c.) It was a big welcome home for our speaker this month, Dr Lesley Yee, as she had been an intern and resident at Mona Vale Hospital 25 years ago. Her subsequent career has included 10 years work as a General Practitioner, and work as a Sexual Counsellor and Medical Sex Therapist. Dr Yee also has a Masters Degree in Medical Psychotherapy, which she has found a useful background for counselling, as the main organ in sexual matters is the brain. Her plan for the evening was to look at the medical perspective on sexual matters and the medical management of issues, and then the psychological perspective.

Cancer affects five domains in each individual patient: physical, psychological, social, cultural, and spiritual, - as well as the sexual. Dr Yee believes it is important to take a holistic view of cancer's effects. 22.6% of cancers in men are due to Prostate Cancer, following colo-rectal, lung and melanoma in significance; and 28.6% of cancers in women are due to Breast Cancer, following colo-rectal, melanoma and lung. All three cancers (breast, prostate and colo-rectal) involve sex organs and sex functions.

sexuality tend to be cultural norms: young, beautiful, slim, fit. The sexual response cycle occurs in four stages: desire/libido, excitement/arousal, orgasm/ejaculation, and resolution (the delay period before another erection occurs). With cancer, there can be difficulty in all four areas. There may be fatigue resulting from treatment, or there may be erectile dysfunction, but it is often uncomfortable to talk about these issues. One patient is quoted as saying: "I had cancer twice. There were questions about all parts of my body, but not about my sexuality". Unfortunately the issues are not being adequately addressed by general practitioners and health professionals; too often it is seen as someone else's job. Courses are being run for health professionals by the Cancer Council, and these are being lapped up.

It is estimated that 30-40% of the population have sex problems which, like cancer, can be related to aging. But the matter is frequently ignored in consultations with older patients. The average age of onset of Prostate Cancer is approximately 60 years. At diagnosis, the emphasis is on survival. It may be a couple of years down the track before sex issues come to the fore. The patient is on his own and not sure where to turn. The fact that he does not ask questions related to sex is seen as an indication that he is coping. However, there are barriers for doctors in tackling the issue:

radical prostatectomy and the removal of the seminal vesicles can affect sexual function. There is often urinary incontinence, and a man's body image may be affected by the need to use pads. With nerve-sparing surgery, normal sexual functioning can return at any time up to three years later. However, there will be a dry ejaculation. Radiation therapy can cause fatigue and a loss of libido, discomfort during intercourse, erectile dysfunction over time, reduced semen output and dry ejaculation, and infertility. Brachytherapy has less long term consequences, but the jury is out on this. Hormone therapy reduces the production of testosterone and reduces libido. It may lead to erectile dysfunction, though this may be reversed when the treatment is stopped, and it may have feminising side effects.

some side effects, and can be life-threatening if used with some cardiac drugs. In fact, there are links between heart problems and erectile dysfunction. Injection therapy, usually three times a week, may give a stronger erection. However, it may also cause priapism (erections lasting more than three to four hours, which can cause damage to the penis). Vacuum devices may be manually or battery operated. They cause blood to flow into the penis, and this is retained by the use of a restricting ring. The ring should not be kept in place for more than 30 minutes. These devices are popular after a prostatectomy, though not in the long term. There is a wide range of devices available at the 'Tool Shed'. There is a whole raft of Penile Prostheses, but these are not usually put in early on.

The effects of Prostate Cancer on the psyche. An individual's body image may be physical, - how you look to others; or it may be in the mind, - how you feel yourself. So we can distinguish between body reality, body ideal, and how we present our body to the world. Body image develops in childhood, - whether or not we feel good about ourselves. (The media have much to answer for in this respect.) What happens to our body image with Prostate Cancer? It may be affected by having a scar, or having breasts, or by having to use pads. There are changes in sexuality with age, but the changes are sudden with Prostate Cancer. It's important to talk things through with your partner.

There is need for help in coping with the mental impact of diagnosis. This may be similar to stages of grieving, and it is important not to get stuck in one stage, but to recognise that it is a process. Depression is an appropriate reaction to a diagnosis of cancer. When you are

feeling depressed, there may be a lower sex drive, - it has an effect on libido and orgasm. Clitoral stimulation may be a more satisfying alternative for one's partner rather than intercourse. However, erectile dysfunction is not an issue when you are wondering about surviving. Feelings on diagnosis may include shame, guilt, anger, shock. There will be social issues that affect relationships. Communication is essential, as may be social support, security, work, and companionship.

The average age for the diagnosis of Prostate Cancer is 60-70 years. Aging is also a factor in erectile dysfunction. Approximately 50% of men aged 50 are affected, 60% of men aged 60, and so on. So the average man hopes he doesn't live to 100!!

Some issues to raise with your partner might include: survival is more essential than having sex; consider the effects of aging; cancer propels us into thinking of other ways of expressing intimacy and connectedness; touching is an important component of intimacy and it is important to get it back; some couples say that devices lack spontaneity and take away from intimacy. It is necessary to think differently, more broadly. Factors that are important include a positive outlook, good health and fitness, and a willingness to experiment.

incontinence, impotence and infertility; radical prostatectomy; orgasm without erection; outercourse as satisfying; still enjoying each other; sense of grief at the loss of one's male ability; letting your wife down; and keeping fit and trim.

* On page 4., under Reminder: Date of Next Meeting it was given that Dr Lesley Yee works at the Australian Centre for Sexual Health. This is not so. Her rooms are in Hampden Road, Artarmon. Many apologies.

The response to the Carers Group meetings has not been overwhelming. However, we are not discouraged as we believe there is a genuine need for the Group. We feel it is still in its formative stage. The question is how best to meet that need. Caring for a Prostate Cancer patient may be somewhat different from caring for other cancer patients.

Our next meeting will be held at 6.30 pm on Tuesday, 14 October, in the Palliative Care Cottage. Christine Holbert will be talking on Relaxation Therapy. Please give this information to your carer and encourage her/him to come along.

Plans continue to go ahead for the Cancer Council's Relay for Life in the Northern Beaches this year, to be held at Kitchener Park, Mona Vale on the weekend of 18 -19 October. Planning meetings are held each fortnight at the Manly Warringah Leagues Club. The next meeting will be at 6.30pm on Wednesday, 2 September.

Don't forget the '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 or to come to the 'Launch' to find out more information.

Several months ago, Members were given a survey form to fill in on belonging to a Cancer Support Group. If you haven't yet returned your form to the University of Western Sydney, the researchers would very much like to receive it in the near future.

On Monday, 18 August, a lecture was given at the St Vincent's Clinic, Darlinghurst by Professor James Mohler, recently of the University of North Carolina. The lecture was entitled: Optimal Use of PSA and Radical Prostatectomy, and was arranged by the Prostate Cancer Foundation of Australia. It was a most interesting update on research into the use of PSA testing. A precis will be published in the October Newsletter.

In order to save space in the Newsletter, the list of Members Phone Numbers will be published once a year only in the first Newsletter for each year. We hope Members will be happy with this arrangement. Please let us know if you would prefer some other alternative.

Program Co-ordinator Dr Peter Moore Northern Beaches Palliative Care 9997 3555	Group Leader John Conroy 9918 9358 conroyjs@bigpond.com
NSW Cancer Council Cancer Support Helpline 13 11 20	Prostate Cancer Foundation of Australia 1800 220 099