Current Newsletter - March 2006

<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>March 2006</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.43  March, 2006</div> <div> Editor: John Conroy</div> <bR> <div> <B>1.  COMING  EVENTS</B></div> <div> Tuesday, 7 March - Dr Stephen Ginsborg (General Practitioner) Prostate Cancer, Your GP, and Complementary Therapies</div> <div> Dr Ginsborg comes to us from the United Kingdom.  He is a General Medical Practitioner working on the Northern Beaches and has wide  experience in this field.  He was a guest speaker at the Conference on Complementary Therapies organised by the Cancer Council NSW, and held at the Sydney Garvin Institute in October last year.  He will discuss the latest information on a range of complementary therapies in relation to Prostate Cancer.  He emphasises the need to talk to your GP about all complementary medicines you are taking, so as to avoid a clash with any other of your medications. Dr Ginsborg will answer questions and discuss with members any issues raised.</div> <div> Tuesday, 21 March - Dr Phillip Katelaris: Rehabilitation after Prostate Cancer Therapy.</div> <div> Correction:  The meeting of the Prostate Cancer Rehabilitation Centre, led by Dr Phillip Katelaris, was incorrectly advertised for February. The meeting will take place on this revised date at 6.30 pm for a 7.00pm start in the Dee Why RSL Club.  Apologies from the organisers to those who had a wasted journey because of the error.</div> <div> Tuesday, 4 April - Ms Kim Pearce (Cancer Council, NSW A Prostate Cancer Support Group? - What's in It for Me?</div> <div> Meetings are normally held (unless otherwise advertised) at 6.30 pm on the first Tuesday of each month in the Palliative Care Cottage, Mona Vale Hospital</div> <bR> <div> <B>2.    Report of the Meeting held on Tuesday, 7 February</B></div> <div> Apologies were received from Ron and Mary Jones, John Kirkland and BarryWest. New members introduced were:  Jack Das, Ron Deane, Michael and Susan Kotzen, Bob Nicholson, and David Stokeld.</div> <div> Members were very pleased to welcome Dr Manish Patel to the Cottage to hear him speak on New Therapies for Advanced Prostate Cancer. This is an area of research interest for Dr Patel, and is a field in which he worked while visiting the Sloane-Kettering Memorial Hospital in New York. Dr Patel provided us with an excellent powerpoint presentation. He began by giving an introductory overview of the anatomy and pathology of the Prostate Gland.  85% of Prostate Cancers occur in the Peripheral Zone of the Prostate. This zone lies just under the capsule (outer covering) of the Gland. Cancers in the Transition Zone (the region surrounding the urethra) are more usual in advanced Prostate Cancer.</div> <div> There are various modes in which Prostate Cancer may present. The most common are through a routine (PSA) blood test, or by a finger examination in the rectum (DRE), or incidentally during a 'rebore' (TURP) for an enlarged Prostate, or as a result of investigating urinary difficulties. Symptoms don't always occur, but they may include obstruction of the rectum, local pain, or blood in the urine. The definitive diagnosis is by a biopsy. However MRI (Magnetic Resonance Imaging) is a new technique being explored. The Gleason Score is an index of the aggressiveness of the cancer. It ranges between 2 (where the cancerous and healthy cells are well differentiated) and 10 (where they are poorly differentiated). The cancer is also staged;  that is, to indicate if it is localised to the Prostate Gland, localised but advanced (that is, spread outside the capsule), or has spread to other parts of the body (distant metastasis).</div> <div> Argument still continues about the desirability of screening for Prostate Cancer.  It does lead to earlier detection of the disease, but this may not be necessarily a good outcome.  However, after 10 years of screening in the USA, while diagnosis of localised disease is up, that of distant metastasis is down, which suggests that early detection and treatment prevents the spread of the disease.</div> <div> The treatment options usually considered when there is a positive diagnosis are surgery or radiation therapy, - either Brachytherapy, or External Beam Radiation Therapy (EBRT).  There is a high risk of recurrence of the disease if, on initial diagnosis, the PSA level is above 20, and the Gleason Score is 8 or above.  Survival rates vary for the different kinds of treatment.  In the United States, statistical devices called Nomograms have been prepared from the data from thousands of cases by assigning points for PSA level, clinical stage, and the grade of the cancer. These data are then applied to estimate an individual¹s chances of having a recurrence.</div> <div> During surgery, there is the problem of identifying and saving the nerve bundle in order to preserve potency.  