May 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>May 2003</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> </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. 12. May, 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> 1. We are one year old! At our May meeting we will be celebrating our first birthday. We began with a membership of just 12 and have now grown to almost 70 persons on our books, so we can feel that the original belief in a need for a Support Group in the Northern Beaches has been justified.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> We are marking our anniversary by having Dr Phillip Stricker, the well known Urologist from St Vincent's Hospital, as our guest speaker for May. Dr Stricker will be remembered for his debate with Dr Hurst on the 60 Minutes television program last year on the virtues of PSA testing. His topic will be: Update on Diagnosis - PSA, Gleason and All That. This should be a worthwhile session.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Also to mark our progress, we shall be holding a meeting in June to establish a Carers' Support Group. It has been part of our policy from the start to encourage carers and family members to attend meetings, and we have had a number who attend from time to time. We now plan to have a firmly established group and at the May meeting we shall announce the date, place and time of our exploratory meeting of carers. Please pass this information on to your own carers'.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> At our first meeting in May, 2002, we issued and discussed a set of Guidelines for our Group. These are being published again in this issue of the Newsletter for the benefit of those who have joined during the year. We invite your comments.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>2. REPORT OF THE MEETING HELD ON:</B> <B>Tuesday, 1 April;</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Apologies were received from: Graham Clark and Chris Lowe, Jack and Louise Conry, Richard Darmopil, and John Reid.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> We welcomed new Members: Brian Bonney¹s wife Helene, Michael Dooley, and Arthur and Jill Gray and their daughter Rachel.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Michael Izard, our speaker for the evening, grew up in Hong Kong and then attended a boarding school in England. He subsequently went on to do his medical training in London. Dr Izard was a little alarmed this morning when he looked in his diary to find that his secretary had booked in a patient, a Mr Con Sohlt, for a consultation at 4.45 this afternoon. He couldn't think how he was going to be able to see Con Sohlt and get to our meeting on time. He said the name over to himself a few times, - and then realised the date was 1 April!<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Izard is currently attached to Sydney Radiology at the Mater Hospital in North Sydney. His talk was entitled: Brachytherapy, - Past, Present and Future Directions. Brachytherapy tends to be thought of as being a label for a radiation therapy peculiar to prostate cancer. However, it is also used in the treatment of other cancers; for example: rectal and cervical cancer, and cancer of the tongue and larynx. It is a special delivery technique and is not new. It was used in 1910 to treat prostate cancer by ramming radio-active material down the urethra. The method was spectacularly unsuccessful, as it was also in 1960 and 1970 when further variations of the treatment were attempted. There was not the computer power to locate the position of the radio-active seeds accurately as there has been since 1985.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The prefix brachy comes from a Greek word meaning 'close'. The technique is based on a mathematical rule known as the inverse square law. For example, the closer you get to a fire, the hotter you feel; the further you move away, the cooler it gets. But the decrease in the amount of warmth you feel depends not on the distance, but on the square of the distance you are from the fire. The same is true with radiation; the effect of the radiation decreases according to the square of the distance of the cancer cells from the source of radiation. 96% of the effect is lost over five units away from the source. Therefore, the procedure is to try to get as close as possible to the tumor. External beam radiation therapy (EBRT) tries to get an even beam over the whole area of the cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Brachytherapy uses two types of procedure: temporary insertion (an in-out process, which is what is used for most other parts of the body) or permanent (such as may be used for prostate cancer, where seeds of radio-active material are implanted, and remain in place). The material used for seed implants is iodine which has a radio-active isotope. (Palladium is used in the USA but not in Australia, as there is no government import license.) It is inserted in a canister 5mm in length and 0.8mm in diameter. This treatment is acceptable for patients with a PSA score (which indicates the bulk of the cancer) less than 10, and a Gleason score (which indicates the quality of the cancer) of 6 or less, but not for the rest of the population of prostate cancer patients. It is inappropriate if the cancer has already escaped into other parts of the body. A Gleason score of less than 6 indicates a slower growing cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Another measure that is significant in relation to Brachytherapy is the notion of the half life' of radio-active materials. The iodine isotope has a half life of 59 days, so that if you begin with 1 million units, there will be only half a million left after 59 days, a quarter of a million after 108 days, and after 177 days 87% of the material has died'. If a cancer is growing at a faster rate, the treatment is not suitable.