October 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>October 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. 17. October, 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, 2 September</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> a.) Apologies were offered by: John Conroy - who now extends hearty thanks to Philip West and Jo-Ann Steeves for very ably conducting the September meeting in his absence.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> b.) My absence was due to the fact that I was spending about four weeks in England. While I was there I kept my eyes and ears open to pick up any information and ideas about what was happening with regard to Prostate Cancer in the UK. I was visiting a small seaside town in Devon, and was about to walk out of a shop owned by a pharmaceutical chain, when I heard an announcement being made over the PA system which contained the magic words 'Prostate Cancer'. I stopped short in my tracks and listened. It was an item on the risks and symptoms of prostate cancer, followed by an invitation to customers to pick up an information kit at the pharmacy counter. I did just that, and was given a small brochure neatly packaged like a couple of torch batteries. It had been produced jointly by the pharmaceutical chain, the national Prostate Cancer Foundation and a chemical manufacturing company. I also found in the same store, a useful little booklet on prostate cancer on a health matters bookstand. High marks to the Brits for their initiative in campaigning for prostate cancer awareness! [J.C.]<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> c.) The report of Ms Joanna Harnett's talk at the September meeting on Complementary Therapies will be included in the next Newsletter.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>2. OPTIMAL USE OF PSA AND RADICAL PROSTATECTOMY.</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> (Talk given at a public meeting at St Vincent's Clinic, Darlinghurst by Professor James Mohler, visiting US Specialist, on Monday 18 August, 2003, under the auspices of the Prostate Cancer Foundation of Australia.)<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Until recently, Professor Mohler was Associate Professor of Pathology and Laboratory Medicine at the University of North Carolina. He is about to move to the Roswell Park Cancer Institute, Buffalo, New York, where PSA testing was first developed.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Many doctors have expressed scepticism about the usefulness of PSA testing, especially that it can lead to over-diagnosis. Professor Mohler believes this is not so. However, diagnosis without successful treatment is of no value. The question becomes: When should we use PSA testing? In the United States, a man dies from Prostate Cancer every fifteen minutes. It is the second leading cause of death among men (as it is in Australia). Prostate Cancer rarely produces symptoms until it is incurable; that is, when it is round the outside of the Prostate Gland. Therefore, participation in a screening program means earlier diagnosis. Nowadays, 70% of cases of Prostate Cancer are curable whereas, to begin with, the figure was only about 4%. Benign Prostate Hyperplasia (BPH - Prostate enlargement) attacks only the 'hole in the donut' -where the urethra passes from the bladder through the Prostate Gland.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Why do PSA testing at all? Prostate Cancer is usually slow growing and only 1 in 40 men with the disease will die of it; therefore testing will reveal irrelevant cancers. Also, there are financial implications of PSA testing; it leads to a cascade of events: biopsies, treatments and so on. Why spend money on old men past their useful working age? Economists say: "Forget it!" The death rate for men over 50 years of age is 79 per 100 000, whereas the autopsy rate shows 30 000 per 100 000 men with Prostate Cancer. So do we want to identify every single man with the disease? Introduction of a screening test should affect the natural history of the disease. It should minimise morbidity and the cost of false positives. It must detect cases of curable cancers and at early stages, but not irrelevant 'autopsy' cancers. And the process needs to be affordable. The argument against screening seems strong.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Current Screening Recommendations. PSA testing has a history of only 16 years. The current guidelines for screening are: a yearly examination for a man from the age of 40 years if he is at high risk. That is, if a man is Afro-American or has a first degree relative (a brother or father) with the disease, he has a 3.7 chance of contracting Prostate Cancer. If he has two first degree relatives who have Prostate Cancer, the risk increases 6-fold. Newly amended guidelines suggest that men in the 50-65 age range should be counselled as to the benefits of PSA testing against their risk. For men with high risk this should be from the age of 40 years. However, this is impossible to implement because of the time factor involved (requiring an estimated 30 minutes per patient). In the United States, the U.S. Preventative Services Task Force is the only organisation against routine screening for Prostate Cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> What's wrong with PSA testing alone?A PSA reading of more than (>) 4 has a sensitivity of 79%; that is 21% of cases are missed. For a reading greater than (>) 10, 47% of cases will be missed. The specific chance that a patient won't have Prostate Cancer but does have it is 66% for a reading of >4, and 90% for a reading >10. It is important when you are reading research reports to know something about the population of people used in the research study. In one case in point, the PSA test results were flawed because the trial group was made up of college students rather than men in the risk group. Present indications are that if a man¹s PSA reading is >4 then there is a 1 in 3 chance that he has Prostate Cancer.