July 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>July 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. 14. July, 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, 3 June</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> a.) Apologies were received from: Richard Darmopil, Bill Liney, John Reid, Keith Stilling and Barry West.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> b.) Dr Peter Brennan from the Pittwater Family Practice spoke to us on the topic: Maintaining Contact with Your G.P. The first connexion we think of between Prostate Cancer and our local G.P. is that he or she is the person we turn to for surveillance and screening. But it is a relationship that is evolving and changing. A second connexion is that he/she is an interpreter of information after we have returned from referral to a specialist, and helps us through the maze of choices, options, decisions, understanding of the technical language, and sorting through of the pros and cons of the alternatives put to us. There is no one right or wrong solution for everybody. It is a very personalised decision to find the most effective treatment with the least offensive side effects.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Brennan based his talk around the video: Why Me? which is endorsed by the Royal Australian College of General Practitioners and by Andrology Australia. It presents case studies and commentaries by specialists. Dr Brennan showed selected segments of the video and invited the audience to feel free to interrupt at any time with questions or comments.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The video's first case study dealt with emotions after the initial positive diagnosis following a biopsy or ultrasound. The advice was to try not to panic, as the cancer is usually slow growing. The PSA test will be an indicator of the rate of progress.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> What is Prostate Cancer? This is the first question posed by the video. A cancer is an uncontrolled growth of cells. At present, the cause of prostate cancer is not known. It may be localised within the walls of the prostate gland, or it may have spread to areas close by or to other parts of the body. The incidence increases with age, and occurs mainly in men over the age of 50 years. The risk is greater if a man's father or brother has been diagnosed with the disease.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> What do you do next when your GP has given you the diagnosis? You would be referred to a urologist or to a radiation oncologist, but it is quite acceptable to ask for a second opinion. Or you may want to get help from the cancer information service on the Cancer Helpline:13 11 20. Websites can also give useful information; for example:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <A HREF="http://www.andrologyaustralia.org" TARGET="_top" TITLE="http://www.andrologyaustralia.org"><U><B><U>www.andrologyaustralia.org</U></B></U></A><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <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="Arial" > </FONT></div> <bR> <div> Or you might want to talk to other men through a Support Group such as ours.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The three main treatment options are: 1. surgery, 2. radiation therapy, or 3. watchful waiting (that is, deferring treatment). Option 3. is usually reserved for men over the age of 75 years, for a cancer which is in its early stages, or if other serious health conditions exist (for example, heart disease). Option 3. can lead to a certain amount of anxiety. However, the PSA is usually tested every three months and alternative treatment will be offered if the PSA shows a significant rise. (This will occur in around one in 10 cases.) If there is a problem urinating due to an obstruction of the urethra because of prostate enlargement, a Trans Urethral Resection of the Prostate (TURP, - often referred to as a rebore') may be recommended. Sometimes this may result in damage to the nearby nerves, causing problems having an erection; or there may be damage to the sphincta, leading to incontinence. However, the risk of either of these side effects is about half what would be expected from surgery or radiation therapy.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Making a Choice of treatments is the next hurdle. The choice of treatment will depend on: how far the cancer has spread, your own health, your age, and what are the likely side effects that might intrude upon your life-style. Things that you will need to clarify before deciding on your treatment will be: Your Gleason score (obtained from a pathology test), which will determine how aggressive the cancer is. The lower the score, the better the prognosis. A score of 7-10 indicates that early radical action is needed. Has the cancer spread? This will be determined by a CT scan for signs of enlarged lymph nodes, or a bone scan. Size of the prostate gland is not the most reliable indicator. The PSA test is the major monitoring tool. Urination problems are an indicator of pressure and may or may not be a sign of prostate cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Dr Brennan gave revealing figures comparing the effects of the two options: radical prostatectomy (RP) and watchful waiting (WW). The figures show the percentages of men suffering the side effects listed after choosing one or other of the two options:<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> i) Erectile dysfunction (over a five year period) RP 85% (of whom 58% are worried by the loss) WW 45% (of whom 43 % are worried by the loss)<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> ii) Bladder leakage RP 18% (of whom 27 % are distressed by the leakage) WW 2% (of whom 18 % are distressed by the leakage; one in five have a urine leakage more than once a week)<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> iii) Death from Prostate Cancer RP 4.5% WW 9.0%<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> iv) Metastasis (spread to other parts of the body) RP 8.6% WW 11.0%<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> v) Local progression RP 9.5% WW 35.0%<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The problem with statistics is that they tell us what is likely to happen in a population, but the question that concerns us is: What will happen to me? A man who has a PSA level of less than 1.0 has a one in 50 chance of developing Prostate Cancer, but the fact remains that one of these 50 men will be unlucky. One in three men diagnosed with the disease will develop a lethal tumor, while others may never know they have it and will die of something else. Nonetheless, PSA testing and Digital Rectal Examination (DRE) do pick up early signs of the disease. In the Tyrol region of Austria, which has had an extensive screening program for some years, statistics show that the death rate from Prostate Cancer has dropped significantly since screening began. With cervical cancer and breast cancer in women, watchful waiting will almost certainly be fatal.