1.  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. 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. 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. 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: lisa@prostatecancertc.comlisa@prostatecancertc.com 415_01_2013(3)

5. 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. 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. 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. 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. 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 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 Stage: T1 or T2a,b Gleason Sum < 6 PSA < 10 ng/ml 15_01_2013(3)

10. 10 7 7 5 5 22 ← Years from Treatment → CRYO Prostate Cancer Results Study Group Numbers within symbols refer to references 1 1 12 24 14 8 8 2 2 23 HIFU % PSA Progression Free 11 15 Protons 21 4 4 18 9 9 10 EBRT & Seeds 25 Robot RP 26 Prostate Cancer Center of Seattle 27 HDR 28 29 30 31 32 33 34 19 36 37 38 LOW RISK RESULTS – STRICT CRITERIA Weighted 3 3 39 35 40 100 101 13 EBRT Brachy Surgery Treatment Success 103 102 6 6 16 104 106 107 108 17 15_01_2013(3)

11. 11 7 7 5 5 22 ← Years from Treatment → CRYO Prostate Cancer Results Study Group Numbers within symbols refer to references 1 1 12 24 14 8 8 2 2 23 HIFU % PSA Progression Free 11 15 Protons 21 4 4 18 9 9 10 EBRT & Seeds 25 Robot RP 26 Prostate Cancer Center of Seattle 27 HDR 28 29 30 31 32 33 34 19 36 37 38 LOW RISK RESULTS – RELAXED CRITERIA Weighted Treatment Success 3 3 39 35 40 41 100 101 13 65 49 76 80 56 59 63 41 75 51 71 72 90 73 74 70 42 57 85 84 66 43 64 44 EBRT & ADT 53 82 81 62 54 79 86 87 88 45 58 69 7878 77 4646 4848 91 + + Seeds & ADT 93 92 89 50 67 68 95 94 55 5252 8383 47 61 BrachyEBRT Surgery Hypo EBRT 96 103 102 97 98 60 6 6 16 104 106 99 107 108 17 15_01_2013(3)

12. 12 29 22 21 5 5 19 % PSA Progression Free 18 12 28 3 3 17 10 32 9 9 8 8 2 2 25 1 1 13 Protons HDR ← Years from Treatment → Prostate Cancer Results Study Group Numbers within symbols refer to references 15 4 4 36 37 38 + + Seeds Alone Seeds + ADT 40 Robot RP 41 42 44 43 45 46 INTERMEDIATE RISK RESULTS – STRICT CRITERIA Weighted 7 7 11 14 20 35 34 39 23 24 16 6 6 26 33 EBRT & Seeds EBRT Surgery Brachy EBRT & Seeds Hypo EBRT EBRT, Seeds + ADT Treatment Success Prostate Cancer Center of Seattle 30 27 48 49 150 151 31 15_01_2013(3)

13. 13 29 22 21 5 5 19 % PSA Progression Free 18 12 28 3 3 17 10 32 9 9 8 8 2 2 25 1 1 13 Protons HDR ← Years from Treatment → Prostate Cancer Results Study Group Numbers within symbols refer to references 15 4 4 36 Prostate Cancer Center of Seattle 37 38 + + Seeds Alone Seeds + ADT 40 Robot RP 41 42 44 43 45 46 INTERMEDIATE RISK RESULTS – RELAXED CRITERIA WEIGHTED 7 7 11 14 20 35 34 39 23 24 16 6 6 26 33 82 66 88 67 70 97 63 65 102 103 101 86 87 85 58 68 71 81 50 EBRT + ADT 94 93 92 77 91 51 69 Hypo EBRT 99 75 90 89 56 55 54 80 57 83 60 73 72 98 53 52 79 95 64 100 84 78 59 62 74 96 76 EBRT Brachy Surgery EBRT & Seeds EBRT, Seeds + ADT Treatment Success 104 105 30 27 48 49 150 151 106 107 31 109 108 15_01_2013(3)

14. 14 6 6 11 36 25 15 5 5 EBRT Seeds + ADT 19 30 16 20 18 29 % PSA Progression Free 17 21 8 8 9 9 22 24 26 37 41 12 Protons HDR ← Years from Treatment → Prostate Cancer Results Study Group Numbers within symbols refer to references Prostate Cancer Center of Seattle 42 43 44 45 46 47 Robot RP 48 49 101 102 103 104 105 106 107 109 HIGH RISK RESULTS – STRICT CRITERIA Weighted 23 35 108 4 4 2 2 31 39 32 33 34 3838 EBRT, Seeds & ADT Brachy EBRT Surgery EBRT & ADT EBRT & Seeds Hypo EBRT Treatment Success 1 1 7 7 110 27 3 3 13 14 28 40 10 111 112 113 114 115 116 Surg & ADT 118 117 119 121 15_01_2013(3)

15. 15 6 6 11 36 25 15 5 5 19 30 16 20 18 29 % PSA Progression Free 17 21 8 8 9 9 22 24 26 37 41 12 Protons ← Years from Treatment → Prostate Cancer Results Study Group Numbers within symbols refer to references 42 43 44 46 47 48 49 101 102 103 104 105 106 107 109 HIGH RISK RESULTS – RELAXED CRITERIA WEIGHTED Treatment Success 10 23 35 108 4 4 2 2 31 39 32 33 34 3838 50 51 52 53 54 55 HIFU 56 86 87 57 58 59 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 88 79 80 81 89 84 83 82 85 Surgery Brachy EBRT EBRT & ADT EBRT & Seeds Hypo EBRT HDR EBRT Seeds + ADT Robot RP Prostate Cancer Center of Seattle 1 1 7 7 90 91 110 27 3 3 13 14 28 40 92 45 111 112 113 114 115 116 Surg & ADT 118 119 60 15_01_2013(3)

16. 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. 17 For More Information  Peter Grimm, DO  peter@grimm.com peter@grimm.com  Lisa Grimm, Research Coordinator  lisa@prostatecancertc.com lisa@prostatecancertc.com  Or ProstateCancerTC.com  Or contact PCRSG member  Prostate Cancer Treatment Center website  www.Prostatecancertreatmentcenter.com www.Prostatecancertreatmentcenter.com 15_01_2013(3)