Current Newsletters - April 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>April 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> <bR> <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.44  April, 2006</div> <div> Editor: John Conroy</div> <bR> <div> <B>1.  COMING  EVENTS</B></div> <div> Tuesday, 4 April Ms Kim Pearce (Cancer Council, NSW A Prostate Cancer Support Group? - What's in It for Me?)</div> <div> Kim is the Project Coordinator with the Cancer Information and Support Services Division of the Cancer Council NSW.  She has 26 years' experience in oncology nursing, working with patients and carers and Support Groups.  She will be talking about the effectiveness of cancer support groups, especially what research shows.</div> <div> After Kim's talk, there will be a short discussion on the future structure and organisation of our Northern Beaches Group. Until now, the Group Leader, John Conroy has taken much of the initiative in running things, with occasional meetings with six or seven interested people and invaluable individual help from many others.  But . . . Leaders are not indestructible! What do we want for the future?</div> <div> Tuesday, 2 May - Maxine Rosenfeld (Counsellor, Northern Beaches): Acknowledging Depression and Taking Action</div> <div> Tuesday,  6 June - Visit to the Sydney Adventist Hospital pathology laboratories The Pathology of Prostate Cancer</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 March</B></div> <div> Apologies were received from David and Norma Bennett, and Mark Tweeddale.  New members introduced were:  Frank Jones, Alan Taylor, and Peter van Wensveen.</div> <div> It was a great pleasure to welcome to our Meeting Dr Stephen Ginsborg, representing Manly-Warringah Division of General Practice, who spoke on the topic:  Prostate Cancer, Your GP, and Complementary Therapies.  Dr Ginsborg completed some of his early training at Cambridge and St  George's Hospital in London and has been in General Practice on the Northern Beaches for approximately 25 years. His G.P. father may well have had Prostate Cancer but refused to have it investigated, being of the school that believes men are more likely to die with it rather than from it.  He did die of a heart attack at the age of 76 years, still with Prostate symptoms.  Stephen's brother had a Radical Prostatectomy three years ago;  his uncle was a Urologist;  so, for these (and other) reasons, he is not in agreement with Professor Alan Coates' stand that he would sue any doctor who took his PSA, though he recognises some of the shortcomings of the test.</div> <div> Complementary (sometimes referred to as 'alternative') Therapy is a somewhat muddy area, as the evidence in favour of different preparations tends to wax and wane.  For example, there seemed to be good evidence that Glucosamine was beneficial in the treatment of osteo-arthritis but then, further trials suggested that it provided little or no advantage.</div> <div> Nonetheless, there is an argument for combining complementary therapies with primary health care.</div> <div> Stephen Ginsborg extends the role of the doctor to include being a companion  in illness, a supporter, a comforter. The line between care and compassion is very fine. The definition of compassion includes:  'to suffer with, fellow-feeling, pity, grief'. However, these broader issues are rarely discussed in the doctor's surgery.  More often than not, discussion is about practicalities rather than emotions. Most important in complementary therapy is the notion of 'care' although, necessarily, care is a part of conventional as well as complementary therapy. Yet, too often, treatment is given but not always care.  For the cancer patient, caring therapies, such as massage, are given not as cure but as care, and there is increasing use of these complementary therapies to give the patient care.</div> <div> Care starts at the first presentation. From the moment of diagnosis, the patient (for example, the cancer patient) may feel a lesser person, and may never feel the same again. This state of being needs 'compliments' as well as 'complements'.  Such things as eye contact or touch can be left out, especially with cancer patients with a poor prognosis. Be suspicious of the five minute consultation with the Urologist.</div> <div> When people are asked to do free association with the word 'cancer' they often supply the word 'death'. After a diagnosis of cancer, the patient is often left wanting to be comforted, like a child needing to be held. You can be left with feelings of guilt or shame. The death of a new born child may lead to feelings of shame in the mother or father.  Shame may lead to blame:  'The doctor didn't do this', or 'The nurse didn't tell me that'.</div> <div> The carer may be taking much of the brunt, especially as the patient gets iller, and the carer may cop some of the shame. The patient can have the feeling of being controlled by his illness, and this may lead to feeling crabby, and the carer cops it all.