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Surgery (Radical Prostatectomy) is not an option if the cancer has spread beyond the prostate gland. In this case, radiation therapy will be recommended, - or hormone therapy if the spread is beyond the pelvic region. During the operation, the neighbouring lymph nodes will be checked, and if there is no spread to them, the procedure will continue with the removal of the prostate gland and the seminal vesicles. There is a recovery time in hospital of, usually, five to seven days, with a catheter remaining in place for another week. Full recuperation will take up to six weeks. Most men return to normal activity, but it is important to maintain physical fitness, - even if it is only through regular walking. It is common to have your PSA tested every three months after surgery. But if the prostate gland has gone, why isn't the PSA level zero? Cancer cells commonly escape to other parts of the body, which is the reason why it may be necessary to have radiation therapy after surgery. There is usually a clear 10 years before a return of the cancer is likely.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Some of the possible negatives of surgery include nerve or blood vessel damage. Sparing the nerves can leave some of the cancer behind, and impotence (the inability to have an erection) is a possible consequence. However, there may be some recovery after six months, with full recurrence after one to two years. An orgasm without ejaculation can take place, but the man will become infertile. Good communication with your partner is essential for recurrence of sexual function. Other methods of gratification may be found without having an erection. There is good advice available. Vacuum devices or penile injections may be used, though with the latter there may be discomfort from prolonged erections. Viagra usually has little effect after surgery.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Incontinence may also occur in up to 40% of cases, with a possible 10% experiencing moderate incontinence. While this may persist, total incontinence is rare. Treatment is available, including bladder retraining and physiotherapy to strengthen the pelvic floor muscles.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Radiation therapy (EBRT), like surgery, cannot guarantee a cure. It is usually recommended for men over the age of 70 years. The treatment is given for five consecutive days over a period of seven weeks. There is the danger of damage to surrounding areas. One in three patients will experience long term diarrhea, while others may suffer the side effects of tiredness, or discomfort while urinating. Things usually return to normal after one month. As the blood supply in the area may be affected by this treatment, there may also be difficulty in having an erection.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Brachytherapy is another form of radiation therapy, and both are controlled through CT scans. Radio-active seeds placed in the prostate gland is a low dose treatment used with slow growing cancers. Hollow needles are used for high dose treatment, sometimes in combination with EBRT. Erectile problems appear to be lower with this approach.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Hormonal Therapy is an option if the cancer has spread, or if it recurs after surgery or radiation therapy. It is not a cure, but stops the cancer growing for a considerable time, as the cells die when the hormones are cut off. Up to 10 years ago, removal of the testicles was the most common form of hormonal treatment. Now tablets may have the same effect. The cancer may return in one to 10 years; - on average, after about two and a half years. The treatment may be given in cycles to prevent osteoporosis, and may also reduce other possible side effects, such as poor erections (due to reduced libido), changes to body hair, tiredness, decline in muscle bulk, breast growth, and hot flushes. The voice is unaffected. Good communication with your partner is essential, and also with your G.P. and specialist.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Complementary and alternative therapies are also used. It is believed that up to 40% of men use some form of natural therapy, most in conjunction with orthodox medicine. It is always advisable to inform your G.P. or specialist of any other medicines you take. There was a case study in a recent issue of the Medical Journal of Australia describing a considerably reduced Gleason score brought about by an intensive dose of red clover (a plant oestrogen). Soy is another source, and is believed to account for the low incidence of Prostate Cancer in China.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> A copy of the video: Why Me? will be purchased and placed in the Group's Library. It may be borrowed at any time.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>2. NORTHERN BEACHES PROSTATE CANCER CARERS' GROUP</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The inaugural meeting of the Carers' Group was held on Tuesday, 10 June in the Palliative Care Cottage. Jo-Ann Steeves contributed some valuable input which helped establish the direction of the group. Meetings will be held on the second Tuesday of every second (even numbered) month at 6.30 pm in the Palliative Care Cottage. Please encourage your carer(s) to come along to the next meeting on Tuesday, 12 August.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>3. HOUSE OF REPRESENTATIVES PRIVATE MEMBER'S MOTION</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Jim Lloyd has sent out an extract from Hansard which is a record of his speech to the House in support of his and Wayne Swan's motion that the government should provide increased funding for research into Prostate Cancer and to promote public awareness of the disease. The PCFA has also circulated a copy of Hansard's report of the full debate. Some of you will have received your own copy, but I am attaching the report for general information.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>4. NSW CANCER COUNCIL RELAY FOR LIFE</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> This year's Relay for Life in the Northern Beaches is to be held on the weekend of 18 -19 October. At present there is some uncertainty as to the exact location of the event. The next planning meeting will be at 6.30pm on Wednesday, 9 July at the Manly Leagues Club. Anyone who would like to give a hand is welcome to attend the meeting. We have been asked to assist with the Saturday morning tea and cancer support information. Please let me know if you are able to give a little time on the day.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>5. CANCER VOICES</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> At the June meeting it was decided that our Group should take out membership of this advocacy organisation which aims to provide a unified voice for all people affected by cancer. Its publications will be available to our members through the Group's library. Cancer Voices recently signed a Memorandum of Understanding with the Prostate Cancer Foundation of Australia to join forces on issues of mutual interest.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>6. REMINDER: DATE OF THE NEXT MEETING: </B>(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 welcome. (Refreshments will be served.)<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 1 July Dr Martin Stockler (University of Sydney): Hormone Therapy forAdvanced Prostate Cancer<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 5 August Dr Lesley Yee (Australian Centre for Sexual Health): Partners, Relationships and Sexual Intimacy<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>