Current Newsletter - November/December 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>November/December 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. 51/52 November/December, 2006</div> <div> Editor: Mark Tweeddale</div> <bR> <div> <B>1.     COMING EVENTS</B></div> <bR> <div> NOTE: Meetings are normally held at 6.30 pm on the first Tuesday of each month in the Palliative Care Cottage, Mona Vale Hospital (unless otherwise advertised)</div> <bR> <div> Tuesday 6 December<B>  </B>-  Christmas Get-together <I>Now, a note to make in your diary for next year …..</I></div> <bR> <div> Tuesday 6 February 2007<B> - </B> Dr Gavin Marx (Medical Oncologist): <I>The Medical Oncologist's Role in Treating Prostate Cancer</I>.  When we become consumers of the Prostate Cancer experience we also become exposed to a varied team of specialists participating in our treatment.  In this session we shall have a Medical Oncologist explaining when and how he is brought into the team and what part he plays.</div> <bR> <div> Tuesday, 6 March 2007 - Dr Phillip Katelaris (Urologist): <I>New Treatment for Incontinence following Radical Prostatectom</I></div> <bR> <bR> <div> <B>2.     Report on our November Meeting</B></div> <bR> <div> <B>"</B><I><B>Prostate Cancer, Genetics and Gene Technology"</B></I><I><B> </B></I><B> </B><B>A/Prof Susan Henshall</B>, Head, Prostate Cancer Research</div> <div> Program, Garvan Institute of Medical Research, on Tuesday 7 November at 6.30 p.m. </div> <bR> <div> Prof Henshall leads the prostate cancer research team at the Garvan Institute. She spoke about the application of science to "contemporary issues in prostate cancer biology relevant to patient care. Her team includes many disciplines: science, medicine, nursing, etc. She works closely with Prof Stricker, who spoke at our previous meeting.</div> <bR> <div> She addressed three main topics:</div> <div> the genetic basis of prostate cancer progression, i.e. distinguishing those patients who will need aggressive treatment;</div> <div> biological markers that will guide selection of the best forms of treatment;</div> <div> development of new therapeutic strategies based on a deeper understanding of the biology of prostate cancer.</div> <bR> <div> Since the discovery of the structure of DNA by Watson and Crick in 1953, the door has been opened for fundamental biological research. Then completion, in 2003, of the mapping of the human genome, has enabled much more focused research.</div> <bR> <div> The reported incidence of prostate cancer peaked around 1994 (due to the intro-duction of PSA testing), yet the mortality - i.e. the rate of fatality due to prostate cancer - hardly changed. This indicates that many of the cancers identified did not need treatment. </div> <bR> <div> The prostate cancer research at Garvan is principally "translational" research, aiming to bridge the gap between pure science to the clinical treatment of patients. The challenges facing translational research are of three types: a) conceptual; b) experimental; and c) logistical i.e. linking patients with scientists.</div> <bR> <div> A major clinical problem is that prostate cancer in some patients develops so slowly that it need not be treated, whereas in others it develops very rapidly and is life-threatening. The clinician (e.g. urologist or oncologist) at present needs to form a judgement of each case, based on limited information, in determining how to advise the patient about treatment.  One aim of the research into the biology of prostate cancer is to enable that judgement to be more reliable, and so ensure that the treatment matches the need, and that cancers which would not be life threatening are not treated unnecessarily.</div> <bR> <div> At present the judgement is based on "conventional" information including: PSA, Gleason score, whether the post-operative pathology testing of the removed prostate shows that that there were "positive margins" (i.e. some cancer cells are likely to have been left behind), whether the cancer has spread outside the prostate (eg seminal vesicles), and other indicators. This information is used with a special type of graph (a "nomogram") to predict the likely outcome.</div> <bR> <div> Research aims to enable the judgement to be made on molecular information, using the biological "fingerprint" of the particular patient's cancer. </div> <bR> <div> St Vincent's hospital has a data base of prostate cancer tissue from over 6000 cases. The aim is to determine the biological fingerprint "biomarker" of each (involving a massive amount of data for each case) and by studying the biomarkers of cases with good and bad outcomes to determine which biomarkers relate to which outcome. This may then be used soon after diagnosis to guide the selection of the treatment. Already a strong correlation has been found between a marker called AZGP1 and the PSA Doubling Time (PSADT - a doubling time of less than 3 months is associated with a much higher probability of secondaries - 20 times - and of a cancer-caused death).