</div> <div> Complementary care in primary health care may include a spiritual component. A balance of good food, plus clean water and physical practice are complementary therapies with a proven track record in care.  Physical activity may give a feeling of being uplifted, which can be this 'spiritual' element.  Dr Ginsborg gave the example of a specialist in the UK who prescribed two weeks in the south of France for patients for whom no further treatment was possible. There are times when a short holiday may be the best treatment.  Similarly, the role of meditation in cancer can be crucial in removing stress.</div> <div> It is important to tell your medical practitioner what complementary medicines you are taking in case they interact with prescribed medications. If you are taking such things as asparagus or blackberry extracts, tell your Urologist;  he needs to know.</div> <div> Dr Ginsborg concluded by considering the efficacy of some of the more popular complementary therapies offered for Prostate Cancer. The problem is to find reliable research as to the effectiveness of these therapies, based on level 1 evidence.</div> <div> Saw Palmetto provides no benefit.</div> <div> Olive oil extract seems to be beneficial.</div> <div> Selenium, lycopene, pulses, and vitamin E are still controversial, although evidence in favour of selenium is fairly certain.</div> <div> Consumption of meat, eggs, coffee, tea, vitamins A and C, beta caretin, dairy produce, - all have no effect.</div> <div> High dose Calcium seems to increase the risk.</div> <div> There is no certainty about the effectiveness of a vaccine against Prostate Cancer, although the evidence is promising.</div> <bR> <div> <B>3.    Report of a Meeting held at Dee Why RSL on Tuesday, 21 March</B></div> <div> Dr Phillip Katelaris has recently established a Prostate Cancer Rehabilitation Centre in Hornsby, with a team consisting of Dr Christina Christopher (Continence Physician), Mr Stephen Carroll (Sexual Counsellor and Psychotherapist) and Ms Taryn Katz (Pelvic Floor Physiotherapist). I quote first from a letter from Dr Katelaris introducing the reasons behind the need to set up such a Centre:</div> <div> I have been caring for men with prostate cancer for twenty years. During this time we have seen a very significant stage migration from late to early disease.  During the last ten years it has been reported throughout the western world that mortality from prostate cancer has fallen 20-25%. Early detection and refinements in radiotherapeutic and surgical technique are responsible for this significant advance in prostate cancer management. Nevertheless, notwithstanding our therapeutic success there does remain significant morbidity attached to both the radiotherapeutic and surgical management of prostate cancer.</div> <div> This morbidity attaches to bladder and sexual function and of course involves significant psychological and emotional strain to the patient and his partner.  I am sure you will agree that it is very pleasing to have a zero PSA level following treatment.  It is also very pleasing to have a person fully rehabilitated and enjoying a good quality life following his successful prostate cancer treatment. The full rehabilitation of the patient unfortunately has not always been a high priority and it is for this reason that the Prostate Cancer Rehabilitation Centre has been established.</div> <div> The Prostate Cancer Rehabilitation Centre (PCRC) is a multi-disciplinary unit comprising professionals who have been working together for many years. This initiative has been instigated by the constant request of patients, partners and general practitioners for a comprehensive service that is focused at rehabilitating men who have been treated for prostate cancer. The PCRC offers contemporary techniques for bladder and sexual rehabilitation as well as ongoing psychological and emotional support.</div> <div> At the meeting, Dr Katelaris spoke on the general theme of Rehabilitation after Prostate Cancer Therapy. The goals of any treatment of Prostate Cancer are:</div> <div> to cure the cancer</div> <div> to preserve continence</div> <div> to preserve potency</div> <div> to support the man and his partner, and (most of all)</div> <div> to preserve quality of life for the couple.</div> <div> Treatment may take the form of: active surveillance (watchful waiting) external beam radiotherapy (EBRT) brachytherapy by iodine seed, or by high dose rate high intensity focus ultrasound (HIFU;  Dr Katelaris has recently returned from studying this technique overseas) or radical prostatectomy </div> <div> by open surgery</div> <div> by robotic surgery</div> <div> by laparoscopic surgery, or</div> <div> by perineal surgery.</div> <div> Staging is the process of detecting how far the cancer has developed. The aim of screening is to detect it at an early stage, and for the past 30 years surgery has been the mainstay in treatment. Trends in mortality for Prostate Cancer have dropped by 25% around the world over the last 10 years. At the same time, metastasis has risen for watchful waiting over radical prostatectomy, as has mortality. This suggests that screening can be effective, which seems to be born out by the Tyrol (Austrian) program of screening and early intervention.