August 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>August 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. 15. August, 2003</B></div> <bR> <div> Editor: John Conroy</div> <bR> <div> <B>1. REPORT OF THE MEETING HELD ON: Tuesday, 1 July</B></div> <div> a.) Apologies were received from: Richard Darmopil, Bob Moxom, Keith Stilling and Barry West.</div> <bR> <div> b.) Our speaker for the evening was Dr Martin Stockler, a Senior Lecturer in the Department of Medicine at Sydney University, and a Consultant Medical Oncologist at the Royal Prince Alfred and the Concord Repatriation Hospitals.</div> <div> Dr Stockler introduced his topic: Hormone therapy for Advanced Prostate Cancer by considering how Prostate Cancer starts. It is a disorder of the Prostate Gland wherein the patterns of cells break down. Prostate Cancer is dependent on the hormone testosterone produced by the testicles in the same way that breast Cancer in women is linked with estrogen produced in the ovaries), and which makes the cancer grow. Pills that we take, or injections we receive during treatment get to the Prostate Gland through the blood stream. Similarly, blood can carry the cancer cells to other parts of the body where the cancer may settle, commonly in the lymph glands or in the bones. Wherever it may be, hormones get to the cancer cells and stimulate their growth. However, we don¹t need to know where they are in order for the therapy to work.</div> <bR> <div> What is PSA? Prostate Specific Antigen (PSA) is a protein made by the cells in the Prostate Gland. All men have PSA in their blood stream. When the PSA level is higher than normal for a man's age, it may indicate either an enlarged Prostate Gland, or inflamation of the Prostate Gland, or the presence of cancer in the Prostate Gland. High levels of PSA can often indicate the spread of the cancer. However, PSA may have no bearing on the case: for example, there may be a high reading with not much cancer, or a medium level with quite a lot of cancer. There can be an over-concern with PSA (what Dr Stockler calls 'PSA-itis') since it may be of no significance.</div> <bR> <div> What kinds of problems are associated with Prostate Cancer? If the disease is localised, the usual symptoms are difficulties in passing </div> <div> water. If it has metastasised (spread beyond the Prostate Gland) there may be, for example, bone pain, or problems with the lymph glands in the abdomen.</div> <bR> <div> What kinds of treatment can be offered? This will depend on a variety of circumstances, but the options include surgery, radiation therapy (which can offer a potential cure), bone therapy (bone scans are not regularly recommended), hormone therapy, chemotherapy, watchful waiting (which can be a sensible option till things need attention), or supportive therapy (which tries to improve the consequences without treating the cancer). The problem is selecting the right treatment at the right time. A US study which extended over 20 years showed that men who had undergone a radical prostatectomy lived longer than men who hadn't. This is probably because prostatectomies are usually performed on younger men and they tend to live longer.</div> <bR> <div> What does a rising PSA mean after treatment? After surgery, there should be no PSA present. After radiation therapy, some normally remains, but it should fall to a low level. After any treatment, if there is a rising level of PSA, it indicates that there are some cells somewhere; there are areas of Prostate Cancer too small to find, or there are Prostate Cancer cells no longer being controlled.</div> <div> Hormone therapy. Since the hormone testosterone makes the cancer grow, it would make sense to try to block the production of testosterone. Hormone therapy will often work for several years, but it depends when the treatment is started. Often a man can be on hormone therapy for many years. We need to know the downside of this.</div> <bR> <div> How can testosterone output be blocked? Several alternatives may be used. (i) One solution is to remove the testicles (orchidectomy), but this has gone out of fashion. It tends to be more attractive to doctors than to patients! (ii) Another is the use of LH-RH agonists (or combatants) such as the drugs Zoladec or Lucrin. The instruction to the testicles to produce testosterone comes from a part of the brain called the hyperthalamus, and this receives it orders from the pituitary gland. These drugs contain chemicals which are the same as the brain makes, and switch off the brain instruction, which in turn switches off the production of testosterone in the testicles. (iii) A third approach is to use anti-androgens to block the effects of the hormones: drugs such as Cyproterone or Androcur. (iv) Yet another alternative is to use both (ii) and (iii) to try to achieve maximal androgen blockade. However, this procedure doesn't seem to make much<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> difference.</div> <bR> <div> Side effects of hormone therapy. The general effect of inhibiting testosterone manufacture is to turn off the sex drive (libido) and interfere<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> with the sex function (impotence). Other consequences may include incontinence, hot flushes (as with breast cancer in women, but not so bad), enlarged breasts (gynecomastia, though it is usually breast tenderness rather than swelling), or weaker bones. This last can occur especially if a man is on drugs for a long time. However the effect on Prostate Cancer far outweighs bone weakness. Bisphosphonates can be taken to strengthen bones.