Current Newsletter - August 2005

<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 2005</B></div> <bR> <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></div> <bR> <div> No.37.  August, 2005</div> <bR> <div> Editor: John Conroy</div> <bR> <div> <B>1.   COMING  EVENTS</B></div> <bR> <div> a)    5.00 pm,  Tuesday, 2 August Group visit to the Institute of Magnetic Resonance Research at the Royal North Shore Hospital, St Leonards</div> <div> Members will recall the very interesting talk given by Dr Carolyn Mountford in June, 2004 in which she outlined the research taking place at the Institute, and the role that magnetic resonance imaging might play in future diagnosis and treatment of Prostate Cancer.  On that occasion, Dr Mountford extended an invitation to members to visit the Institute and we are now taking up that offer to see first hand some of  the work that is being done there. The visit should last about 90 minutes.</div> <div> If you plan to come, please call me (9918 9358) so that I can tell the Institute  how many are likely to be present.  Also let me know if you need transport or if you are able to offer a lift to someone.</div> <div> Parking can be a problem, though it should be easing after 4.30pm. If you enter by the main entrance off Pacific Highway, use the multi story car park at the top of the entry road. There may be parking in Pacific Highway at that time of day.</div> <div> A map with instructions is enclosed to help you locate the Institute Building.</div> <bR> <div> a)    6.30 pm,  Tuesday, 6 September</div> <div> Dr Michael Izard [Sydney Radiology, Mater Hospital, North Sydney]: Update on Brachytherapy -technology and treatment. Meetings are normally held in the Palliative Care Cottage, Mona Vale Hospital. All welcome.</div> <div> Please note:  During meetings, all discussion and comment about members' individual circumstances and experiences are confidential and should not be repeated outside the Cottage walls!</div> <bR> <div> <B>2.   SEPTEMBER IS - - - NATIONAL PROSTATE CANCER AWARENESS MONTH!</B></div> <div> And the Group is planning a Public Awareness Campaign along the Northern Beaches. The program is as follows:</div> <div> Thursday, 1 September, 10.00am.:  'Adam's Apple' - an Older Men¹s Health Forum,  Dee Why RSL.</div> <div> Saturday, 3 September, 10.00am.:  Dee Why Village Plaza</div> <div> 5 - 9 September: - Manly Council Chambers</div> <div> Thursday, 8 September, 5.00pm.:  Manly-Warringah Master Builders' Club, Dee Why</div> <div> Friday, 9 September, 5.00pm.:  Pittwater RSL, Mona Vale</div> <div> Saturday, 10 September, 10.00am.:  Warringah Mall</div> <div> 12 - 16 September: - Warringah Council Chambers</div> <div> Saturday, 17 September, 10.00am.:  Forestway Shopping Centre</div> <div> 19 - 23 September: - Pittwater Council Chambers</div> <div> Thursday, 22 September, 5.00pm.:  Manly-Warringah Master Builders' Club</div> <div> Friday, 23 September, 5.00pm.:  Pittwater RSL, Mona Vale</div> <div> Saturday, 24 September, 10.00am.:  Warriewood Square</div> <div> At each location we aim to have a Œmanned¹ information table with one or two members handing out leaflets and answering questions from the public.</div> <bR> <div> <B>WE NEED YOUR HELP!</B></div> <div> If you can spare an hour or two on any of these dates at any one or more of the above locations, please give me a call:  John Conroy, on 9918 9358.</div> <div> Let's get the message out to the Northern Beaches men!</div> <bR> <bR> <div> <B>3.    REPORT OF THE MEETING HELD ON TUESDAY, 5 JULY, 2005</B></div> <div> Dr Phillip Mark Katelaris was our speaker in July.  He gave us an update, with excellent visuals, on diagnosis and treatment of Prostate Cancer as presented at the American Urological Association Conference held in San Antonio, Texas in May of this year. The Conference was a week of solid information exchange, amounting to 30 to 40 sessions taking place at any one time. There was an indication of catch-up in the funding of research  into Prostate Cancer, and a great amount is being done.</div> <div> A summary of Dr Katelaris' presentation is attached to this Newsletter.</div> <bR> <div> <B>4.        INFORMATION  UPDATE</B></div> <div> a.    Name Badges</div> <div> At the July meeting, we tried out a new system for identifying and introducing ourselves at meetings. It follows a method instituted by the Penrith Support Group. Instead of an adhesive label, which may or may not stay put, each Member collects at the door an individual plastic badge which his/her name on it, plus one or more coloured dots under a 3-letter code. The dots and letters indicate the kind of treatment that that Member has had. This should enable men to identify others who have had similar experiences to themselves. In particular, it should enable new Members to find men to talk to in order to discuss their own situations.