April 2005

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=120 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="03f8dfe1esnpes.jpg"> <div> <B>April 2005 </B></div> <bR> <bR> <div> <A HREF="id3.htm" TARGET="_top" TITLE="Calendar"><U><B><U>Calendar</U></B></U></A><A HREF="id3.htm" TARGET="_top" TITLE="Calendar"><U><B> </B></U></A><B>  |   </B><A HREF="id60.htm" TARGET="_top" TITLE="Carers Group"><U><B><U>Carers Group</U></B></U></A><B>   |   </B><A HREF="id2.htm" TARGET="_top" TITLE="Group Guidelines"><U><B>Group Guidelines</B></U></A><B>   |  </B><A HREF="id61.htm" TARGET="_top" TITLE="Library"><U><B> </B></U></A><A HREF="id61.htm" TARGET="_top" TITLE="Library"><U><B><U>Library</U></B></U></A><B>   |   </B><A HREF="id4.htm" TARGET="_top" TITLE="Current Newsletters"><U><B><U>Current Newsletters</U></B></U></A><B>   |   </B><A HREF="id16.htm" TARGET="_top" TITLE="Archived Newsletters"><U><B><U>Archived Newsletters</U></B></U></A><B>   |   </B><B><U>Pamphlets</U></B><B>  |  </B><A HREF="index.htm" TARGET="_top" TITLE="Northern Beaches Prostate Cancer Support"><U><B><U>Hom</U></B></U></A><B><U>e</U></B></div> <div> </div> </td> </tr><tr> <td valign="top" height=360 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="03f8dfc3.jpg"> <div> <B><U>NEWSLETTER</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>No.33. April, 2005</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Editor: John Conroy<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>1. COMING EVENTS</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> a) 6.30 pm, Tuesday, 5 April Dr Kenneth Vaux [Urologist]: Regaining Bladder Control after Treatment for Prostate Cancer<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Ken Vaux was a speaker at our inaugural meeting held in May, 2002. We are delighted to welcome him back to talk to our Group on a topic of special interest to him, and one which is of general concern to all men facing treatment for Prostate Cancer. Although incontinence as a side effect of treatment is a worry, it is usually only temporary and, in those cases where it persists, most can be controlled by drugs or prosthesis. Be sure to make a note of this session in your diary.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> b) 9.30am, Monday, 11 April Look Good... Feel Better. This is a workshop to help men face cancer treatment with confidence. It lasts about two hours, and will be held in the Palliative Care Cottage at Mona Vale Hospital. It teaches you not only grooming techniques; it "boosts self esteem and helps you to be confident and positive during cancer treatment". </div> <bR> <div> To register for this fun and informative workshop, please call:1800 650 960. You are welcome to bring a friend.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> c) 6.30 pm, Tuesday, 3 May Open meeting with representatives from members of other Prostate Cancer Support Groups in the Sydney Region. Regular meetings are normally held at 6.30 pm on the first Tuesday of each month in the Palliative Care Cottage, Mona Vale Hospital All friends, partners, carers, and family members are welcome. Refreshments will be served.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Please note: During meetings, all discussion and comment about members individual circumstances and experiences are confidential and should not be repeated outside the Cottage walls!<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>2. Report of the Meeting Held on Tuesday, 1 March</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Apologies were received from: Una Conroy, Richard Darmopil, Geoff Emanuel, George Phelps and Jo Ann Steeves. </div> <bR> <div> We were pleased to welcome Ms Melanie Griffin and a colleague, both from Novartis Pharmaceuticals. </div> <bR> <div> Our speaker for the evening was Dr Justin Vass, Urological Surgeon, who introduced the topic of Advanced Prostate Cancer. Dr Vass began by emphasising the importance of educating society about Prostate Cancer, as it is the most commonly diagnosed cancer in men, and second only behind lung cancer as a cause of death. The lifetime risk of contracting microscopic disease is about 30% (1 in 3). 25% of men under 40 who die from other causes have been found to have signs of Prostate Cancer; 10% of these will have a clinical problem later in life, of whom 3% will die from the disease. One of the current problems related to Prostate Cancer is to know which of the men diagnosed will die with it and which will die of it. Not every Prostate Cancer constitutes a threat to the patient and, therefore, does not warrant treatment.