c. Dr Gordon F. O'Neill was our speaker for this month's meeting. His topic was: All About the Prostate: Its structure, function and diseases. For Dr O'Neill, his visit was something of a homecoming, as he had been a wardsman at Mona Vale Hospital when he took time off during his medical training, and later came back as a registrar.

Dr O'Neill began by describing the Prostate Gland. It is a gland similar to the ovaries in a woman, and is part of the anatomy of the urethra. The Prostate Gland is about the size of a walnut. It sits underneath the bladder and is part of the urinary tract. The urethra runs

on through the pubic wall to the penis. Altogether it is more than 20 cm long in a man, and about 5 cm long in a woman. When a doctor does a Digital Rectal Examination (DRE), he/she can feel the back of the Prostate, - but only part of it.

The function of the Prostate Gland is to secrete a substance to keep the male sperm healthy. It produces PSA to liquefy the semen after ejaculation. A normal ejaculation is around 3 - 5 millilitres. Of this, about 5% comes from the testicles, 70% from the seminal vesicals, and 25% from the Prostate.

The most common problem associated with the Prostate Gland is Benign Prostate Hyperplasia (BPH), - enlargement of the Prostate, which occurs as men get older, and is almost universal. It starts enlarging in men during their 30s, and by the time they reach 60, 60% of men will have BPH; by the time they reach 80, 80% will be affected. If a male is castrated before puberty, BPH will not develop. The effect of BPH is that the Prostate grows (it can get as big as a grapefruit) into the urethra, causing problems by constricting the urinary tract. The symptoms of BPH are blockage or irritative (frequency in urinating; note also that alcohol and chilli are irritants to the bladder). These symptoms are similar to Prostate Cancer in its later stages. However, it is not a cancer, and it does not metastasise (spread to other parts of the body). Its usual treatment is by what is commonly called a 'rebore' (Trans Urethral Resectioning of the Prostate, - or TURP). An instrument is inserted through the eye of the penis and part of the Prostate Gland, which is causing the obstruction, is removed. Treatments are generally good, but infertility or absence of ejaculation at orgasm can occur.

Another problem associated with the Prostate Gland is Prostatitis. This can come from Cystitis (inflamation of the bladder) or by an infection in the penis. If symptoms exist, the usual treatment is a course of antibiotics. One in 10 men are likely to get Prostate Cancer but if a man has a high PSA level, it does not automatically mean that he has Prostate Cancer. Dr O'Neill has seen men with Prostatitis recording a PSA of 120. With a PSA reading of 4-10, there is a 35-40% chance of Prostate Cancer. The remaining 60-65% would have Prostatitis or BPH.

When a doctor does a Digital Rectal Examination (DRE), he/she is checking the feel of the Prostate Gland. If it feels smooth and rubbery, any enlargement will be benign. It will feel hard if Prostate Cancer ispresent. 70% of Prostate Cancers occur in the periphery of the gland,

which makes a DRE useful in diagnosis. Prostate Cancers are predominantly on the outside of the gland, and may not cause symptoms till late in their development because they are not near the urethra. 25% of cancers can be missed because of their position, and 15% can also be missed on the first biopsy.

Only since about 1994 have population studies been made to work out what PSA levels mean. In the USA, all men between 50 and 70 years of age (or from age 40 if they are black) have a PSA screening test. There has been a 20% decline in Prostate Cancer mortality since this began. The United Kingdom, like Sweden, didn't believe in mass screening. In Australia there is selective screening but the government is against mass screening because it doesn't want to pay for it. The Commonwealth will allow a man only four PSA tests per year, beyond which there is no refund unless there is a diagnosis of Prostate Cancer. The amount of funding available for Prostate Cancer research is about 10% of that for Breast Cancer. There is a low incidence of Prostate cancer in Asian countries, where there is a low consumption of animal fats and a high consumption of vegetables and soy products. However, that life style needs to start in childhood rather than as a preventative later on in life.

Metastasis with Prostate Cancer is not like lung cancer, which is a big killer. In that disease, a person can be dead within 18 months of diagnosis. With Prostate Cancer there can be from 15 to 20 years on average from start to finish. However, it is difficult to create studies to show why treatment is working. The doctor has to look at the life expectancy of the patient. For example, for a man in his 40s, there is no question but to treat; for a man in his 60s, we don't always know. Prostate Cancer is an interesting and diverse cancer. Each patient is different and difficult, and it is more difficult for men in their 60s and 70s. If the disease is diagnosed early, then it is recommended to have treatment. 'Active surveillance' is the term for delaying action which is now used to replace 'watchful waiting'. It is a long process.

