Current Newsletter - December 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>December 2005</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> <div> </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> <div> No.41  December, 2005</div> <div> Editor: John Conroy</div> <bR> <div> <B>1.   COMING  EVENTS </B></div> <div> 6.30 pm,  Tuesday, 6 December CHRISTMAS  GET-TOGETHER. If you haven't booked in yet for our Christmas Party, you'll need to do so no later than Friday, 2 December.  Entry will be by tickets only, so that Jo-Ann Steeves and her merry band of helpers are able to cater for everyone. Phone Jo-Ann on 9918 6575, or John on 9918 9358.</div> <div> It will be a relaxed, fun night at the Palliative Care Cottage with plenty of good food and something to drink. There will be lucky door prizes (so a ticket is a must!), and Norma Bennett has planned one of her famous trivia competitions: 'Christmas Trivia', with a startling array of prizes! We hope to have a few special guests but basically it is an informal night when you and your partner can get to know the rest of the gang better.</div> <div> Roll up!    Tickets $10 per head  ( - or what you can afford).</div> <bR> <div> PROGRAM,  2006</div> <div> The program for 2006 has been drawn up and we have organised a varied list of topics which we hope will meet the interests of all Members of the Group. Invitations are being sent to speakers and the full Program will be sent out early in the New Year.</div> <div> The first meeting for the year will be held at the Palliative Care Cottage, Mona Vale Hospital at 6.30 pm on: Tuesday, 7 February, 2006</div> <bR> <div> <B>2.    Report of the Meeting Held on Tuesday, 4 October:</B></div> <div> a.    Apologies were received from:  Richard Darmopil, Jack and Merryl Godfrey, and Barry West.</div> <div> b.    We welcomed new Members:  George and Karin Dipton, Mark Freehill, John Nicoll and Lidy Alysener, George and Shirley Phelps, Rocco Scamarsia, and Reg Zammit.</div> <div> c.    Under the heading of 'What's new?' Professor Stricker began by considering where we are now in the diagnosis and treatment of Prostate Cancer, the established methods and the current results of these.  For him, the study of the disease is a passion.  He is very much involved in the current public awareness campaign 'Be a Man', which has had the support of the Insurance company APIA, the Urological Society and the Prostate Cancer Foundation (PCFA). There has been a big response, but the increase in awareness has yet to be tested.  Many GPs still don't go for testing, and still follow the line:  'You're more likely to die of something else'. This is despite the fact that 10% of all cancers in men are Prostate Cancer. A big education program for GPs is necessary.</div> <div> How can we prevent Prostate Cancer, - if not for ourselves, for our children and grandchildren?  Diet seems to be a major factor. The broad indications are that too many fatty meals and too many calories consumed over our lifetime are contributors. In Japan, where fish, vegetables, soy products and green tea are a significant part of the diet, the incidence of Prostate Cancer is low. Yet Japanese emigrants who move to a Western diet will move from a low risk to a much higher risk within one generation. Selenium deficiency is also suspect. Selenium is a trace element in soil and may be fed to cattle. There have been three proper randomised studies to see what effect the regular intake of Selenium has on the incidence of Prostate Cancer. A randomised study of a large number of men given Finasteride resulted in an overall drop of 25% in Prostate Cancer.  Another study of the effects of Dutasteride is in process.</div> <div> On the question of early detection, Professor Stricker argues that the benefit of early treatment over watchful waiting is not a question any more. He referred to the recent Holmberg trial which followed a group of men diagnosed with Prostate Cancer.  Over a period of 10 years, it compared those who had had surgery with those who had had no treatment. The study revealed a 50% reduction in death rate in the treated group.  Professor Stricker also suggested that taking a PSA reading at 40 years of age in men at risk before prostate enlargement occurs and whose fathers have had Prostate Cancer, may be predictive. If the level is 0.9 or above, there is a greater risk of Prostate Cancer developing later. This may be one way to make PSA a more accurate predictive test.</div> <div> PSA is the common test used as an indicator for the presence of Prostate Cancer.  Because ejaculation can cause a rise in PSA level, it is wise to wait at least 24 hours afterwards before taking the test. Infection of the Prostate may also cause PSA to rise.  In general, men don't like the finger method of examination (DRE, - Digital Rectal Examination) as a means of diagnosis. If any abnormality is present, GPs will then tend to go on to a biopsy. Indeed, we don't know if there is a problem until a biopsy is taken. It used to be the case that six samples were taken but nowadays there will be more, and usually with an anaesthetic. To avoid infection, the biopsy can be taken through the perineum rather than through the rectum. This process is probably as accurate and is  safer. Taking a biopsy will not cause the cancer to spread, but a spread can occur if a group of cancerous cells erode into the blood stream.