April 2003

<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 2003</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. 11. April, 2003</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. REPORT OF THE MEETING HELD ON: Tuesday, 4 March</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Apologies were received from Richard Darmopil, Bill Liney and Dr Michael Lowy.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Our speaker for the evening was David Smith, Research Co-ordinator in the Cancer Epidemiology Research Unit of the NSW Cancer Council. While David's undergraduate degree was in Arts, his subsequent career has been extensively in medical and health research of one kind or another. He has been with the Cancer Council for about seven years, and is currently working toward a PhD with Professor Bruce Armstrong at Sydney University.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> David began by pointing out the difference between epidemiology (the study of disease in large populations) and epidermis and dermatology (which are to do with the skin). The two are sometimes confused! His work has included looking at causes of cancer and, more recently, the ways cancer care services are used.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> He outlined his talk as covering three topics: (I) to look at recent trends in the incidence of prostate cancer in (a) NSW and North Sydney and (b) in urban and rural NSW; (II) to give some preliminary results of a study of prostate cancer care (that is, where we are now and where we are heading); and (III) to outline recent Australian epidemiological research on the causes of prostate cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> (Before getting underway, David made a brief comment about the recent media coverage of the statements of Professor Alan Coates, of the Australian Cancer Council in which Professor Coates said that he would never choose to take a PSA screening test. David believed these comments were taken out of context. While the NSW Cancer Council was not an advocate of testing, it was, nonetheless, wise for men to be aware of the negative effects not only of treatment but also of watchful waiting.)<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> (Ia) David began by outlining the trend in the incidence of prostate cancer in NSW from 1975 to 2000. (Unfortunately, we are not able to reproduce the tables that David used in his power point presentation.) The rate per 100 000 men showed a steady increase to 1994 with an upward spike in 1994, which marked the advent of PSA testing. After that time the growth rate tended to plateau out, but at a higher level than in the 70s and 80s. These figures were age adjusted to take account of the aging population. The figures for North Sydney followed a similar pattern.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The mortality rate for prostate cancer over the same period remained fairly stable. In NSW the rate has declined over the past 10 years. Possible reasons for this include:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * PSA testing (which has led to early diagnosis and early treatment, though the effects of this are unquantifiable);<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * changes, and especially advances in treatment; and<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * attribution bias. - that is, greater accuracy in what is written on the death certificate as the cause of death.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> (Ib) The incidence of prostate cancer by region across 18 regions in NSW for the period 1996 to 2000 showed that North Sydney had one of the highest levels, compared to the state average. Further, the incidence by Local Government areas showed that Manly and Warringah/Pittwater had the highest rates in the North Sydney area. On the other hand, mortality rates are slightly lower in the North Sydney area, compared with the state average. Uptake of screening tests is higher among higher socio-economic communities. Figures for NSW showed, further, that Australian-born men have higher rates than men born overseas, with Asian-born men having the lowest rate. The highest incidence in the world is among black American men. However, we know only a fraction of the possible causes of prostate cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> (II) David went on to say that a second study on cancer in remote areas of NSW, aims to describe variations in cancer survival according to remoteness of services, and to suggest explanations for any variations. Standardised rates show higher incidence of cancer in the more remote areas, and also very high mortality rates. Also there is less access to screening in these areas. The relative risk of high death rates from prostate cancer is again high in remote areas and this, also, is related to lesser availability of both testing and treatment. There is growing differentiation in incidence of prostate cancer between remote areas. The reasons why such differences exist include: (i) clinical issues connected with geographic location leading to differences in access to PSA testing; (ii) race/biology issues, - for example, cancer appears more aggressive in indigenous people; and (iii) the decisions patients make about having (or not having) treatment.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> (III) David has also been involved over the past three years in the Prostate Cancer Outcomes Study, for which funding has been extended for a further three years. Some members of our own Group are, in fact, taking part in this study. It is a population wide study in NSW of patterns and outcomes of care for prostate cancer. It involves baseline data collected in a half-hour telephone interview which is compared with a one, two, three and five year follow-up. Interviewees must consent to the Study obtaining medical notes from doctors and data from the Health Insurance Commission. There are 2 000 cases being followed, and 500 controls from the general population. In order to be accepted into the Study, patients needed to be under 70 years of age at the time of first diagnosis.