</div> <div> Members at the last meeting found the system worked well.  Many thanks to Mark Tweeddale who has taken this project under his wing.</div> <div> The key to the codes, which will be on display at the registration desk at each meeting, is as follows:</div> <bR> <div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="715" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="206"><div> <B>Letter Code</B></div> </tD> <tD VALIGN=TOP WIDTH="206"><div> <B>Colour</B></div> </tD> <tD VALIGN=TOP WIDTH="287"><div> <B>Treatment Type</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="206"><div> Sur</div> </tD> <tD VALIGN=TOP WIDTH="206"><div> Red</div> </tD> <tD VALIGN=TOP WIDTH="287"><div>  Radical Prostatectomy</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="206"><div> Ext</div> </tD> <tD VALIGN=TOP WIDTH="206"><div> Royal Blue</div> </tD> <tD VALIGN=TOP><NOBR><div> External Beam Radiotherapy</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="206"><div> Bra</div> </tD> <tD VALIGN=TOP WIDTH="206"><div> Sky Blue</div> </tD> <tD VALIGN=TOP WIDTH="287"><div> Brachytherapy</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="206"><div> Inc</div> </tD> <tD VALIGN=TOP WIDTH="206"><div> Yellow</div> </tD> <tD VALIGN=TOP><NOBR><div> Specialist Treatment For Incontinence</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="206"><div> Dys</div> </tD> <tD VALIGN=TOP WIDTH="206"><div> Magenta</div> </tD> <tD VALIGN=TOP WIDTH="287"><div> Erectile Dysfunction</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="206"><div> Hor</div> </tD> <tD VALIGN=TOP WIDTH="206"><div> Bright Green</div> </tD> <tD VALIGN=TOP WIDTH="287"><div> Hormone Treatment</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="206"><div> Che</div> </tD> <tD VALIGN=TOP WIDTH="206"><div> Orange</div> </tD> <tD VALIGN=TOP WIDTH="287"><div> Chemotherapy</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="206"><div> Tri</div> </tD> <tD VALIGN=TOP WIDTH="206"><div> Pale Green</div> </tD> <tD VALIGN=TOP WIDTH="287"><div> Participant in Trials</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="206"><div> Oth</div> </tD> <tD VALIGN=TOP WIDTH="206"><div> Grey</div> </tD> <tD VALIGN=TOP WIDTH="287"><div> Other</div> </tD> </tR> </TABLE></div> <bR> <div> b.    Websites</div> <div> For men interested in restoration of erectile function: <A HREF="http://www.ErectileRestoration.com.au" TARGET="_top" TITLE="http://www.ErectileRestoration.com.au"><U>www.ErectileRestoration.com.au</U></A></div> <div> 'On this website you can read an overview of male impotence, learn about the causes and many treatment options.'</div> <bR> <div> c.    Treatment Issues</div> <div> An article in the Daily Telegraph for Friday, 22 July reported the commencement of cryotherapy [the use of intense cold to destroy cancer cells] at St George Hospital's Prostate Cancer Institute in mid-August. According to the article, this form of treatment has special relevance for men for whom other treatments have not been successful.  The website of the St George Institute is: <A HREF="http://www.prostatecancer.org.au" TARGET="_top" TITLE="http://www.prostatecancer.org.au"><U>www.prostatecancer.org.au</U></A></div> <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> <div> Every effort is made to report information in this Newsletter accurately but no responsibility is accepted for any error or omission. Always seek the advice of a qualified health professional.</div> <bR> <div> <B>PROSTATE DIAGNOSTICS AND THERAPEUTICS</B></div> <div> PHILLIP KATELARIS  Transrectal ultrasound with</div> <div> Prostate biopsy </div> <div> Urological Surgery</div> <div> Prostate MRI </div> <div> Rooms: Hornsby, St Leonards, Castle Hill</div> <div> Nerve sparing </div> <div> All correspondence~ 51 Palmerston Road, Hornsby Radical Prostatectomy</div> <div> Phone: 9477 7904 </div> <div> Facsimile: 9477 7599</div> <div> High Dose Rate Brachytherapy</div> <div> <A HREF="http://www.prostatecancer.com.au" TARGET="_top" TITLE="http://www.prostatecancer.com.au"><U>www.prostatecancer.com.au</U></A></div> <div> Iodine Seed Brachytherapy</div> <div> BPH Management </div> <div> Prostate Laser Surgery</div> <div> AUA UPDATE 2005 </div> <div> Dr P M Katelaris </div> <div> The American Urological Association meeting this year was in San Antonito, Texas. This is the biggest urological meeting in the world with a very strong emphasis on prostate cancer update with respect to basic scientific research and clinical techniques and attitudes. The following is a brief summary of most current information presented at the AUA.