NEWSLETTER
No. 53/54 January/February, 2006
Editor: Mark Tweeddale
1. COMING EVENTS
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)
Tuesday 6 February Dr Gavin Marx (Medical Oncologist): The Medical Oncologist's Role in Treating Prostate Cancer. When we become involved in the Prostate Cancer experience we encounter a team of various specialists participating in our treatment. In this session a Medical Oncologist will explain when and how he is brought into the team and what part he plays.
Tuesday, 6 March Dr Phillip Katelaris (Urologist): New Treatment for Incontinence following Radical Prostatectomy.
Proposed Events for the rest of 2007:
3 April
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Bruce Robertson (Counsellor): Handling the Issues of Living with Prostate Cancer
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1 May
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Members' Open Forum
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5 June
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Dr Lisa Horvath (Garvan Institute for Medical Research): Update on Chemotherapy
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3 July
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Jane Ewins (Cancer survivor and volunteer, Cancer Support Centre, Sydney Adventist Hospital): Survivorship
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7 August
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Professor Karen Phelps (St Vincent's Hospital): Chronic Disease Management
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4 September
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Dr Rob King (Sydney Centre for Men's Health, Bondi Junction): Men's Reproductive Health, Sexuality and Relationships
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1 October
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Dr Doug Mitchell (Chairman of Opal Clinic, Melbourne): Photodynamic Diagnosis and Treatment of Prostate Cancer
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6 November
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Professor Philip Hogg (University of NSW, Principal Research Fellow, National Health and Medical Research Council): Recent Advances in Cancer Research, with Special Reference to Prostate Cancer
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4 December
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Christmas Get-Together
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Carers' Proposed Program of Meetings, 2007
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12 March
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Maxine Rosenfield (Counsellor): Dealing with Carers' Deeper Attitudes and Feelings
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1 May (Tues)
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Carers' Open Forum
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9 July
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Topic to be decided by Carers
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10 September
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Topic to be decided by Carers
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4 December (Tues)
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Christmas Get-Together
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2. REPORT ON OUR CHRISTMAS GET-TOGETHER
During the day several willing volunteers made light work of table moving, chair toting, table setting, decorating, peeling, cutting, plating up and setting up the bar. (We didn't burn the spinach triangles, Jo Ann!)
By 6.45-ish, starters were started, conversation drowned the background music and the festivities began.
Jo Ann was unable to cook (because she was on her hols in Canada!). We, who were left, manned the kitchen! Thanks to a HUGE salad donated by Joni, a massive bowl of coleslaw donated by Mary, some very welcome cash donated by Jeff and some very deft haute cuisine tricks by helping hands, we sat and enjoyed a Christmas meal courtesy of Mr. Woolworth !!!
Full of Mr.W's pud and fruit salad with trimmings, we attempted the Quiz, drank copious cups of coffee, tippled the last of the wine and continued getting to know each other until the barman (John) did his speech of thanks, wished us all a Merry Christmas, and called "Time Gentlemen Please!!!" We issued the indigestion tablets, cleared the tables, washed the dishes, moved the furniture and then wandered off into the very warm moonlight to await next year's events. (Psssst! Don't tell Mark, but because he wasn't there we didn't wear our badges!!! Naughty eh?)
A Happy and Healthy New Year to you all. (Report by A. Scribe).
3. REPORTS ON MEETINGS HELD ELSEWHERE
3.1 Exercise and Cancer: by Michelle Pisani A summary of the presentation at Jacaranda Lodge, the Cancer Support Centre,
Sydney Adventist Hospital, on Monday 23 October 2006 at 7.00 p.m.
3.1.1 Introduction
Everyone can benefit from exercise and smile about it!
Why exercise ?
to reclaim one's life;
to take control of one's life and health;
to be pro-active in one's recovery; and …
to feel good !
Michelle started by posing two questions: "Why exercise?" and "Why cancer patients particularly?" The answers were: to reclaim one's life; to take control of one's life and health, and to be pro-active in one's recovery. (Numerous specific benefits, including improved survival, are listed later.)
Michelle is a physiotherapist who works with cancer patients at St Vincent's Private Hospital and also practises privately.
The next question was: "What sorts of exercise? Answer: There are two classes of exercise for cancer patients to consider: a) specific exercise appropriate to the cancer and the treatment, and b) exercise for general fitness, suitable for anyone as well as cancer patients.
She then listed the parts of the body to be exercised for different cancers. (From this point, these notes will cover only what is relevant for prostate cancer patients)
3.1.2 Exercises for Prostate Cancer Patients.
For prostate cancer the particular regions to be exercised were: Pelvic floor & Core.
Pelvic Floor: Those who have had surgery or radiotherapy for prostate cancer will already be familiar with pelvic floor exercises as part of their recovery or maintenance of urinary and bowel continence. They aim to strengthen the muscles that run from the pubic bone back to the pelvis, and which form part of the muscle set that close off the bladder and rectum. Exercising these enables one to recover or maintain continence, and also to relax when needing to urinate or defecate.
To exercise the pelvic floor muscles, take following steps:
sit forward on the chair;
put the legs apart, resting your arms on your legs;
tense the muscles that one uses to retain urine or faeces such that one can feel the perineal region between the legs being pulled upwards
and inwards. Hold the tension, but DON'T hold your breath.
Exercise ten such contractions each lasting ten seconds, doing this five or six times per day. (The test is to be able to stop mid flow whilst urinating and hold for 10 seconds, but this should not be done often or it can interfere with the ability to relax to urinate.)