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> A diagnosis of Advanced Prostate Cancer indicates that the disease is incurable, and that there is a metastatic spread [that is, it has spread to other parts of the body]. Even after spreading, it may be some time before the patient is aware of any symptoms. Indeed, Advanced Prostate Cancer may not be fatal as it is usually slow growing. Common local symptoms, due to ureteric obstruction, may be: difficulty urinating, retention of urine, blood in the urine, or incontinence. However, these symptoms commonly also indicate BPH [Benign Prostate Hyperplasia] which is treatable by a TURP procedure [known as a 'rebore']. While symptoms of localised prostate problems are usually blockage of the urethra [the tube leading from the bladder], distant spread [for example to the lymph nodes or to the bones] may have no symptoms [asymptomatic], although bone pain and/or fracture may subsequently occur. Metastases arise because microscopic cancer cells are carried to other parts of the body via the lymph system or the blood stream. Treatment. In 1941, the researcher Huggins discovered that Prostate Cancer was sensitive to the male hormone testosterone. 90-95% of this hormone comes from the testes and 5-10% comes from the adrenal glands. Hence treatment has been aimed at reducing the supply of testosterone. The result is that Prostate Cancer cells begin to die. However, the decrease in testosterone affects normal as well as cancer cells, and there is an increase in the rate of normal cell death. On the other hand, some Prostate Cancer cells are non-responsive to this testosterone link, which is why Advanced Prostate Cancer can't be cured. These resistant cells form the basis from which the cancer begins to grow again. This condition is called hormone refractory Prostate Cancer. Because metastatic Prostate Cancer is often lethal [70% of men die within five years], the mainstay of treatment is androgen [testosterone] deprivation. The method of testosterone reduction is: a.] bilateral orchidectomy [removal of the testicles]; b.] LHRH analogues [to block the flow]; and c.] anti-androgen drugs. Orchidectomy is the most cost effective treatment and is the fastest way to lower testosterone; however, it is less attractive to patients. LHRH [Leutinising Hormone Releasing Hormone] analogues cause an initial stimulus of Leutinising Hormones and a rise in testosterone [by up to 140-170%], but within 21 days, suppression occurs to the same level as castration. The familiar drugs [LHRH agonists] for this treatment are Lucrin and Zoladex, which are given by injection at 1-4 month intervals, and are usually given with an anti-androgen during the first four weeks to prevent problems. The anti-androgen drugs include Androcur, Eulexin and Cosudex. They act by blocking testosterone at the receptors level. By themselves, they may not be quite so effective but they are not associated with impotence. For this reason they may have a greater role to play in the treatment of younger men, - at least, temporarily For maximum androgen blockade, a combination of LHRH plus anti-androgen treatment is used. This aims to block all testosterone production. Currently this treatment is not thought to be more effective than the LHRH agonists, though it may have a role to play in younger men with low volume metastasis. The effects of decreased testosterone may be: loss of libido [sex drive], impotence, reduction of body hair, hot flushes, breast tenderness, breast enlargement [gynaecomastica], or osteoporosis [brittleness of the bones].<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> As to timing of therapy, should it be immediate or only when there is a problem, - that is, at the onset of symptoms? Research suggests that, if an early start is made, the chance of subsequent complications of death in younger men will be less. Intermittent therapy has been introduced in the hope of delaying the progression of the disease to the hormone resistant stage. If PSA falls with treatment to less than 4 over 24 to 32 weeks, the chance of survival for these patients is greater than 40 months; if PSA remains above 4, chance of survival is about 18 months. For those patients whose PSA falls to below 4, intermittent LHRH is an option. This means that they are taken off LHRH until their PSA reaches either 20 or their pre-treatment level. This treatment is still experimental, and long term results are not clear.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Management. Indications of metastatic Prostate Cancer are: a PSA levelabove 20, bone scan revealing bony metastasis, and lymph node metastasis indicated through a CT scan. Treatment begins with LHRH agonists, plus a four-week cover of anti-androgens. PSA is measured at the end of the month. The rate of fall and the lowest point reached [the nadir] are prognostic indicators. Symptoms are assessed, anti androgens stopped, and injections are given at 3-4 monthly intervals. PSA and symptoms are monitored every 4-6 months. The first signs of recurrence [a rise in PSA in 80% of patients] occur on average after two years. Two consecutive rises 3-4 weeks apart, with a 50% increase above the lowest point, precede a clinical recurrence by 8 months. The testosterone level is measured and anti-androgen therapy is discontinued, which may lead to a fall in PSA in some patients. Secondary hormonal therapies or chemotherapy may be considered.