July 2002

<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>July2002</B></div> <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> </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.3. July, 2002</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>1. REPORT OF THE MEETING HELD ON:</B> <B>Tuesday, 4</B> June Dr Harvey Alexander, urologist, from the Royal North Shore Hospital spoke on: Coming to Terms with Prostate Cancer - Treatments and Decision-making.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Alexander made the point right at the start of his talk that, with some cancers, the patient doesn't have to make any real decision once diagnosis has been made; the patient usually doesn't have to consider the legacies of treatment. However, the man who is diagnosed with prostate cancer, whether it is localised or extensive, faces the high probability that treatment will affect his sexual activity, - totally and permanently, or temporarily, or in the way in which activity is resumed. This fact can affect a man's willingness to investigate symptoms, or to undergo treatment. Because of the anxiety raised by this threatened attack on his sexuality, regardless of how sexually active he may be, a man needs to be informed in order to make decisions. The situation is somewhat similar for a woman who is diagnosed with breast cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Alexander began by taking us on a short historical journey. Back in the 1940s it was found that if there is a reduction in the patient's production of male hormones, the cancer goes into remission; hence the procedure was used of removing the testes. This often led to complications, such as cardio-vascular disease or the development of breasts. Subsequently, only part of the testes was removed. This, too, was invasive, so a wide range of chemicals was tried and a lot of money was poured into treatment, with no great improvements.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> In the 1980s, urologists rarely saw a prostate cancer that was amenable to treatment. Most cases were advanced, not localised. Then came PSA testing, which enabled early localised cancer to be detected, but with a high PSA, there was only a 1 in 3 chance of effective treatment. It takes 10 to 15 years of research to check whether or not a new treatment is effective; hence the current uncertainties, for example, about the effectiveness of Brachytherapy, which is still in its infancy. However, the decline in deaths from prostate cancer since the 1990s leads us to assume that this might be the result of early diagnosis and treatment.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Alexander then went on to look at Prostate Specific Antigen (PSA) testing. At the age of 50, if a man is healthy, he should live to 80, but if he has prostate cancer he is unlikely to be alive at 80. Hence, if a man finds his PSA is raised, it seems sensible to act. The aim of treatment is to keep the patient alive and symptom free. If the initial diagnosis is made in a man of 80, it is probable that he will die of something else; it would seem pointless to treat someone with a life expectancy of less than 10 years. (It is a fact that 90% of men who die over 80, of whatever cause, are found to have prostate cancer.) Prostate cancer is amongst the first three diseases as a cause of death among men in Australia. It is a slow death, with the chance of spreading to other parts of the body, so it would seem questionable to do nothing.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> If PSA is high, and a rectal examination indicates an enlarged prostate, the next step would be a biopsy, and then treatment. For a man over 70, treatment may not be advised, as it may be possible to keep him alive by other means. If a man's age is under 70, he has a right to know his PSA score. If it is high, it could be merely the result of prostatitis, or a benign enlarged prostate, so the PSA test isn't all that great as a diagnostic test, but it's always a good idea to follow it up. It still remains that men have the right to know whether or not they have a treatable cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The Gleason Score is obtained from looking at the worst and best cells from a biopsy, grading them each on a scale of 1 to 5, and then adding these two scores together. The lowest Gleason score is 4 and this indicates a slow growing cancer and probably one not worth acting on. Scores of 5, 6 or 7 are the uncertain ones. The doctor also needs to know what the PSA is before having anything done. The worst Gleason score is 10.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Alexander next looked at kinds of treatment. Radical prostatectomy is the treatment that has been done for the longest time. The risk ofimpotency following this operation ranges between 50 and 70%; the risk of incontinence is around 5%. There is more chance of a cure, but one has to take into account the risk of complications, as there is always the chance of leaving some of the cancer behind.