</div> <bR> <div> Many of these side effects are treatable with drugs. Some men also report fatigue, or mood/attitude changes; but it is not clear whether </div> <div> this is due to the treatment or to the cancer.</div> <bR> <div> When should treatment begin? In a study in the UK, approximately 1 000 men affected by Prostate Cancer were randomly assigned to two groups. Members of one group received immediate hormone therapy; the other group had the treatment deferred. The broad conclusions were that when the cancer had spread but there was no trouble yet, there was benefit from an early start to treatment. However, it is still an open question when to start the therapy.</div> <bR> <div> Dr Stockler also referred to a study by Pound in the USA. Typically, there is a period of 10 to 15 years from the time of a rise in the PSA </div> <div> level to the situation where metastasis has occurred. The dilemma is whether to start treatment early or to wait. It boils down to the individual's situation and decision.</div> <bR> <div> Current variations of Hormone Therapy. One of these is maximum androgen blockade. This costs about $1 000 for injection and tablets. A second is intermittent androgen blockade, with injections every month, three months or four months. A third is high dose anti-androgen treatment using tablets. Interestingly, stopping the tablets can sometimes cause the cancer to go away.</div> <bR> <div> Key points. Prostate Cancer is slow growing, so it is important to stay well as long as possible without treatment. There are lots of </div> <div> treatments that don't work. As usual, we reach the point where we realise that while much research is taking place, there are many areas needing further research. Which cancers need to be treated? When is it best to begin treatment? How is it best to use and combine treatments? If PSA starts rising some years after surgery or radiation therapy, it is an open question when to start hormone therapy. Hormone therapy may be begun prior to radiation therapy in order to shrink the prostate gland, but it is not clear whether or not this has any advantage before surgery.</div> <bR> <div> Dr Stockler concluded by giving some useful references for further information:</div> <div> People Living with Cancer: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.oncology.com/plwc/" TARGET="_top" TITLE="http://www.oncology.com/plwc/"><U><B><U>www.oncology.com/plwc/</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> Cancer Council of NSW: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.cancercouncil.com.au" TARGET="_top" TITLE="http://www.cancercouncil.com.au"><U><B><U>www.cancercouncil.com.au</U></B></U></A></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> Cancer Trials NSW</div> <bR> <div> <B>2. NORTHERN BEACHES PROSTATE CANCER CARERS' GROUP</B></div> <div> Please encourage your carer(s) to come along to the next meeting of the Carers' Group to be held at 6.30 pm on Tuesday, 12 August in the Palliative Care Cottage. Jo-Ann Steeves will present the Group with some ideas on resources for carers' and some useful skills for problem solving.</div> <bR> <div> <B>3. HOPE HEALTHCARE</B></div> <div> This organisation has recently taken over the administration of the Palliative Care Unit at Mona Vale Hospital. John Conroy, Group Leader, and John Stuart, General Manager of Hope Healthcare (North), and based at Greenwich Hospital, had a most amicable and productive meeting on Friday, 25 July. Mr Stuart acknowledged the work and worth of our two Support Groups and saw the possible opportunities for our mutual co-operation. We shall maintain close contact with Hope Healthcare, and look forward to working with that organisation. We acknowledge with gratitude Hope Healthcare's support and sponsorship of our activities.</div> <bR> <div> <B>4. NSW CANCER COUNCIL'S RELAY FOR LIFE</B></div> <div> Philip West and John Conroy are our two representatives on the Cancer Council's organising group for this year's Relay for Life in the Northern Beaches - but we could do with some more helpers. The event will be held at Kitchener Park, Mona Vale on the weekend of 18 -19 October.</div> <div> The next planning meeting will be at 6.30pm on Wednesday, 6 August at the Manly Leagues Club. Please come along to help get this year's Relay up and running so that we give a great boost to raising funds for the Cancer Council's fight against Cancer.</div> <div> There will be a Launch to begin recruitment of Relay teams from 11.00am to 11.30pm on Saturday, 6 September at the Cancer Council Shop, Warringah Mall. Please publicise the Relay amongst your friends, family and colleagues. Get them to form teams and sign up at Warringah Mall on 6 September, or get them to come to the Launch to find out more information.</div> <bR> <div> <B>5. VALE</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> It is with sadness that we report the deaths of Robert Mepham's partner, Mary, and of Brian Coghlan. We also report the death of Gerry Davies whose wife, Lyn, is a member of our Carers' Group, though Gerry did not attend any<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> of our meetings. They will be sorely missed.</div> <bR> <div> <B>6. REMINDERS: DATES OF NEXT MEETINGS: </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 are welcome. (Refreshments will be served.)</div> <div> 5 August Dr Lesley Yee (Australian Centre for Sexual Health): Prostate Cancer and Sex: Partners, Relationships and Intimacy</div> <div> 2 September Ms Joanna Harnett (Northern Beaches Care Centre): Complementary Therapies and 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>