</div> <bR> <div> Another approach is to look for genes in the cancers that could be made targets for drugs. Normal chemotherapy involves use of medications that are highly toxic to all cells, particularly rapidly multiplying cells such as cancer cells, but all cells are affected. By targeting specific genes it may be possible to destroy the cancer cells without significant effect on normal cells, in which case that type of chemotherapy would not be as difficult to tolerate as the current types (of which there are currently very few appropriate for prostate cancer, and even they are mainly palliative and not curative).</div> <bR> <div> Two chemotherapy drugs currently used for treatment of advanced prostate cancer are Mitoxantrone (which eases symptoms but does not appear to extend survival); and Taxotere (which has much more toxic side effects, and it can extend survival by a number of months although only around 40-50% of patients respond to it). </div> <bR> <div> The known best approach for patients comprises: a) a healthy diet; b) exercise; and c) maintaining a healthy weight.  It is possible that some supplements <I>may </I> help, but there is no strong evidence that this is so. Such supplements include antioxidants including Vitamin E and selenium.</div> <bR> <div> There were many and wide-ranging questions from those present.</div> <bR> <div> Our thanks to Prof Henshall for a most interesting address. </div> <bR> <bR> <div> <B>3.     Reports on meetings held elsewhere</B></div> <bR> <div> <B>3.1     "</B><I><B>Radiotherapy in Cancer Treatment</B></I><B>"</B>: <B>Dr Gordon Adler</B>, Radiation Oncologist, Sydney and Central Coast Radiation Oncology Centres. (Summary of a talk given at the Cancer Support Centre, Sydney Adventist Hospital, on Monday 25 September 2006 at 7p.m.)</div> <bR> <div> There are three types of ionising radiation used in radiotherapy. They are: a) X-rays; b) Gamma rays; and c) Electron radiation. The biological effects of radiation are complex. Radiation does not directly kill cells, rather it causes damage to the chromosomes in the cells, and suppresses replication by the cells. As a result, a dose of radiation may not show any effect for some days or weeks.</div> <bR> <div> Normal practice in radiotherapy is now "fractionation", by which the dose is divided into small amounts given daily, typically 5 days per week for several weeks. This allows for some repair of the damage by normal tissue, and so lessens the impact on it. It also allows some repair by the cancerous tissue, but as the cancer cells are dividing more rapidly they are more affected. </div> <bR> <div> A variety of factors influence the management of radiotherapy. These include:</div> <div> the type of malignancy: radiotherapy is a localised treatment and those cancers, e.g. leukemia, which involve the whole body, are not</div> <div> suitable for radiotherapy;</div> <div> the natural history of the disease;</div> <div> the extent of the tumour spread;</div> <div> the expected life span of the patient, e.g. if the tumour is slow growing, and the patient is elderly, the tumour may never be a problem </div> <div> during the patient's life;</div> <div> the presence of unrelated conditions, e.g. a lung condition may make radiotherapy inappropriate for a lung cancer;</div> <div> the fitness of the patient to cope with the planned treatment.</div> <bR> <div> Tumours vary in sensitivity to radiotherapy. </div> <div> <I>Very sensitive tumours</I> include: seminoma - of the testes; lymphoma; many childhood malignancies.</div> <div> <I>Resistant </I>tumours include: bone sarcomas; melanoma</div> <div> <I>Intermediate tumours</I> include: head and neck; bronchus; colon; anal canal - commonly treated with both radiotherapy and chemotherap;</div> <div> genito-urinary system; gynaecological; & skin.</div> <bR> <div> There are several possible aims of radiotherapy. They are:</div> <div> <I>radical</I> (to eliminate the tumour) - producing more side effects</div> <div> <I>palliative </I>(to improve quality of life where the tumour cannot be totally destroyed)</div> <div> <I>prophylactic</I> - e.g. when surgery appears to have removed the cancer but radiotherapy is used in case some microscopic residues remain.</div> <bR> <div> RT and chemotherapy are often used together. Typical cases include: oesophagus; rectum; breast (in partnership with surgery); anus; head and neck</div> <bR> <div> Dr Adler then addressed prostate cancer more specifically. He said that some side effects cannot be avoided, because of the proximity of the prostate to other organs. Typically the treatment is 5 days per week for 6 ½ weeks, with radiation from four directions: front and back, and each side.