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> External Beam Radiation Therapy (EBRT) has had its uses in the past. However, there is the risk of bowel and bladder damage. Brachytherapy, another form of radiation therapy, uses 16 gm implants of radio-active seeds or the insertion of needles directly into the prostate gland. This treatment is in its early days and research is being done into its long term effectiveness. Doctors are selective as to whom to treat, - usually the treatment is for cancers with a Gleason score of 6 or less. Ultrasound is now being used to help place the material in the right position.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Finally, Dr Alexander reported on some current research activity. Intermittent hormone therapy was being used to try to preserve sexual potency. Decisions have to be made as to when to use hormones. If the PSA score doubles within six months this would be an indication to use hormones. Researchers are looking for a better marker than PSA, and work is being done in this area at St Vincent's Hospital in Sydney. Also, there may be an answer in gene therapy but this is still a long way off.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>Responses to Questions:</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * PSA is a protein, produced only by the prostate. It is present in large amounts if there is a cancer. It is detected by a blood test and scores are compared to a range based on readings for healthy and diseased men.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * The older you are and the lower your Gleason Score, the better you will do on hormones. However, it is not a curing treatment: what it does is to prolong life and reduce symptoms.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * Metastasis, - the spread of the cancer beyond the prostate, - worsens the prognosis, which will depend on the patient's age and the Gleason score. If the Gleason score is 4, the patient should do well, but if it is 10, life expectancy will be about six months. Where the secondary cancer is located is less important than age and how well you respond to treatment.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * Physical fitness certainly plays a part in how one responds, as does a positive approach. Alternative medicine can be effective, especially if the patient believes in it.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * First symptoms of prostate cancer are: difficulty in urinating, in starting to urinate, and frequent trips to the toilet at night. However, if one waits for these, by the time they appear the cancer is probably advanced.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * If a diagnosis of localised prostate cancer is given, the question arises of the likelihood of the cancer spreading if one follows the line of watchful waiting.There may be some anxiety associated with following this option, but it provides a broader range of time to chose treatment options. Debulking (reducing the bulk of the prostate) may be carried out to bide time.There should never be any need to rush into treatment.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * Treatment for enlargement of the prostate may include drug therapy, or what is referred to commonly as a 'rebore'. This is the removal of part of the prostate and relieves the symptoms, but it is not a cure for cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * Sexual potency is dependent on presence of hormones, nerve functioning and blood flow. In old age, arteries thicken and this can have the effect of reducing potency. Treatments for prostate cancer may also have an effect on potency.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Alexander completed his presentation by emphasisng the great importance of educating men in all the issues relating to prostate cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>2. GENERAL MATTERS</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Those present agreed that a box should be put out at the end of each meeting for members to make a voluntary donation to defray the costs associated with running the Group. It was emphasised that there is absolutely no obligation for members to contribute.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>3. USEFUL WEB SITES</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> If you have a copy of the little book: Localised Prostate Cancer, produced by the Australian Prostate Cancer Collaboration (see me if you would like a copy), some useful web sites are given on pp.73-74. I have attempted to give you a run down on what each site contains.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>i) </B><FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.prostatehealth.org.au" TARGET="_top" TITLE="http://www.prostatehealth.org.au"><U><B><U>www.prostatehealth.org.au</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> This is a very informative presentation prepared by the Lions Club of Australia. It treats issues under nine general headings: Welcome and What's Hot, Prostate Cancer Information, Australian Support Groups, Access to Treatment, Educational Resources, Ask Andy, Special Topics and Consumer Guide, Links, and Australian Prostate Navigator.