</div> <div> EPIDEMIOLOGY </div> <div> Age of diagnosis has continued to decrease in the PSA era. Ballentine Carter reported that younger men are more likely to have curable disease. PSA interpretation in younger men is less likely to be confounded by co-existent benign prostatic hyperplasia.</div> <div> The decrease in mortality of 4% per annum since 1994 was confirmed. The incidence rate however, is increasing at 2% per annum since 1995. This is independent of the effect of PSA screening. It is postulated that this increase may be due to lifestyle factors such as an increase in the average body mass index of the Western population.</div> <div> The Centre for Prostate Disease database found that by 1998 only 3.5% of men with carcinoma of the prostate presented with metastatic disease. They concluded that this is consistent with the screening program. For mortality to decrease as a result of screening the presentation of incurable disease must decline. </div> <div> AETIOLOGY </div> <div> Aetiology refers to the causation of a disease. Work presented at the AUA confirmed that a first-degree relative has at least a three times increased incidence of contracting prostate cancer. The younger the age of the first-degree relative, the greater the risk to, for example, the son. A history of prostate cancer on the maternal side is also associated albeit more weakly with an increased risk of prostate cancer. The difference in racial susceptibility is thought to be due to differences in androgen metabolism, especially with respect to the activity of the five alpha reductase enzyme, which is responsible for converting testosterone to dihydrotestoster. Three important unifying hypotheses were presented the relationship between the oxidant and anti-oxidant balance, the intra-pro static androgen balance as evidenced by the activity of five alpha reductase enzyme and the activity of 1GF-1 levels. IGF represents insulin growth factor. </div> <div> Fascinating work based on the work of Dennis (Urol. 2002) demonstrated an eightfold increased risk for prostate cancer in men with a history of chronic prostatitis. This was based on a meta-analysis of the literature. It was postulated that infection increased the rate of free radical concentration within the prostate cancer cell and this combined with altered GST pi enzyme activity combined to create cellular mutation. It was postulated that anti-oxidants such as selenium may act to counter the increasing concentration of free radicals resulting from chronic prostatitis. The model of stomach cancer caused by a bacteria known as helico bacter pylori was compared. It was postulated that the three common anti oxidants taken to prevent prostate cancer, selenium, lycopene and vitamin E may act to interfere with this pathway towards cellular mutation.</div> <div> Once again, a diet high in animal fat was implicated with respect to causation. Also strongly implicated was obesity and a lack of physical exercise. It was postulated that obesity modifies the free radical concentration within the prostate. Obese men have doubled the risk of dying from prostate cancer and are more likely to be diagnosed with metastatic disease. </div> <div> PREVENTION </div> <div> Large-scale prostate cancer prevention trials have been conducted and are currently underway. The Prostate Cancer Prevention Trial found that men taking Proscar (Finasteride) had a decreased likelihood of being diagnosed with prostate cancer at seven years, however, those who were diagnosed had an increased likelihood of having high-grade prostate cancer. This latter finding is the subject of considerable conjecture with many authorities suggesting, that this observation is more artefactual than real. Nevertheless, the widespread use of Finasteride for chemo-prevention is not recommended. </div> <div> The SELECT trial suggests that a protective effect for daily vitamin E consumption. This was contrasted by other studies suggesting in fact a disadvantage and a third result suggesting no change at all in the likelihood of contracting prostate cancer. The use of statins which are cholesterol lowering drugs was observed to be linked to a lower risk of advanced prostate cancer. The men taking Statins had a third the risk of metastatic disease or death.</div> <div> The much-applauded work of Leitzmann (Jama 2004) concluded that "high ejaculation frequency was related to decreased risk of prostate cancer" Leitzmann defined high ejaculation as 21 ejaculations per month.