</div> <bR> <div> The principal side effects, as noted in a study of 500 patients at the SAH between 1988 and 1991, were:</div> <bR> <div> <B>Late condition proctitis     </B></div> <div>     Grade A       5.1%                (least serious - occasional blood on the toilet paper)</div> <div>           Grade B       6.9%</div> <div>           Grade C       2.1%</div> <div>           <U>Grade D       0.8%</U>                (necessitating colostomy </div> <div>           <U>Total                     15   % </U>        - none since 1992)</div> <bR> <div> <B>2.</B>     <B>Impotence</B>               33   %</div> <div> <B>3.     Urethral stricture</B>       4.8%</div> <bR> <div> (There is also some risk of urinary or bowel incontinence. <I>Ed</I>.)</div> <bR> <div> The treatment of radiation proctitis entails:elimination of other possible causes (e.g. bowel cancer) checking the haemoglobin level to determine the extent of the bleeding trying steroid suppositories or steroid enemas if these do not succeed, use of formalin packings or laser treatment (day surgery).</div> <bR> <div> <I>(For a full account of radiation proctitis and its treatment, please refer to the article on the talk by Dr Chapuis in the Sept/Oct issue of this Newsletter - it is on our website)</I></div> <div>  </div> <div> The current program for radiotherapy of prostate cancer entails:</div> <div> locating the prostate precisely using CT and other radiography;</div> <div> the patient lies in the supine position;</div> <div> the radiation is from four directions (above, below, and each side) with carefully defined fields of cover;</div> <div> the dose of 6000 - 6600 cGY is administered over 30 - 33 sessions.</div> <bR> <div> A fairly recent development is the use of conformal radiotherapy which, because it is more precisely focused on the prostate, will permit higher doses while limiting damage to nearby organs. Similarly, brachytherapy will be used increasingly, in some cases along with external beam radiotherapy.</div> <bR> <div> In question time, discussion ranged very widely. In response to questions about radiotherapy, Dr Adler provided the following information.</div> <div> <I>Because brachytherapy uses radioactive beads inserted into the prostate precisely where the cancer is, the radiation is able to be localised </I></div> <div> <I>and there is less risk of damage to adjacent organs. </I>The rates of cancer control with brachytherapy are similar to those from external </div> <div> beam radiotherapy.<I>Where external beam radiotherapy tends to damage the rectum rather more than the urinary tract, the reverse is </I></div> <div> <I>the case with brachytherapy. </I>Brachytherapy for prostate cancer is appropriate only with a cancer that is confined within the capsule of the</div> <div>  prostate.</div> <div> <I>If a patient has had radiotherapy for one cancer in the past, this does not rule out radiotherapy for a different cancer. There does not </I></div> <div> <I>seem to be a significant risk of an excessive total dose of radiation. </I>No genetic effects of radiotherapy have been proved, but the situation </div> <div> is not clear.</div> <div> <I>If a patient has had radiotherapy as the primary treatment for prostate cancer, and this has been found to be less than fully successful, </I></div> <div> <I>follow- up surgery is not an option because of the internal scarring caused by the radiotherapy. This factor should be considered when</I></div> <div> <I>deciding between radiotherapy and surgery as the primary treatment. </I>Radiotherapy is preferred for older patients (as a rule of thumb, </div> <div> over 70  years, although the treating doctor will appraise each individual patient) as they have a greater risk of complications following</div> <div> surgery. If the cancer is of a slow growing type, the preferred treatment may be "Active Surveillance". <I>While there is substantial statistical</I></div> <div> <I>information about  the effectiveness of various forms of treatment, it is not possible to predict with confidence how any particular patient </I></div> <div> <I>will respond.</I></div> <bR> <bR> <div> <B>3.2     </B><I><B>Survivorship</B></I><B> - Jane Ewins</B><B> </B><B>(A summary of points made by participants in a meeting at Jacaranda Lodge, the Cancer Support Centre at the Sydney Adventist Hospital, on Tuesday 11 October.)</B><B>     </B></div> <bR> <div> (I understand that a "survivor" is technically described as someone who is not receiving active treatment, and who is not in palliative care, i.e. someone who appears to be cured. Personally, I prefer to believe that, regardless of my medical situation, as long as I am surviving I am a survivor! - <I>Ed</I>.)