Prostate Cancer remains in the Prostate for years. It may then move on to the capsule, then to the seminal vesical, then become fixed to the pelvic sidewall, then the lymph nodes, and then the aorta. Prostate Cancer loves bones and will spread via the blood. To cure it, we need to get it before it leaves the Prostate. In 70% of cases, the cancer is in the peripheral zone; in 25% it is around the urethra. As Dr O'Neill said before, PSA liquefies the semen. It is produced by particular cells in the Prostate, and part leaks into the blood stream. It is possible to read normal levels in the blood. It is more leaky when Cancer is present, hence the clue from raised PSA. After a radical prostatectomy, the PSA level should be zero. Any rise means that there is still some cancer about. If the PSA level is less than 10, there is a 99.9% likelihood that there is no bone metastasis. If the PSA is around 50, then there is a risk of bone cancer.

'launched nationally on 22 March' in Melbourne. Developed in the UK by Matthew Sweetapple, Peeball is a fabulous initiative that uses a combination of sport and humour to capture the imagination of Australian men of all ages, (particularly the younger demographic), and will get our blokes talking about a vital issue for their future health.

Made from sodium bicarbonate and citric acid, Peeballs are biodegradable compacted balls (approximately the size of large marbles) that are placed in men's urinals to test the strength of urine flow. It is a light-hearted method of raising awareness of a serious issue. If is not a diagnostic tool for prostate cancer.

All profits from sales of Peeball will go to the Prostate Cancer Foundation of Australia to fund ... research, support and awareness programs. Peeball will be distributed through Carlton and United Breweries supplied pubs and clubs and will cost $3, of which a minimum of $1 will go to the Foundation.

There was a segment on Peeball on ABC Radio National's Today program on Tuesday, 23 March (AM frequency 536). It included some interesting discussion on Prostate Cancer. You should be able to track down a transcript on: www.abc.net.au/rn

b.) Our own Jim Rogan has also been riding the airwaves. He was interviewed in a segment on the ABC afternoon Drive program on Tuesday, 24 February. Jim is now reaching celebrity status as an ambassador for Prostate Cancer! Well done, Jim!!

c.) About 150 people attended a Public Meeting held in the Wharf Theatre 2 on Tuesday, 9 March under the auspices of the Prostate Cancer Foundation of Australia (PCFA). The two speakers were introduced by Dr John D'Arcy. The first was Dr Phillip Katelaris, whose address was similar to the one he gave at the Cottage in February. He was followed by Professor Ajay Nehra, Professor of Urology at the Mayo Clinic, Rochester, Minnesota. He spoke on Life after Prostate Cancer: Erectile Dysfunction and Incontinence - Surgical and Non Surgical Treatments At the conclusion, the speakers were joined by three 'consumers' (including Pam and David Sandoe who spoke to us last year) to form a discussion panel. Notes were taken and leaflets were distributed, and the information is available to anyone who is interested in the topic.

d.) Issue #17 - February, 2004, of Prostate News published by the PCFA is now available. Topics include: 'Are You Depressed'? by Stephen Carroll, Psychotherapist; 'Changing the Face of Surgery - Australis's first robotic - assisted surgery'; 'A Personal Story' by Jim Lloyd, MP; 'Prostate Cancer 2004 - What's New'?, by Phillip Stricker; and a report by Reg Mayes of Adelaide's Prostate Cancer Support Group, of a lecture given by Urologist Graham Sinclair. If anyone would like to be on the mailing list for Prostate News please let me know.

The Cancer Council of NSW and the University of Western Sydney are jointly funding a project to examine the well-being and needs of caregivers of people with cancer. They are looking for primary caregivers of persons with cancer who would be willing to complete a questionnaire about their experiences as a caregiver..If you are a caregiver and would like to help, please contact: the Research Coordinator, Mirjana Petrovic on (02) 9772 6766

Website. Thanks to Ron Faulkner's daughter, Lee Purser, who has been working hard on preparing our website. It is now close to finalisation and is looking good, and should be accessible by mid April. We shall give you Internet address details as soon as they are available. The website will cost around $100 per annum to run. We are hoping we might find a sponsor so that we can get on and stay online.

Library. Thanks to Geoff Emanuel and Ron Faulkner who have undertaken to try to bring our collection of resources it into some semblance of order. Geoff has been doing a great job preparing an Index for our Newsletters, which we hope to include on the website.

6 April Dr Lisa Horvath (Garvan Institute, Sydney): Recent Research at the Garvan Relating to Prostate Cancer. There is a range of research into Prostate Cancer being carried out at Sydney's Garvan Institute which we don¹t hear about. Dr Horvath is an interesting and entertaining speaker and we look forward to learning what is being done on our own doorstep concerning the diagnosis and treatment of Prostate Cancer.

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