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> So far, there has been a low response rate to chemotherapy. It has a high incidence of toxicity. In the period 1988-91, 26 trials were held with an approximate 10% response rate. It is used after other therapies fail and may have a place in the treatment of lower stage Prostate Cancer or for palliation. It doesn't appear to add many years to life. New developments are being explored.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Recently, bisphosphonate drugs have been used to inhibit bone re-absorption and may help to prevent osteoporosis. They tend to reduce pain and skeletal events, and prevent bone loss, and can also increase bone density.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Various specific problems may be associated with Advanced Prostate Cancer. One such is ureteric obstruction, a blockage of the vessels leading from the kidneys. This may be alleviated by insertion of a 'pigtail' stent in the kidney. Another which is not uncommon is spinal cord compression, where the metastasis occurs in the vertebrae. This may occur in 1-12% of patients, causing severe back pain. It may lead to leg weakness, urinary incontinence or bowel problems. Treatment may be by high dose steroids, radiotherapy or surgical decompression.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Patients with bone metastasis may develop debilitating pain in 50-70% of cases. This may be treated with radiation therapy and has an 85-100% response. In the case of diffuse bone pain, aggressive administration of narcotics has shown unequivocal improvement in quality of life. Treatment may include bone seeking radio-pharmaceuticals, such as strontium 89. With increased density of weight bearing bones, early orthopedic intervention may prevent bone fracture.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Eventually, palliative care will become necessary when the disease reaches the incurable phase. The palliative care team will include the family GP, the urologist, oncologist and radiotherapist, the palliative care specialist, nurse, psychologist and social worker, and the family.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Vass believes there are reasons for optimism concerning the treatment of Advanced Prostate Cancer. Earlier detection now takes place, and there are new treatment strategies, including tumour vaccines and gene therapy. Dr Vass concluded that while the disease has no cure at present, it is possible to delay its progression, and a patient may die of something else. There is a new team approach to management of the disease and many therapies are being developed to relieve suffering. Also, there is more research money becoming available. Wider community education has led to earlier detection and more chance of cure.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>3. INFORMATION UPDATE</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> a. Further information on the latest treatments for Advanced Prostate Cancer can be found in an article by Jill Margo, published in the Australian Financial Review, 3 March, 2005. The article is entitled: Cause for hope in battle against prostate cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> b. Another very readable article by Jill Margo published in the Australian Financial Review about the same time, entitled Blocking testosterone to starve prostate cancer, deals with intermittent hormone therapy in early localised as well as advanced prostate cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> c. A copy of the latest issue [No.13, Summer, 2005] of The Healthy Male, published by Andrology Australia, is available in the Group's Library. The focus of this issue is on Undescended Testes.</div> <bR> <bR> <div> <B>YOUR CONTACT NUMBERS</B></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="664" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 116 WIDTH="357"><div> <U>Program Co-ordinator</U> </div> <bR> <div> Dr Peter Moore </div> <div> Northern Beaches Palliative Care<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> 9997 3555 </div> </tD> <tD VALIGN=TOP WIDTH="296"><div> <U>Group Leader</U></div> <bR> <div> John Conroy<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> 9918 9358<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <A HREF="mailto:conroyjs@bigpond.com" TARGET="_top" TITLE="mailto:conroyjs@bigpond.com"><U><U>conroyjs@bigpond.com</U></U></A></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 89 ><NOBR><div> <U>NSW Cancer Council Cancer Support Helpline</U></div> <bR> <div> 13 11 20<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> <U>Prostate Cancer Foundation of Australia</U></div> <bR> <div> 1800 220 099</div> </NOBR></tD> </tR> </TABLE></div> <bR> </td> </tr></table></body>