</div> <bR> <div> Jane started by giving a very open account of her "journey" since diagnosis with rectal cancer four years ago. She then arranged those present (survivors and carers) into groups of four people, asking them to address three fundamental questions:</div> <bR> <div> The discussions were very lively, and the results were listed. My paraphrasing of them is (not in any special order):</div> <bR> <div> <B>Current Challenges.</B></div> <div> Working out how best to use one's time. </div> <div> Impatience with trivia.</div> <div> Emotional vulnerability - being emotionally moved by small events.</div> <div> Coping with the fear of recurrence.</div> <div> Limited tolerance of stress - getting stressed out easily.</div> <div> Re-evaluation of life.</div> <div> Changes in friendships.</div> <bR> <div> <B>Help that would have been valuable.</B></div> <div> Information about the condition, treatment, side effects etc.</div> <div> Understanding by friends - there is sometimes a feeling by friends that being in the survival phase means that the cancer is all behind</div> <div> now, and that one should return to normality as if it had never happened.</div> <div> Emotional support.</div> <div> Information, at the outset, about the sort of emotional highs and lows that are commonly experienced.</div> <bR> <div> <B>Best Features of Survivorship.</B></div> <div> Still being here (!)</div> <div> Knowing that there is a reasonable chance of having been totally cured.</div> <div> Hope.</div> <div> Gratitude for the journey, and the sense of peace that has been reached.</div> <div> Friends (although in one case the phone calls from friends, though encouraging, take a lot of effort.)</div> <div> Being more focused on what matters in life.</div> <div> An increased closeness within the family.</div> <bR> <div> Jane recommended a book: <I>Surviving Survival: Life After Cancer</I> by Miles Little; Christopher Jordens & Kim Paul, Published by CHOICE Books, ISBN 0 94727780 3. (Unfortunately it is now out of print, but libraries may have copies.)  <I>A review of this book is included later in this Newsletter</I>, and an interesting Consumers Association article about this book is accessible on the website: </div> <div> <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.choice.com.au/viewarticleasonepage.aspx?id=102374&catId=100409&tid=100008&p=1" TARGET="_top" TITLE="http://www.choice.com.au/viewarticleason"><U><U>http://www.choice.com.au/viewarticleasonepage.aspx?id=102374&catId=100409&tid=100008&p=1</U></U></A></FONT>            </div> <bR> <bR> <div> <B>4.     GENERAL NEWS</B></div> <bR> <div> <B>FROM THE Prostate Cancer </B><B>Foundation of Australia</B></div> <bR> <div> The Minutes of the Teleconference Meeting of the NSW Chapter of the PCFA Support and Advocacy Committee (SAC) held on Thursday, 16 November are available for Members to peruse in the files in the Group's Lending Library. At the Meeting, Mr Steve Callister of the St Vincent's Support Group was elected Chairman</div> <bR> <div> <B>Cancer Council: </B>The latest e-newsletter is about "spirituality" with cancer, for both religious and non-religious people. Contact the Cancer Council for a copy to be sent to your e-mail address.</div> <bR> <div> <B>PUBLICATIONS RECEIVED</B><B>  </B>(Copies of all of the following are available for borrowing from our Lending Library.)</div> <bR> <div> <I>The Healthy Male.</I> Newsletter of Andrology Australia.  Issue 20, Spring, 2006. Focuses on Sport and Reproductive Health.</div> <div> <I>Protein triggers new prostate treatment.</I> National Nine News; Health News (ninemsn).  Monday, 13 November, 2006.Report of new</div> <div> research coming from Johns Hopkins University, Baltimore, Maryland.</div> <bR> <div> <B>Diet  </B>For an informative and authoritative article on diet for prostate cancer prevention, and for patients who already have it, see: <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="http://www.prostate-cancer.org.uk/pdf/toolkit/diet.pdf" TARGET="_top" TITLE="http://www.prostate-cancer.org.uk/pdf/to"><U><U>www.prostate-cancer.org.uk/pdf/toolkit/diet.pdf</U></U></A></FONT> </div> <bR> <bR> <div> <B>5.     BOOK REVIEWS</B></div> <bR> <div> <B>5.1     Surviving Survival - Life after Cancer</B><B>: by Miles Little, Christopher Jordens, Kim Paul & Emma-Jane Sayers.</B> Published by <B>Choice Books</B>, Australian Consumers' Association, Adelaide 2001, 159 pages, ISBN 0 947277 80 3 <I>(Unfortunately it is out of print, but it is available in many libraries, including the Cancer Support Centre, Sydney Adventist Hospital).