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> David explained the way in which patients were recruited into the Study: The NSW Cancer Registry wrote to clinics to invite participation. 86% of those approached said yes. Contact information was given to the Study researchers. The Registry wrote to patients. 89% of those approached said yes. Patients were interviewed, consent was obtained and a questionnaire was completed.There was an annual quality of life interview.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Feedback from GPs indicated that there were certain threats perceived by participants: the process was a burden, - patients felt the questions were intrusive; some patients rejected the process; some patients needed persuasion to participate or continue. One spanner in the works was that some adverse publicity for the project resulted in the withdrawal of some men.1072 men responded to the survey of unmet supportive care needs. This survey attempted to discover what the support needs are. Among the top eight were:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * dealing with sex feelings (25%),<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * changes in sexual relations (22%) and<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> * information on sexual relations (21%).<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The results showed the necessity of lowering the level of need across all areas, and the disclosed the area of sexuality as having greatest need.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> In outlining the future development of the program, which will continue to 2007, David stated that it was hoped to complete recruitment of patients by the end of April this year. Other forthcoming activities will include analysis of the coping mechanisms of patients and of the aid that is available to them, the economic impact of prostate cancer, and the publication of a report.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> David concluded his presentation by reporting the results of a recent Australian epidemiological investigation, during the years 1994-1998, into the causes of prostate cancer among a group of men aged 70 years or less. Findings included the following: There appears to be no association with smoking. There appears to be no association with body size (that is, size or weight). There appears to be some association with a late growth spurt in adolescence. There appears to be some reduced risk among men who suffered facial acne.There appears to be some relation with certain patterns of baldness (baldness at the apex of the skull). There is some question as to whether delayed androgen action is associated with risk.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> We certainly look forward to having David back with us towards the end of next year when he should be able to give us further results of his much needed and most useful research.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>2. INKJET AND TONER CARTRIDGES</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> PCFA receives $3 for used inkjet and toner cartridges. They will call and collect 10 or more used cartridges free of charge. Alternatively, bring your used cartridges to the monthly meetings and we will arrange to get them to the Foundation. For further information, contact PCFA on 02 9418 7942.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>3. PCFA LAPEL BADGES</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The Prostate Cancer Foundation of Australia (PCFA) has produced a small and smart lapel badge, bearing the words Finding the Answers Together and the Foundation's sunflower logo. The cost is only $4.00 and badges can be obtained at the sign-in desk at each meeting. Proceeds go towards the vital work of the Foundation.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>4. PROSTATE NEWS</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Any member who does not receive a regular copy of the Prostate Cancer Foundation's quarterly newsletter, Prostate News, and would like to do so, please contact me and I will forward your mailing details to the Foundation. Issue No. 13 (February, 2003) has just been released. It has a major article on incontinence, and others on PSA, vasectomy and prostate cancer, a new treatment, and an invitation to participate in a Melbourne based research study into incontinence.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>5. IMPOTENCE AUSTRALIA NEWSLETTER</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Impotence Australia also publishes a newsletter. The latest issue is dated February, 2003. Please contact me if you would like an address to become a subscriber.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>6. WEBSITES</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> One of our former speakers, Dr Michael Lowy, from the Australian Centre for Sexual Health, sent us an e-mail reminding us of a website which provides helpful information on sexual dysfunction: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.impotenceaustralia.com.au" TARGET="_top" TITLE="http://www.impotenceaustralia.com.au"><U><B><U>www.impotenceaustralia.com.au</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>7. REMINDERS:</B> Next Meetings (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 are welcome at all our meetings. (Refreshments will be served.)<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 1 April Dr Michael Izard from Sydney Radiology, The Mater Hospital, North Sydney: Brachytherapy: Past , Present and Future Directions<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 6 May Dr Philip Stricker (Urologist, St Vincent's Hospital): Update on Diagnosis - PSA, Gleason and All That.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Stricker is noted for his defense of PSA testing. Members will probably recall his television debate last year with Dr Geoffrey Hurst (of Brisbane) who holds views similar to those expressed recently by Professor Alan Coates.</div> <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> <bR> </td> </tr></table></body>