than 100 patients, or  (c) relate to high risk patients with 5 years or more of follow-up but with less than 50 patients  “Weighted” means that the ellipses shown have taken into account the numbers of patients in each study EXPLANATORY NOTES FOR FOLLOWING SELECTED CHARTS 15_01_2013(3)

7  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 do not indicate 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 -1 15_01_2013(3)

8  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 - 2 *Next Slide 15_01_2013(3)

9 Risk Group Definitions Intermediate Risk Stage T1 or T1-2 Stage T1-2 Stage T1 or T1-2 Stage T1-2 Gleason Score 7 or Gleason 6 PSA < 10 PSA 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 Stage: T1 or T2a,b Gleason Sum < 6 PSA < 10 ng/ml 15_01_2013(3)

← Years from Treatment → CRYO Prostate Cancer Results Study Group Numbers within symbols refer to references HIFU % PSA Progression Free Protons EBRT & Seeds 25 Robot RP 26 Prostate Cancer Center of Seattle 27 HDR LOW RISK RESULTS – STRICT CRITERIA Weighted EBRT Brachy Surgery Treatment Success _01_2013(3)

← Years from Treatment → CRYO Prostate Cancer Results Study Group Numbers within symbols refer to references HIFU % PSA Progression Free Protons EBRT & Seeds 25 Robot RP 26 Prostate Cancer Center of Seattle 27 HDR LOW RISK RESULTS – RELAXED CRITERIA Weighted Treatment Success EBRT & ADT Seeds & ADT BrachyEBRT Surgery Hypo EBRT _01_2013(3)

% PSA Progression Free Protons HDR ← Years from Treatment → Prostate Cancer Results Study Group Numbers within symbols refer to references Seeds Alone Seeds + ADT 40 Robot RP INTERMEDIATE RISK RESULTS – STRICT CRITERIA Weighted EBRT & Seeds EBRT Surgery Brachy EBRT & Seeds Hypo EBRT EBRT, Seeds + ADT Treatment Success Prostate Cancer Center of Seattle _01_2013(3)

% PSA Progression Free Protons HDR ← Years from Treatment → Prostate Cancer Results Study Group Numbers within symbols refer to references Prostate Cancer Center of Seattle Seeds Alone Seeds + ADT 40 Robot RP INTERMEDIATE RISK RESULTS – RELAXED CRITERIA WEIGHTED EBRT + ADT Hypo EBRT EBRT Brachy Surgery EBRT & Seeds EBRT, Seeds + ADT Treatment Success _01_2013(3)

EBRT Seeds + ADT % PSA Progression Free Protons HDR ← Years from Treatment → Prostate Cancer Results Study Group Numbers within symbols refer to references Prostate Cancer Center of Seattle Robot RP HIGH RISK RESULTS – STRICT CRITERIA Weighted EBRT, Seeds & ADT Brachy EBRT Surgery EBRT & ADT EBRT & Seeds Hypo EBRT Treatment Success Surg & ADT _01_2013(3)

% PSA Progression Free Protons ← Years from Treatment → Prostate Cancer Results Study Group Numbers within symbols refer to references HIGH RISK RESULTS – RELAXED CRITERIA WEIGHTED Treatment Success HIFU Surgery Brachy EBRT EBRT & ADT EBRT & Seeds Hypo EBRT HDR EBRT Seeds + ADT Robot RP Prostate Cancer Center of Seattle Surg & ADT _01_2013(3)

16  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 16 OBSERVATIONS 15_01_2013(3)

17 For More Information  Peter Grimm, DO   Lisa Grimm, Research Coordinator   Or ProstateCancerTC.com  Or contact PCRSG member  Prostate Cancer Treatment Center website  _01_2013(3)