</I></div> <bR> <div> Professor Miles Little and his colleagues noticed that many cancer survivors were less happy than might have been expected. They researched this and, after publishing a number of academic papers, wrote this book to make their findings more accessible to non-academic readers (such as most cancer survivors and their carers).</div> <bR> <div> The book starts with a number of case histories selected from the survivors whom the authors had interviewed. While undoubtedly many cancer patients find positive dimensions in their cancer journeys (including, of course, survival!) these histories illustrate some of the difficulties the survivors are now experiencing in that survival phase. Some regard survival as the end in itself, and a cause for immense gratitude. However, many encounter difficulties. For example, survivors, having come face to face with the frailty of human life, have a different perspective from others, and may find their interests now differ from those of old friends. Some find that their carers have been emotionally and physically worn out by the experience, and now expect them to be just as they were before the cancer was diagnosed. Some find that former friends have found it too hard to relate to the cancer and have opted out and stayed away. Some survivors experience unexpected bursts of anger or tears. Some find that they can no longer engage in the activities they used to enjoy. Some find that their families cannot understand their new situation - nominally cured, but with the possibility of recurrence hanging over their heads, and being quite sensitive and vulnerable to their emotions. Some are depressed. Some have difficulty adjusting to being now the weaker member of the marriage partnership. </div> <bR> <div> As the book notes, "<I>these anecdotes are full of paradox and puzzlement. Most outsiders assume that to survive must be wonderful. …. </I>(but many survivors)<I> register profound and serious disturbances in many aspects of their lives.</I>"  The recurring themes were: a persistent awareness of being a cancer patient regardless of the time since treatment and of the presence or absence of disease; a feeling of being separated from friends due to an inability to communicate and share the experience of the illness; and a persistent sense of being fragile and having limited time and capability.</div> <bR> <div> The rest of the book explores these disturbances, seeking to understand them, to explain them, and so enable survivors to manage them. </div> <bR> <div> This is a fascinating and important little book, but it is not a "quick read". There are many concepts that need careful thought before they can be understood and, in spite of the authors' aim of writing a readable book, it still has a somewhat academic style. This is my only reservation.</div> <bR> <bR> <bR> <div> <B>5.2     You can conquer cancer: Prevention and management </B>by<B> Ian Gawler,  2</B><B>nd</B><B> Edition, </B>ISBN 0 85572 320 3,<B> </B>Published by <B>Hill of Content, </B>Melbourne 2001, 258 pages</div> <bR> <div> Ian Gawler was a practising vet when his right leg was amputated in January 1975 with a form of bone cancer. The cancer reappeared, and by March 1976 his specialist thought he would live for only around two weeks. He tried the full range of treatments available, from mainstream medicine to highly controversial alternative approaches. He has been free of cancer since June 1978. He now heads a noted cancer support centre in Victoria.</div> <bR> <div> The first edition of this book was published in 1984, and has been reprinted frequently and translated into many languages.  However, this is a book that will appeal strongly to some, and much less to others. While it mentions the role of mainstream medicine, most of the material is complementary to mainstream medicine, and there is an "alternative" flavour running through it.  Regardless of what one thinks of the more controversial approaches he mentions, the thrust of the book is no longer controversial: learning physical and mental relaxation; developing positive thinking; and designing a nutritious diet.</div> <bR> <div> The introduction to the first edition stated that: <I>"This book presents the good news about cancer. It is not a book about dying gracefully with cancer. It is about a process of living - living to the full." </I> It starts with the premise that <I>"a body with properly functioning defences cannot have cancer"</I>. It then explores possible causes for the defences being weak and methods of strengthening them again.</div> <bR> <div> First he discusses the principles behind meditation: "<I>the silent healer</I>".  