June 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>June 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></div> <bR> <div> <B>No. 13. June, 2003</B></div> <bR> <div> Editor: John Conroy</div> <bR> <div> <B>1. REPORT OF THE MEETING HELD ON: Tuesday, 6 May;</B></div> <bR> <div> a.) Apologies were received from: Graham Clark and Chris Lowe, and Arthur and Jill Gray.</div> <div> We welcomed new Members: Philip West¹s wife Wallis, Steve Clark, Edwin Crabb, Peter Morrow, and Bob Perry. We also welcomed guests: Dr Peter Brennan, who will be our speaker in June, and Erica Brar, physiotherapist.</div> <bR> <div> b.) Our birthday meeting began with an impassioned plea from Ron Schmarr, from the Royal North Shore Support Group and representing the Prostate Cancer Foundation of Australia. Ron drew our attention to a Private Members Motion that was to be presented to the House of Representatives requesting government funding for research into Prostate Cancer and for programs to raise awareness of the risk to men of Prostate Cancer. He also urged us to write letters to our Members of Parliament asking them to support the motion, as well as letters of support to the mover and seconder of the motion. I know that many of you have responded. I have had a reply from the Hon. Jim Lloyd saying that the motion should go before the House on 30 May, and that he was receiving mail from all over Australia. Let's hope we get a result!</div> <bR> <div> c.) Our Anniversary guest speaker was Dr Phillip Stricker, Urologist, from St Vincent's Hospital, who treated us to an absorbing evening<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> discovering Everything we need to know about Prostate Cancer. To begin with, Dr Stricker presented us with some statistics:</div> <div> Prostate Cancer is the commonest form of cancer among men; 12 000 men are diagnosed with Prostate Cancer each year; the incidence </div> <div> of Prostate Cancer increases with age; Prostate Cancer accounts for 40% of young cancer (that is, in men 55 years of age or less); in<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> the Sydney region, 20-25% of men are being screened (in Dubbo, the figure is only 2-8%); over 2500 men die from prostate cancer </div> <div> each year; in NSW, the death rate has fallen by 20% in recent years; internationally, Afro-American men are most at risk; 10% of cases of prostate cancer are inherited. Men most at risk of being diagnosed with prostate cancer are those who have a family history of prostate cancer: if your father or brother has been diagnosed, you are twice as likely to develop the disease; however, if both your father and brother have had it, the likely risk increases to five times. If a man has a PSA level greater than 0.9 at age 40, he has a tenfold risk of contracting prostate cancer.</div> <bR> <div> Prostate cancers can be given a 'T score': a cancer with a score of T1 cannot be felt by digital rectal examination; a cancer scored as T2 can be felt as a bump on the prostate gland; T3 indicates that the cancer is outside the prostate and invading the surrounding area; a cancer scored T4 is incurable, - it has invaded other areas of the body. A tumor allows itself to spread by making its own chemicals which are released into the bloodstream. It may also run along the fibres of the nerves which cause erections, hence the value of catching the cancer early by such means as PSA testing. The typical spread outside the area may be to the lymph nodes around the bladder or to the bones.</div> <div> New statistical information from around the world (which can be used to argue the case in favour of PSA testing) reveals that since the advent of screening programs in the USA, there has been a 16% drop in mortality rates from prostate cancer, while in the Tyrol, where there has been a big screening program, mortality figures have dropped by 42%. Other advantages from screening programs are that early detection may mean fewer side effects from treatment, as well as the need for less invasive treatments. Consequently, a watching and waiting program is not a good idea for a younger man who is positively diagnosed. Only one in 10 tumors diagnosed are regarded as insignificant. It's more important to catch a significant tumor in a 60 year old man.</div> <bR> <div> What is PSA (Prostate Specific Antigen)? It is a protein chemical produced only in the prostate gland. Its function is to change semen from a thick to a thin fluid at ejaculation. If it leaks into the bloodstream, it is an indication that there is something wrong with the prostate gland: it may be inflamed, or enlarged, or there may be cancer present. The normal PSA level for a man aged 40 years is 0.3; at 60, a he might expect a PSA of 4.5 - 5.0 or below.</div> <bR> <div> When should screening occur? Normally this should take place annually for ages from 50 to 70 years, using PSA testing and digital rectal examination (DRE). If there is a family history, screening should start at 40. A biopsy is performed if the DRE is abnormal, or if the PSA level is above the average for the age group, or if the rate of rise is 0.75 Ng per year or greater.</div> <bR> <div> A biopsy will reveal five different patterns of cancer cells: patterns 1 and 2 indicate a good cancer - that is, there is a good outlook; patterns 4 and 5 indicate a bad cancer; pattern 3 indicates that the cells will proceed to cancer. A Gleason Score is obtained by adding the two commonest patterns that show on the biopsy. With a Gleason 6 cancer, there is an 80% chance of surviving for 20 years. It is important to get an experienced pathologist to analyse the tissue samples taken at the biopsy. In previous years, only 6 samples of tissue were taken. Nowadays, it is usual to take up to 20 samples. Also, there is a shift from trans-rectal sampling to trans-perineal. Taking the samples does not cause the cancer to spread.</div> <bR> <div> Can Prostate Cancer be prevented? In China and Japan, the incidence is low. This is put down to diet: a low calorie intake, low intake of saturated fats, and high vegetable consumption. In Italy, where the incidence is also low, there is a high consumption of tomatoes (a source of lycopene) and olive oil. General dietary guidelines are: eat less fat, more fruit and vegetables, lycopenes (cooked) and soy protein. Useful food supplements include selenium (if the intake is low through natural diet, as appears to be the case in Australia) and vitamin E, especially if cancer is already present. From the viewpoint of lifestyle, there is no proof that stress is a causal factor. Regular exercise is a help, and meditation, - maybe.