</div> <div> The downside of treatment may be incontinence or erectile dysfunction. The risk of incontinence is less than 3% at 3 months following a radical prostatectomy.  Prevention can be by pelvic floor training pre-operatively, and by meticulous apical dissection during surgery (that is, disturbing the sphincter muscle as little as possible). Treatment can take the form of: patience and reassurance over the three months post surgery, pelvic floor training, neo-control chair (which stimulates and exercises the pelvic floor muscle), in-vance sling (for mild post operative incontinence), or artificial urinary sphincter implant (the device with a double cup seems to cover most cases)</div> <div> Erectile dysfunction is often pre-existing, especially in older men. In the 60 year age group, 60% of men are likely to have erectile dysfunction However, it may be prevented and is very treatable, and it is important that men should talk to their doctors about it. Prevention may be by:meticulous dissection during surgery, commencing injection therapy one month post-surgery (an erection twice per week preserves the health of the penis and helps the marital relationship), trial PDE5s (drugs like Viagra and Cialis) starting three months after surgery, but these will only work if the nerve function has been preserved.</div> <div> Treatment may be by Injection therapy, PDE5s, vacuum device or penile prosthesis. Treatment by injection is by using a juvenile diabetes needle and injecting into the base of the penis.  Sometimes this can lead to priapism (an erection that lasts from four to five hours); this is unusual but painful.  Drugs will provide an erection lasting for about 20 minutes. Many men try using a vacuum device but often don¹t stay with it over the long term, as it is found to be a bit unromantic. Also, it only affects the pendulous part of the penis, which may mean that there can be difficulty controlling the thrust. The penile prosthesis is similar to an artificial sphincter. It requires a 24 hour stay in hospital to be fitted, and the man can be back in function after one week and feeling normal after one month. Major technical advances with the device are the use of a parylene coating which extends its life from eight to 15 years, and treating the material with an antibiotic to reduce the risk of infection. The major benefits are that it feels normal, it is more spontaneous (it takes about 20 seconds to bring on an erection), there is no performance anxiety, and the external appearance looks normal. The total cost is about $20 000 and, if you are in a health fund your out-of packet expenses are about $3 000.  However, public hospitals won't give cover.</div> <div> At the end of the meeting, Dr Katelaris made available four papers, all of which have been placed in our Lending Library:</div> <div> Katelaris, P.M.,  Treatment options for localised prostate cancer. Medical Observer, 28 November, 2003</div> <div> Katelaris, P.M.,  Sexual rehabilitation after prostate cancer treatments.  Medical Observer, 12 November, 2004</div> <div> Katelaris, P.M.,  Bladder rehabilitation after prostate cancer treatments.  Medical Observer, 19 November, 2004</div> <div> Carroll, Stephen,  Are you depressed?  Prostate Cancer Rehabilitation Centre, 2006</div> <bR> <div> <B>4.    PCFA</B></div> <div> You are warmly invited to attend a Rotary Community Forum conducted by the Beaches Rotary Clubs and the Australian Rotary Health Research Fund.The details are:</div> <div> Dee Why RSL Club, Reef Lounge (Level 3):  932 Pittwater Road, Dee Why </div> <div> Tuesday 4th April 2006:  6.30pm for 7pm start.</div> <div> (Note:  This is the same date and time as the Northern Beaches Support Group meeting.) Three knowledgeable Keynote Speakers on Mental Health:  Bernard McNair, Ted Sheedy and Craig Scott.  MC:  Pat Boydell</div> <bR> <div> <B>5.  INFORMATION  UPDATE</B></div> <div> Publications Received</div> <div> (i)    Below the Belt  Newsletter of the Nepean/Blue Mountains Prostate Cancer Support Group.  Vol. 5, No. 1 (Dec. 2005-Feb. 2006), and Vol. 5, No. 2 (Mar.-May 2006).</div> <div> (ii)    Cancer voices nsw,  Newsletter 22, March 2006</div> <div> (iii)    Cancer Support News,  The Cancer Council NSW.  Issue 3, February 2006.</div> <div> (iv)   Volunteer Voice, The Cancer Council NSW.  Autumn Edition - March, 2006.  (Includes Volunteer Training Calendar, 2006.)</div> <div> (v)    Local News, The Cancer Council NSW.  Autumn Edition - March, 2006. (Includes Volunteer Training Calendar, 2006.)</div> <div> (vi)   The Word Is Out,  Cancer Support Centre - Jacaranda Lodge Newsletter.  Vol. 5, Issue 2, Autumn, 2006.</div> <div> (vii)    Prostate Cancer Support Group, - Jacaranda Lodge.  March/April 2006</div> <bR> <div> Copies of all the above are available for borrowing from the Lending Library.</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>