This is a very helpful section. He notes that the body responds to stress in a way that fits it to fight the cause of physical stress, but which actually weakens the immune response. Meditation leads to both physical and mental relaxation, eliminating stress, and enabling the immune response to tackle the cancer cells. He reports that <I>"Meditation increases quality of life and quantity of life. People who do it feel better and live longer"</I>, and cites numerous examples. There is extensive explanation of how to meditate, and of different approaches to meditation for different situations.</div> <bR> <div> He places great emphasis on "positive thinking", and presents a list of possible approaches to starting to think positively and to creating a healing environment. There is an interesting and helpful chapter on pain control, explaining the nature of pain and its control using meditative and other techniques, including simply a caring touch from a loved one. I was rather repelled by the reference to coffee enemas, but he says that he has found them to ease severe pain, and as I have never been in a position where I might have wanted to try one, I am not competent to comment further.</div> <bR> <div> There are several very interesting chapters on diet.  They address: the principles of diet; the psychology; the practice. He notes that: <I>"Recovering from cancer is a very special situation and requires very special food"</I>, but also that: <I>"Diet is not the total answer, but without a good diet, there is no answer"</I>. The emphasis is on fresh food, as little processed as possible and free from preservatives etc. Vegetables, fruit, and limited white meat are recommended, and fresh vegetable and fruit juices are suggested as a good way of getting the nutrients in quantity without prohibitively large bulk. (In view of other reading, I remain sceptical of using diet for "detoxing" and for "stimulating the liver", but not being a medico, my opinion is uninformed.) He recommends that any dietary approach be supervised by a qualified and experienced health professional, and that the diet should be one that the particular patient believes in and enjoys, and can <I>"eat with a smile on your lips and a song in your heart!"</I> rather than as an ordeal. </div> <bR> <div> The later chapters are more philosophical, and may not be to everyone's taste, but form an important integral part of the author's approach. There is a very good chapter on death and dying (presented as a normal part of life) including discussion of how to approach the subject with children. Other interesting chapters include: The <I>Principles of healing</I>; <I>the mystery of healing</I>; and <I>the mystery of life</I>. One may agree or disagree with the author's philosophies, but they are very thought-provoking. The conclusion sets out a clear summary of the foregoing material.</div> <bR> <div> Clearly the book is very highly regarded my many (as evidenced by its numerous reprintings etc.) but it did not resonate so strongly with me.</div> <div> My <I>personal </I>rating for <I>prostate </I>cancer patients: <FONT SIZE="4" COLOR="#000000" FACE="Wingdings" >«««</FONT></div> <bR> <bR> <div> <B>6.     Contacts</B></div> <bR> <bR> <div> Program Co-ordinator: <B>Dr Peter Moore</B>,  Northern Beaches Palliative Care, Tel 9998 0222 </div> <div> Group Leader:  <B>John Conroy</B>  Tel 9918 9358, <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="mailto:conroyjs@bigpond.com" TARGET="_top" TITLE="mailto:conroyjs@bigpond.com"><U><U>conroyjs@bigpond.com</U></U></A></FONT></div> <div> <B>Jo-Ann Steeves</B> ; <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="mailto:steeves@pacific.net.au" TARGET="_top" TITLE="mailto:steeves@pacific.net.au"><U><U>steeves@pacific.net.au</U></U></A></FONT>  or leave a message at Palliative Care: 9998 0222</div> <div> Newsletter Editor: <B>Mark Tweeddale</B>, Tel 9440 8184, <FONT SIZE="3" COLOR="#0000FF" FACE="Tahoma" ><A HREF="mailto:hmarktw@bigpond.net.au" TARGET="_top" TITLE="mailto:hmarktw@bigpond.net.au"><U><U>hmarktw@bigpond.net.au</U></U></A></FONT> </div> <bR> <div> NSW Cancer Cancer Council Support Helpline Tel  13 11 20 </div> <div> Prostate Cancer Foundation of Australia: Tel 1800 22 00 99</div> <bR> <div> Commonwealth Carelink Centres Tel  1800 052 222  </div> <div> Northern Beaches Neighbourhood Service, Inc.: Tel  9982 3044</div> <bR> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>A request from the Editor.</B> Book Reviews, Letters to the Editor etc. <I>actively wanted </I>(not just "welcomed"). Don't be shy! Write one today, and send it to <A HREF="mailto:hmarktw@bigpond.net.au" TARGET="_top" TITLE="mailto:hmarktw@bigpond.net.au"><U><U>hmarktw@bigpond.net.au</U></U></A></div> <bR> <bR> <bR> <div> <I><B>Best wishes for a joy-filled Christmas, and a healthy and happy New Year</B></I></div> <bR> <bR> </td> </tr></table></body>