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Professor Mohler believes there is no doubt that PSA screening helps. The best way to use the test is not as a snapshot but as a serial view. The suggestion is often made that PSA testing will find too many cancers, but there is no doubt that PSA testing compared with other forms of diagnosis does not over-detect. PSA testing has been widely used from 1987, and the number of cases of Prostate Cancer appearing skyrocketed. However, mortality rates began to fall some three to four years later. In weighing up the cost for a screening program, it has to be balanced against an improved quality of life. There is no controversy with mammogram screening. Women have been better advocates, whereas male advocacy is just beginning.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Why should men with a family history of Prostate Cancer be screened? There is a two-to three-fold increased risk for men who have recorded cases of Prostate Cancer in a first degree relative. If the cancer presents at an early age, sons and other close family should be screened, beginning at the age of 40. Professor Mohler noted that familial cancer did not tend to be more aggressive. The risk can pass through daughters to sons through the X-chromosome, so men and women are both contributors to the risk factor. PSA derivatives: </div> <bR> <div> i) Velocity: PSA should be measured three times over three years for men over the age of 50. A rise in the level >0.75 per year suggests an 80% chance of being affected. If the rise is less than (<) 0.75 per year, there is little chance. For men in the age-range 60-65 years, if the reading remains flat over the years, there should be no worry. The more benign the cancer, the less chance there is of an increased PSA level. </div> <bR> <div> ii) Density: Controls for Benign Prostate Enlargement. This measure is made by dividing the PSA reading by the Prostate size (volume). If this figure is >1.5 then there is cause for concern; and the converse, if it is <1.5 there is no cause for worry.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> iii) Age Specificity: Since PSA levels tend to increase with age normally, cut-off levels are 4.5 for men in the age range 60-69 years and 6.5 for men aged 70 years and over.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> iv) PSA Isoforms: This is a more technical area and has been omitted.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Radical Prostatectomy. When these operations were performed around 1985, knowledge of pelvic anatomy was limited. About four litres of blood would be lost and patients would need to stay in hospital for up to two weeks. Subsequent steps have been taken to improve the procedure. </div> <bR> <div> (a) Photographs and cartoons have been used to show how the neuro-vascular bundle is preserved during surgery. </div> <bR> <div> (b) Bladder neck preservation has been followed to avoid incontinence. Urinary incontinence after surgery should be no more than around 30%. Before committing himself to surgery, a man should compare and investigate the individual urologist's results in this respect. Social incontinence (using more than two pads per day) is unacceptable. Bladder neck preservation should improve (lower) the risk of incontinence. </div> <bR> <div> (c) Pelvic drainage. Nowadays, 95% of cases need no drain and the length of stay in hospital averages 1.5 days. There is a low risk of deep vein thrombosis, though there is always a risk of pulmonary embolism.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Potency preservation. This is more a pre-operative concern, whereas incontinence is more a post-operative concern. Preservation of neuro-vascular bundles has a high success rate for maintaining potency, which returns from anywhere between nine months and three years; normally within 18 months. Erections may return within six weeks to six months. Again, when preparing for surgery, a man needs to check the performance success of his individual urologist. Viagra is no use without the nerves being spared. Superior results for maintaining potency are recorded for neuro-vascular preservation over radiation therapy. Radiation therapy tends to be palliative rather than curative. It is appropriate in order to put the individual back into the life cycle.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> In conclusion, Professor Mohler said that no surgeon has the answer: each person and each cancer is different. Whereas the normal hospital stay at present is one to two days, he sees robotics as the future direction in surgery and men will be treated as out-patients. The current cost in the United States for a radical prostatectomy is around $17 000 all up; for radiation therapy, $25-27 000; for a seed implant, about the same, and for a combination of seed implant and radiation therapy, the cost is approximately $45 000.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>3. NORTHERN BEACHES PROSTATE CANCER CARERS' GROUP</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> The 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(s) and encourage her/him/them to come along.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> Let us know if you have ideas on how this group might best proceed.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B>4. NSW CANCER COUNCIL'S 'RELAY FOR LIFE'</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> This year's event will be held at Kitchener Park, Mona Vale on the weekend of 18 -19 October. Keep some time available over that weekend to go along and give it your support.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <bR> <div> <B>5. 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.)<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 7 October Ms Maree McCausland (Social Worker, Palliative Care Unit, Mona Vale Hospital): Cancer and Social and Psychological Issues. NB. This will be followed by small group discussions for men in various categories of diagnosis and treatment.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> 4 November David and Pam Sandoe (Group Co-Leaders of the Sydne Adventist Hospital Prostate Cancer Support Group) The Prostate Cancer Journey - A Couple's Retrospective Journey.<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>