</div> <bR> <div> Does complementary medicine cure cancer? The answer is probably no, though it may help prevent it. It's probably a helpful supplement </div> <div> to traditional medicine.</div> <bR> <div> How do I choose the best treatment? There are multiple options, and the decision comes down to personal preference. Surgery may lead </div> <div> to incontinence side-effects; radiotherapy may lead to bowel problems; nerve-sparing surgery may or may not prevent impotence; treatment may involve radioactive seeds (brachytherapy - involving minor surgery; - it has a high failure rate with more advanced cancers) or hollow wires (used for more advanced cancer); hormone therapy may be an option; alcohol injection is another option (it can be a reasonable treatment to use, though it may have the downside of causing swelling); or you may be content with active surveillance (watchful waiting). Factors to consider are weighing risks against benefits, the cure rate, possible side effects, one's own general health and life expectancy, and what pre-and post-treatment support is available. It is possible to use a pre-operative nomogram (a table to work out the chance of a cure) to calculate Prostate Cancer recurrence. A second opinion should always be sought if it will assist easing your mind on the various issues. Making the choice usually comes down to head versus heart. Usually the decision is based on emotions rather than logic.</div> <div> Choosing surgery as an option. The mortality rate for a radical prostatectomy should be zero.The chance of incontinence resulting is down to 2%. (One treatment for incontinence is the insertion of an artificial sphincta.) Erectile dysfunction may be a problem after surgery, but 80% of men under the age of 60 years are likely to get the function back within 1 to 2 years. Bladder neck contraction may occur in less than 1% of cases, and major complications in less than 3%.</div> <bR> <div> Nerve sparing surgery. If the cancer has not broken through the shell of the prostate gland the nerves are easily teased out. If the </div> <div> Gleason score is equal to or greater than 7 the surgeon will usually go wider and take the nerve, and use nerve grafting if necessary. During surgery it is possible to use a machine to check whether the erectile nerve is functioning. On the whole, it is better to take the nerves and cure the cancer. Options in the event of impotence include counselling, taking tablets (such as Viagra), using urethral pellets, penile injections, vacuum devices or penile implants. There is a 30-40% response to Viagra after a radical prostatectomy. It only works after nerve sparing surgery, and works better after some recovery period. The normal dose is 100 mg. Side effects may include headaches, problems with vision, indigestion or flushing.</div> <bR> <div> What of the future? Possible advances in treatment include improved surgery (though keyhole surgery seems to be inappropriate at this stage), the use of focused ultrasound, improved radio therapy (using seeds or wires), gene therapy (though this is in its early stages of development) and enzyme producing therapy. We look forward to hearing about some of these developments in later meetings.</div> <bR> <div> For more information, Dr Stricker recommended two Websites:</div> <div> <A HREF="http://www.prostate.com.au" TARGET="_top" TITLE="http://www.prostate.com.au"><U><B><U>www.prostate.com.au</U></B></U></A><FONT SIZE="3" COLOR="#000000" FACE="Tahoma" > (Dr Stricker's and his St Vincents Team's own website:- 11 links, including a direct personal link to the Centre) </FONT></div> <div> <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 SIZE="3" COLOR="#000000" FACE="Tahoma" > (the Lions Australia website).</FONT></div> <bR> <div> <B>2. CARERS' GROUP</B></div> <div> As part of our initiative for our second year of operation, we plan to set up a Carers' Support Group. While it has been part of our policy </div> <div> from the start to encourage carers and family members to attend meetings, more and more there has been an expressed need for a group specific to carers. We plan to hold the inaugural meeting on Tuesday, 10 June at 6.30pm in the Palliative Care Cottage. This should be a short meeting when we decide on a suitable format and direction for the group. Jo-Ann Steeves has offered to help with the co-ordination of the group. Please pass this information on to your own carers and any family members who would like to attend.</div> <bR> <div> <B>3. COMPLEMENTARY MEDICINES</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> Many of you will remember Joanna Harnett from the Northern Beaches Care Centre, who spoke to us last year on dietary matters. She will be with us again in September to talk about complementary therapies. In the meantime, Brian Bonney, one of our members, has access to natural health products at a 15-20% reduction from prices charged in health food stores. If any members wish to make enquiries from Brian, his phone number is in the members' list below.</div> <bR> <div> <B>4. NSW CANCER COUNCIL RELAY FOR LIFE</B></div> <div> Philip and Wallis West and myself attended an informal meeting on 10 May at the Manly Leagues Club to meet members of the team who will be organising this year's Relay for Life in the Northern Beaches on the weekend of 18 -19 October. Brian Bonney has offered to help. </div> <div> The next planning meeting will be at 6.30pm on Wednesday, 11 June at the Manly Leagues Club. Anyone else who would like to give a hand on the day is welcome to attend the meeting. Please let me know if you can¹t make it but would be able to give a little time.</div> <bR> <div> <B>5. REMINDERS:</B></div> <div> Next Meeting (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.)</div> <div> 3 June Dr Peter Brennan (Pittwater Family Practice): Maintaining Contact with Your GP.</div> <div> 1 July Dr Martin Stockler (University of Sydney): Hormone Therapy for Advanced Prostate Cancer</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>