</div> <div> PATHOLOGY </div> <div> Twelve biopsies are now recommended as a routine rather than sextant biopsies. The biopsies should be taken from a lateral prostatic position. The number of positive cores, tumour length and percentage involvement was predictive of the pathological stage, (Singh H J, Urol. 2004).</div> <div> The significance of high-grade prostatic intra epithelium neoplasia was extensively studied. One study concluded that only 4.5% of men would be found to have prostate cancer on repeat biopsy after the initial biopsy demonstrated the presence of high grade PIN. Atypical small acinar proliferation (ASAP) was associated with a 36% chance of positive biopsy on re-biopsy of the prostate (More C K J, Ural 2005).</div> <div> Bastian P J (Cancer 2001) reported that "insignificant prostate cancer as defined as Gleason score less than six and less than three positive cores with less than 50% affected had associated with it an 8.4% chance of non organ confined disease. He concluded that the majority of TIC disease had significant disease.</div> <div> PSA </div> <div> The work of Antenor in a longitudinal screening study demonstrated that an initial PSA was strongly associated with subsequent prostate cancer development. For example, an initial PSA between 2-3 had a relative risk of prostate cancer of 14.9 in the Antenor study whereas it was associated with a relative risk of 5.5 in the Gann study. PSA velocity, an increase in PSA over time was presented as being by far the most dependable of all the PSA parameters. The annual increase of .75 nanograms per ml per year was presented as being acceptable.</div> <div> Work was presented demonstrating that a PSA increase of greater than 2 nanograms per ml two years before diagnosis was associated with a poor prognosis regardless of treatment. Whereas, a PSA velocity of less than .5 nanograms per ml per year in a man diagnosed with prostate cancer may indicate a patient suitable for active surveillance rather than active *intervention. </div> <div> Thompson (NEJN 2004) demonstrated that at seven years 15% of men with a PSA less than 4 would have prostate cancer and that 15% of those diagnosed would have Gleason 7 prostate cancer.</div> <div> The PSA doubling time following surgical or radiotherapeutic, treatment was highly significant with respect to prognosis. A PSA doubling time of less than three months was associated with a poor five-year survival. It was felt that the PSA. doubling time post treatment could be used to identify those at risk of rapid progression. These men could be offered multi-modality therapy including the new chemotherapy protocols in a trial setting.</div> <div> THE ROBOT </div> <div> The technique of robot assisted laproscopic radical prostatectonly was much discussed at tile AUA. It was agreed that meticulous surgical technique was the most critical determinant of a good surgical outcome, not the technology used to perform tile operation. It was concluded that "the robot does not make a bad surgeon into a good operator". Conversely, it was accepted that many good surgeons prefer to use the robot to perform radical prostatectomy. In conclusion, the three goals of cure, preservation of potency and preservation of' continence are more important than the manner in which the operation is performed.</div> <div> THE FUTURE </div> <div> The development of the fields of Genomics with its gene micro array technology and proteomics utilising mass spectroscopy are attempting to find new prostate cancer specific bio-markers. The use of magnetic resonance imaging and spectroscopy continues to generate interest both for guiding prostate biopsies and for predicting biologically significant prostate cancer. </div> <div> Emerging therapies include the use of Docetaxel, a chemotherapeutic agent which has been shown to prolong life by two to three months for patients with hormone resistant prostate cancer. Prostate cancer vaccines such as the dendritic cell vaccine continue to attract research interest.</div> <div> AUSTRALIAN CONTRIBUTION</div> <div> Professor Tony Costello is to be congratulated on his excellent anatomical work further delineating the anatomy and morphology of the cavernosal nerves. This work was much quoted and was well received.</div> <div> CONCLUSION </div> <div> Prostate cancer continues world wide to attract significant research funding in all aspects from screening to managing hormone resistant disease. Prevention is better than cure. Men should focus on a high fibre low fat diet supplemented by regular exercise.</div> <bR> </td> </tr></table></body>