</div> <div> Other diagnostic techniques are MRI (Magnetic Resonance Imaging) and PET scanning. It is now possible to get the MRI machine to look at the chemical make-up of the Prostate tissue and if there is more of one particular chemical and less of another, then there is a risk that cancer is present. Soon we will have sophisticated ways of finding just where the cancer is. The lead with this technique is being taken in Melbourne but work is also being done in Sydney at St Vincent's Hospital and at the Magnetic Research Institute.  In fact, it is close to being in general clinical use. Diagnosis is being done free of charge while clinicians are learning.</div> <div> In the realm of treatment we seem to be in a land of plenty. There is no perfect treatment, and we might think there are too many alternatives..</div> <div> Five things must be considered by doctor and patient in the treatment decision-making process: the cancer (the Gleason Score, the PSA level and the size of the cancer); the patient (his age and general health and other factors that influence surgery) urinary symptoms (which ma affect the choice between surgery and brachytherapy) the size of the Prostate Gland; and patient priorities.</div> <div> If we choose a radical prostatectomy, will it be open surgery, laparoscopic (keyhole) or robotic? The advantage of either of the latter two is that they will get patients home more quickly. Laparoscopy and robotics seem to be the ways for the future but, at present, no results are as good as open surgery in terms of urinary control, potency, and cancer cure.  With robotic surgery, the surgeon loses the sense of touch and this can be critical. You can certainly see better but, with open surgery, the surgeon has a better feel. Surgery is not advised for men over 70 because they can be physically less strong, and there is a greater chance of incontinence. The oldest patient treated surgically by Phillip Stricker was 74, and he was fit and in good health.</div> <div> Nerve sparing during surgery runs the risk of missing some of the cancer so, if there is a lot of cancer, the surgeon probably won't try it. Sural nerve grafting (taken from the side of the leg) is a possibility and has been around for at least five years. It is still unproven and, at best, only improves erections by about 10%.</div> <div> Radiation therapy injures both the cancerous and healthy cells. The dose has to be accurate, - and enough to kill all the cancerous cells. It, too, may take several forms.  Seed implants may be applicable for patients with a Gleason Score less than 6 and a PSA less than 10. Sexual side effects are more common with seeds.  HDR (High Dose Rate) Brachytherapy has a high chance of cure and a lower chance of bowel damage, but the procedure is more invasive. IMCRT (focused beam radiation) is a technique currently being developed at the Sloane-Kettering Institute in the United States.</div> <div> Recent publicity has been given to high intensity ultra sound (Ablatherm) and this has appeal for some. The treatment is through a probe inserted in the back passage.  Sound waves destroy the whole prostate along with the cancer. The treatment requires only an overnight stay, and the catheter is removed after four to seven days. The success rate is 70-80% of patients who, on first treatment, have a low PSA and a negative biopsy at 5 years of follow up.  However, there is a high impotence rate.  Repeat treatments are possible with this technology.</div> <div> Other alternative treatments include Cryotherapy (freezing the cancerous cells) and Proton therapy (which causes less damage to the bowel). And there may be the alternative of watchful waiting (active surveillance).</div> <div> Professor Stricker regards himself as a prostate cancer specialist rather than, specifically, a surgeon or a radiation therapist.  St Vincent's tries to provide a multi-disciplinary clinic, although this can be an expensive provision. There is a clinical nurse for contact before and after treatment, and also a sex health physician, both of whom are available to deal with concerns over possible side effects. The chance of urinary problems is predictable to a large extent, and treatment can be effected without major surgery through pelvic floor exercises, collagen implants or insertion of an artificial sphincter.  Similarly, recovery of sexual function can be assisted by drugs, such as Viagra or Cialis, by injection, or by various mechanical aids.</div> <div> Professor Stricker stayed on to answer individual questions, and all present appreciated the generous giving of his time.</div> <bR> <div> <B>3.    'VIAGRA, CIALIS OR LEVITRA... Is It Working for You'?</B></div> <div> 'Men aged 40+, and their partner, are invited to have their say in a new national research project exploring the impact of erectile dysfunction (ED) medications on relationships.</div> <div> 'What does it involve?  