Dr Patel provided photographs to illustrate the location of these bundles, which lie beside the Prostate Gland. Where preservation is difficult, there may be the possibility of grafting a section of the sural nerve taken from the leg.  Approximately 80% of men recover potency after sural nerve grafting, compared to approximately 40% of men who do not have the graft.</div> <div> With EBRT, the higher the radiation dose, the better chance of improvement. In Australia, the maximum dose given is 74 Gray (the unit of radiation energy received at the treatment site).  With a higher dosage, there is the risk of too much damage to the bladder and rectum. The higher the Gleason Score, the less chance there is of EBRT being effective.  Another process, Intensity Modulated Radiation Therapy (IMRT) provides precise delivery of external radiation to the Prostate, and can achieve an intensity of 86 Gray.  This treatment is used in about 11 hospitals in the United States, but is not yet in Sydney.</div> <div> High Dose Rate (HDR) Brachytherapy increases the dose of Radiation Therapy locally to the Prostate. The needles which are inserted stay in position for 36 hours and, over that time, the patient is given about three treatments. This is fairly new technology.  Over five years, results are about equivalent to IMRT results.  We are waiting for 10 year and 15 year results to assess its effectiveness.  We don't yet know how it effects younger men later in their lives.</div> <div> Adding Hormone Therapy to Radiation Therapy for patients with locally advanced Prostate Cancer significantly improves survival rate, after 7 years, from about 40% to about 70%.</div> <div> What is Advanced Prostate Cancer?  Generally it is incurable. It presents as a rising PSA after EBRT or Radical Prostatectomy, or as nodal or distant metastasis.  A slow rise in PSA usually indicates local disease in the pelvis;  a faster rise indicates metastasis. Treatment may take the form of radiation therapy to the pelvis, or hormone therapy.  The natural history progression of the disease after a radical prostatectomy, followed by a rising PSA after two to three years, is for an average total remission of about 13 years.</div> <div> Salvage prostatectomy after EBRT is normally a no-no because the tissue is like concrete because of scarring, and the Prostate is difficult to remove.  If the PSA was originally less than 10 and the Gleason Score was less than 8, it is possible to remove the Prostate without too much morbidity. The dangers are injury to the surrounding organs, incontinence and impotence.  If the Prostate Cancer is confined, the outcomes can be excellent.</div> <div> The standard treatment for Advanced Prostate Cancer is androgen deprivation, using drugs such as Zoladec or Lucrin (known as LHRH agonists). Side effects can include hot flushes, decrease in muscle mass and energy, osteoporosis, loss of libido and potency, anaemia, depression, and cognitive impairment.  Because of the risk of osteoporosis for men on androgen deprivation, maintaining exercise, and calcium and vitamin D levels are important considerations.</div> <div> When should Androgen deprivation begin?  As early as possible for both locally advanced disease and distant metastatic disease, as this improves the chance of survival, and decreases the risk of complications.  When should it begin for men with a rising PSA?  We don¹t know the answer to this yet. An Australian study on the Timing of Androgen Deprivation (TOAD) is currently evaluating this. There is a need to balance it with side effects. Is there any advantage in adding anti-androgen drugs to LHRH drugs?  Yes, but there is a very low survival advantage. Another variation is Intermittent Androgen Blockade. This may lead to an improved Quality of Life, but more studies are needed, although it seems to be safe.  Results of two current studies will be available in 2007.</div> <div> How long should Androgen Deprivation last? This varies.  When the PSA rises again after androgen deprivation, the cancer has found new ways of growing. Adding an anti-androgen may work for several months, when the anti-androgens can be changed.</div> <div> This can be continued until a state of hormone resistance is reached. This occurs when androgen independent cells survive. This eventually develops in all men on Androgen Deprivation.</div> <div> Clinical problems of three kinds can arise:  local ( including bladder, ureteric obstruction, pain, and bleeding);  bone (pain and fractures); and systemic (anaemia, malaise, and weight loss).  Chemotherapy may be used for Hormone Resistant Prostate Cancer.  Metoxantrone and Prednisone may be used for pain relief, and Docetaxol will improve quality of life and improve survival by about three months.