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>ii) </B><FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.prostatehealth.org.au/links.html" TARGET="_top" TITLE="http://www.prostatehealth.org.au/links.h"><U><B><U>www.prostatehealth.org.au/links.html</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> This is an extension of the Lions Club Australia material. It deals with 37 issues listed under eight headings: General, Diagnosis, Treatment Options - Surgery, Treatment Options - Brachytherapy, Treatment Options - Hormone Therapy, Prostate Cancer Support, Side Effects, and References.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>iii) </B><FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.prostate-cancer.org/tools/tools.html" TARGET="_top" TITLE="http://www.prostate-cancer.org/tools/too"><U><B><U>www.prostate-cancer.org/tools/tools.html</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> (Yes, that repetition of tools is correct.) The Prostate Cancer Research Institute of the US has prepared this rather technical site, - probably a site for the expert. It has two main divisions: I. Forms, which is dealt with under five headings: Diagnosis ( with 2 subsections), Evaluation (3 subsections), Staging (4 subsections), Treatment (2 subsections), and Surveillance (with only one subsection). II. Software, which looks at 7 software programs.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>iv) </B><FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.prostate.org.au" TARGET="_top" TITLE="http://www.prostate.org.au"><U><B><U>www.prostate.org.au</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> You won't find this listed in the booklet. It is the web site for our own Prostate Cancer Foundation of Australia and contains 15 very readable and easily understood sections: Home page, Foundation Information, Donations, Prostate Cancer - What Is It?, The PSA Test, Treatment Options, Choosing a Specialist, Public Awareness, Value of Support Groups, Contacting Support Groups, Prostate News Magazine, Latest Developments, Diet and Supplements, Publications, and Research Grants.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> All of these are worth a look, - provided you have access to the Internet, of course! As Dr Harvey Alexander said at our last meeting, it's just so important for men to have information about Prostate Cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>4. REMINDERS: Dates of next meetings</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 1. The July meeting will be held on Tuesday, 2 July at 6.30 pm in the Palliative Care Cottage, Mona Vale Hospital. To begin with, a 25 minute video will be shown, entitled: Understanding the prostate and prostate cancer. This will be followed by a talk by Dr Richard Foster, radiation oncologist, from the Seventh Day Adventist Hospital, Wahroonga. Dr Foster's topic will be: Zapped by the Ray: Radiation Therapy.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 2. August meeting (Tues., 6 Aug.): Professor Miles Little and Ms Emma Sayers from the University of Sydney: General Problems of Cancer Survival.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 3. September meeting (Tues., 3 Sept.): Dr Michael Lowy from the Australian Centre for Sexual Health: The Effects of Prostate Cancer on Sexual Function. All friends, partners, carers, family are welcome at all our meetings.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>5. Members' phone numbers</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Also, please let us know if your name is missing or if there are any wrong numbers!</div> <bR> <bR> <bR> <div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="705" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="171"><div> <B><U>Name</U></B></div> </tD> <tD VALIGN=TOP><NOBR><div> <B><U>Phone number</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="171"><div> <B><U>Name</U></B></div> </tD> <tD VALIGN=TOP><NOBR><div> <B><U>Phone number</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="171"><div> BUGGLE, Albert</div> </tD> <tD VALIGN=TOP WIDTH="171"><div> 9400 9651</div> </tD> <tD VALIGN=TOP WIDTH="171"><div> McLEAN, Bill</div> </tD> <tD VALIGN=TOP WIDTH="171"><div> 9997 5639</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 ><NOBR><div> DARMOPIL, Richard </div> </NOBR></tD> <tD VALIGN=TOP WIDTH="171"><div> 9999 3434</div> </tD> <tD VALIGN=TOP WIDTH="171"><div> OWEN, David<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> <tD VALIGN=TOP WIDTH="171"><div> 9918 9426</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="171"><div> HALLIDAY, Lex</div> </tD> <tD VALIGN=TOP WIDTH="171"><div> 9999 3070</div> </tD> <tD VALIGN=TOP WIDTH="171"><div> REID, John</div> </tD> <tD VALIGN=TOP WIDTH="171"><div> 9913 8836</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="171"><div> HUGHES, Tony</div> </tD> <tD VALIGN=TOP WIDTH="171"><div> 9974 5079</div> </tD> <tD VALIGN=TOP WIDTH="171"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="171" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="171"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="171" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></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>