You and your partner will separately complete a survey pack and a friendly, open telephone interview. You will be asked questions about your ED treatment (Viagra, Cialis or Levitra), and how it has affected you and your relationship. All of your responses will be completely confidential, and will not be shared with your partner (unless you want it to be).</div> <div> 'What are the benefits for you?  You will receive a $40 shopping voucher for your time and involvement. You will also have the opportunity to have a chat about your ED, treatment and relationship, and you will have access to a summary report of findings from other couples in similar situations to you.</div> <div> About us:  This project is conducted by Monash University with funding support from Andrology Australia.  Findings from this study will be reported back to Andrology Australia, to inform their future education strategies on men's sexual health.</div> <div> We encourage you to be involved!  This project is open to all couples - gay, straight, married, de facto, or living apart. The only criteria ar that one of you is successfully using an oral ED medication, and you are willing to have a chat about it.</div> <div> For more information, or to get started, contact: </div> <div> Cath Andrews, </div> <div> Research Fellow Department of General Practice</div> <div> Monash University</div> <div> (03) 8575 2223</div> <div> <A HREF="mailto:Catherine.Andrews@med.monash.edu.au" TARGET="_top" TITLE="mailto:Catherine.Andrews@med.monash.edu."><U>Catherine.Andrews@med.monash.edu.au</U></A></div> <div> (This project was announced at the November Meeting.  Enrolment forms are also available from John Conroy:  9918 9358)</div> <bR> <div> <B>4.   'BE A MAN' CAMPAIGN</B></div> <div> The thrust of this campaign is to encourage men to see their GP and to consult freely with him/her about Prostate Cancer.  Not an easy task, according to an article printed in the UK Daily Telegraph newspaper earlier this year.  A study showed that the majority (55%) of men in England regarded reporting sick as 'weakness'.  In fact, 42% would rather wait until symptoms got bad before they would visit the doctor. Another 34% confessed that they were scared of a visit to the GP.  Women (51%), on the other hand, were prepared to visit a doctor when symptoms first appear.</div> <div> The response to the 'Be a Man' campaign has been extremely good.  It remains to be seen whether Australian men have got the message, have taken up the challenge of the gloved finger threat, and are prepared to 'front up' to their GP.</div> <bR> <div> <B>5.  INFORMATION  UPDATE</B></div> <div> a.    Publications</div> <div> During September and October, the journalist Jill Margo published a series of articles in the Financial Review giving a 'blow by blow' account of Chris Callahan's encounters as he journeyed through his Prostate Cancer diagnosis and treatment - with complications.  A copy of the four articles is available in the Lending Library.</div> <div> b.    Incontinence</div> <div> As reported in the ABC¹s broadband news a few months ago, a new device to treat severe incontinence has been invented by Australian doctors, and will be undergoing clinical trials in Melbourne. The device works like a pacemaker.  It's developer, Urologist Dr Helen O'Connell, says:  'What we are doing is harvesting a graft of the patient's tissue, wrapping it around the urethra and then supplying it with an electrical impulse to get it to act as a sphincter, or closing device. ... When the patient wants to urinate they turn off the device and that relaxes that piece of muscle and enables them to pass urine naturally.'</div> <div> The device has worked well in animal studies and, if successful in human trials, it offers the possibility of a significant improvement in quality of life for patients suffering severe incontinence.</div> <div> c.    Advanced Prostate Cancer, Bones and Bisphosphonates</div> <div> An article in a recent issue of the New England Journal of Medicine announced the use of a drug to counter the effects on bones of hormone treatment for advance Prostate Cancer.  According to the lead author, Dr Matthew Smith of the Massachusetts General Hospital, Boston, survivors of Prostate Cancer need to take as much care of their bones as menopausal women.</div> <div> In a study, partly funded by the drug company Novartis, of 47 men with advanced or recurrent Prostate Cancer, those who received leuprolide, which lowers androgens, saw their bone density fall in their lumbar spine, the hip, or the top of the thigh.  However, those who took a combination of leuprolide and Pamidronate (a bisphosphonate;  Australian name 'Aredia') fared much better.</div> <div> Bisphosphonates 'slow the natural destruction of bone - resorption - by inhibiting the action of osteoclasts, the agents that eat bone to make room for new bone to grow.  Normally, bone undergoes resorption and formation on an ongoing basis, but when testosterone is lowered or removed as part of Prostate Cancer treatment, normal bone resorption overtakes bone formation.</div> <div> In the study, Pamidronate prevented the increased resorption.</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> <bR> </td> </tr></table></body>