</div> <div> Use of bisphosphonate drugs like Zometa inhibits bone resorption and, while very expensive, inhibits bone metastasis and may reverse osteoporosis.</div> <div> What for the future?  Dr Patel concluded by outlining several new developments which offer promise:</div> <div> a)    A new drug, Antrasenten (to be introduced into Australia next year from the United States), blocks andothelin receptors which promote tumour growth.</div> <div> b)    Vaccine Therapy has distinct possibilities.  Prostate Cancer tumour specific proteins are injected back into the patients, along with drugs. This then works with the white blood cells and appears to have minimum side effects.</div> <div> c)    Anti-angiogenic drugs (Thalidomide with Docetaxol) disrupt the flow of blood to the tumour which is highly dependent on blood supply. There has been a good response to this.</div> <div> d)    Gene Therapy.  This is a process designed to replace or silence abnormal genes responsible for the cancer.</div> <div> Correction:  Dr Patel was described in the last Newsletter as having spoken last year at the Cancer Council Conference on Complementary Therapies.  This should have read:  'at the Australian Prostate Cancer Collaboration Conference'.</div> <bR> <div> <B>3.    PCFA</B></div> <div> The inaugural PCFA Golf Challenge was launched at Mona Vale Golf Club on Tuesday, 28 February. Over 140 men and women participated in the afternoon event, and over 160 attended the dinner in the evening. Generous sponsorship was provided by Raine and Horne. A huge success!  It is hoped that this will become an annual and national event.</div> <bR> <div> <B>4.  INFORMATION  UPDATE</B></div> <div> a.    Publications - The Healthy Male. Newsletter of Andrology Australia, Issue 17, Summer, 2006. In this Issue:  Focus on Sexuality, fertility and contraceptive use in older men. A copy is available for borrowing from the Lending Library.</div> <div> b.    Heart Drugs and Cancer.</div> <div> An article in a January issue of the Weekly Telegraph (UK).reported that drugs used 'to reduce cholesterol levels and prevent heart disease do not', as previously claimed, reduce the risk of Prostate Cancer.  Researchers from the University of Connecticut re-examined data from 86, 000 cases 'and found that taking statins did not reduce their chances of either developing or dying from any type of cancer.'</div> <div> c.    Stem cells and Prostate Cancer.</div> <div> An article in the Weekly Telegraph (UK) in December, 2005 reported that scientists at the University of York had found 'a new way of inhibiting prostate cancer cells ...that could prevent the disease returning after treatment. 'Present treatments can work in the same way as a gardener who cuts down weeds but leaves the roots behind so that the plant can grow again.  For the first time, scientists have been able to identify the tumour stem cells (which make up one in 1000 of cancer cells), extract them from the Prostate Cancer, and propagate them in the laboratory.  However, 'the therapies for treating tumour stem cells have still to be developed.'</div> <div> d.    Can biopsies increase cancer growth speed? (The following information (dated 26 February) has been found on the website of a West Australian Support Group, and is copied with their permission with thanks.  The website was: <A HREF="http://www.jarrahbark.com" TARGET="_top" TITLE="http://www.jarrahbark.com"><U>www.jarrahbark.com</U></A>/ Follow the link to Forums and click on Prostate Cancer.)</div> <div> 'Several people have contacted the S-E Metro (Perth) PCSG asking if there is any evidence that a biopsy can increase the progression rate of the disease or metastases which results in the cancer spreading to other parts of the body'.</div> <div> 'The results of some biopsies have ranged from negative to low grade tumours and indicated a "watch and wait" management scenario. But within a relatively short period of time rapidly climbing PSA readings and second biopsies have discovered aggressive cancers'.</div> <div> 'We asked leading Urological Surgeon, Tom Shannon of Perth's Hollywood Hospital for an answer'.  Tom has replied:</div> <div> 'There is no evidence in the literature that biopsies increase the risk of either metastases or disease progression. What has happened in these cases is the failure of the original biopsies to detect the cancer, which is known to occur 15% of the time and is a real problem'.</div> <div> 'Extended biopsy sets are often employed but even then the cancer can be missed. What I tend to do after 2 negative biopsies and a rising PSA is MRI spectroscopy to look for the cancer, with repeat biopsies directed at the suspicious sites'.</div> <div> Biopsies must be done under good analgesia to allow deep penetration of the prostate, which is the most common site for missed cancers.</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>