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The material used in the temporary radiation procedure is Iridium 192, which is a more active source and has a half life of 1 month. The dose is given over a few hours rather than months. The method uses 17 needles, each 10 inches in length. An epidural anesthetic is given, so there is no pain. There may be some bruising but no wounds, and there is a minimum chance of infection. The worst part of the procedure is having to lie flat for two days. The needles are connected to a tube running to a machine with a barrel like an old fashioned machine gun. This is tied to a computer for control. The inverse square rule is used to get an even distribution of radiation dose across the prostate gland in such a way as to cause minimal damage to the rectum.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The problem with the seeds implant is the movement of the prostate glanddue to the elasticity of the gland's tissue. The patient may need external beam top-up if cold spots' occur (that is, areas where the radiation has not reached or has not had full effect, as it is difficult to insert additional seeds to make up for the short-fall. With the temporary treatment, some margin of radiation is achieved for about 5mm around the prostate (but not on the side next to the rectum). With seeds, the implants are inside the prostate only. For TURP patients, iodine seeds are not suitable, whereas the needles of the temporary treatment are quite OK. Because the prostate is mobile, there can be problems with EBRT (external beam radiotherapy). A full bladder or rectum may cause movement. Therefore, the side effect profile for this treatment can be less than ideal. Implants, on the other hand, can provide doses of 80-90 gray (the units or radiation dosage) and they have a better chance of long term effect. Side effects depend on where the radiation beams are working, - where they are being aimed. With prostate cancer, the areas at particular risk are the bladder, bowel and sexual function. Tolerance varies from 66 gray to 70-80 gray.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Arguments about which is the better treatment are due to the fact that none is perfect. With a PSA level of less than 20, there is a 5% risk of the disease spreading, whereas with a PSA of greater that 100, the risk is 95%. The risk depends on the doubling time of the PSA. It is the activity of the cancer which determines the need for treatment. Referral for treatment by radiation therapy tends to be for patients for whom surgery is less appropriate (for example, those who have a PSA of 18 and a Gleason score of 9), that is, for patients where the disease has progressed beyond a point where surgery is an option. Radiation therapy is administered for better control of the disease. The question of cost can not be ruled out as an issue in choice of treatment.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Once again, our speaker provoked wide-ranging discussion through his interesting presentation, and members were reluctant to let him get away!<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>3. WEBSITES</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> For those of you who are net-surfers interested in finding out information about prostate cancer and various aspects of the disease, below is a list of some websites that are useful and worth exploring. These have been published in various earlier issues of the Newsletter. Seasoned surfers may have discovered many more. If you would like to share some of the more interesting and reputable sites, please get in touch with me so that I can add to the list and pass them on to others.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> ia) The Lions Club of Australia: <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> ib) <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> ii) The Prostate Cancer Research Institute of the US <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> (Yes, that repetition of tools is correct.)<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> iii) Prostate Cancer Foundation of Australia <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> iv) Cancer Voices NSW : <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.cancervoices.org.au" TARGET="_top" TITLE="http://www.cancervoices.org.au"><U><B><U>www.cancervoices.org.au</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> v) Andrology Australia: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.andrologyaustralia.org" TARGET="_top" TITLE="http://www.andrologyaustralia.org"><U><B><U>www.andrologyaustralia.org</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> vi) The Australian Centre for Sexual Health: <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>4. REMINDERS:</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 10 May, The Cancer Council NSW will be holding another Relay for Life in the Northern Beaches around September this year and it is hoped that ourgroup will again have a high profile. There will be a meeting of the organising group on Monday, 10 May and we plan to have a few representatives there. Please let me know if you would like to participate one way or another.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>Next Meeting </B>(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 at all meetings. (Refreshments will be served.)<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 3 June Dr Peter Brennan (Pittwater Family Practice): Maintaining Contact with Your GP.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></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> <bR> </td> </tr></table></body>