Core: Core stability is currently receiving a lot of attention. The core comprises deep abdominal and back muscles. They are linked with the pelvic floor muscles. The core muscles of the abdomen form a corset around the abdomen, and work together with the muscles around the spine. The roles of the core muscles are: to stabilise the trunk; to prevent injury both to the abdomen and the spine; and to allow efficient movement. Normally the core muscles "turn on" before we move in anticipation of the movement, but after surgery the activ-ation may be slower (or may not happen at all), and so the back may not be protected in time for the movement.
Two particular core muscle exercises were described: a) pulling the abdomen in; and b) "the plank".
a) Pulling the abdomen in: The steps are:
lie on the floor on your back with the knees bent;
place your thumbs just in from the hip bone;
breathe in;
while breathing out, pull the belly button back toward the spine, flattening the tummy;
hold this position, while continuing to breathe normally;
hold for 10 seconds.
Once this has been learned, the aim should be to be able to do this while sitting, progressing then to standing, and then to doing it while moving around. The contractions should be done ten times, and this should be repeated several times (e.g. 5 - 6) per day.
b) The Plank. Get down on your knees and elbows with arms flat on floor and back flat like a plank, not letting your tummy sag or your bottom stick up in the air, and with eyes looking down. Hold and work up with practice to hold this for two minutes.
3.1.3 General Exercise
There are two classes of general exercise: a) cardiovascular, and b) strength. Research into exercise is providing very positive results for breast and colon patients , showing that it improves survival and reduces the probability of recurrence.
Two classes of general exercise:
Cardiovascular (for the heart and circulatory system: it takes effort, raises sweat)
Strength (to build muscle and prevent muscular and joint injuries)
The references to breast cancer are principally due to the large amount of research that has been done for this particular cancer. While the same benefits have not been demonstrated for prostate cancer, the absence of positive evidence (due to lack of research) does not mean that there is no benefit!
a) Cardiovascular exercise
Cardiovascular exercise needs to entail a bit of effort, enough to raise a sweat, but Michelle advised that all exercise should start at an easy level at first. Typical cardiovascular exercises include brisk walking, swimming, stepping up and down, exercise bicycle, etc.
b) Strength Exercises
In addition, it is wise to include some strength exercises e.g. with weights, or using the weight of the body (as in Exercises B, C, G & H below), or of limbs when doing some floor exercises (such as Exercises E and F below), and/or use of one of the inexpensive elastic straps such as "Theraband".
Abdominal exercises may include the following (see pictures below):
a) Core: Pulling abdomen in (see earlier)
b) Core: "Plank" (see earlier)
c) Lying on the back, and raising upper trunk off the ground, with hands behind head to support it.
d) Lying on the back, and bending and reaching sideways down toward alternate heels.
e) Lying on the back, and raising legs together toward ceiling.
f) Lying on the back, and cycling with legs.
g) Squats or h) Sitting on the edge of a chair and repeated standing and sitting without using hands. This also strengthens the legs.
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A
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B
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C
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D
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E
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F
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G
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H
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Recommendations
check with your doctor first.
Exercise 3 - 5 times per week, for around 30 - 40 minutes at least on each occasion.Check with your treating doctor before starting.
Start lightly, and build up.
"Cross train" i.e. use a variety of forms of exercise (e.g. cardiovascular / weight / stretching / abdominal etc.)
Drink plenty of water (e.g. 2 litres per day)
Join a group or a club.
Choose something that is fun.
Another approach suggested by my GP was to exercise such that one can (new breath) still speak but must take a new breath before finishing (new breath) a sentence. But check with your own doctor,
as this sort of guidance naturally depends on one's individual fitness. (Editor)
For cardiovascular exercise, as a rough guide, aim to develop a pulse rate that is between 60% and 70% of "Max Heart Rate" (MaxHeart Rate = 220 - Age). (For example: a person aged 60 would aim to exercise maintaining a pulse rate above 60% of (220 - 60), i.e. 60% of 160, i.e. above 96 per minute, and not more than around 70% of 160, i.e. not more than 112 per minute. See the table below).
Get help from your support group, local physiotherapists, local gyms or personal trainers
The benefits of exercise for everyone include:
improved cardiovascular functioning;
decreased body fat and improved weight control;
improved mood and reduced likelihood of depression;
prevention of osteoporosis;
prevention of diabetes;
improved concentration;
prevention of muscle and joint injuries;
improved balance with fewer falls.
Suggested Pulse Rates when Exercising
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Age Min Rate
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Max Rate
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40
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108
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126
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45
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105
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123
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50
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102
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119
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55
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99
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116
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60
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96
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112
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65
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93
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109
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70
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90
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105
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75
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87
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102
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80
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84
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98
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The particular benefits for cancer patients include:
survival improved by 50% (in breast and colon cancer) and reduced probability of recurrence;
improved quality of life (comfort, enjoyment, ability to engage in normal activities etc.);
maintained bone mineral density during chemotherapy (and hormone therapy);
decreased nausea and fatigue during chemotherapy (exercise is the only proven treatment for fatigue during chemotherapy);
prevention of weight gain (weight gain during chemotherapy has been found to be principally due to lack of exercise, not increased food intake - exercise 3 times per week has led to less body fat and increased lean muscle) - weight gain can also occur due to hormone therapy;
improved body image and self esteem;
enhanced immune system, reducing vulnerability to various infections such as colds (this has been demonstrated in breast cancer patients);
decreased depression;
fun! (Group or class exercising is fun and also a good source of mutual support. Typically a class exercise will include both cardiovascular and strength exercises.)
3.2 Gene Therapy for Prostate Cancer: Professor Pam Russell, Presented at Jacaranda Lodge Cancer Support Centre, the
Sydney Adventist Hospital, Wahroonga on Monday 27 November 2007 at 7.00 p.m.
Prof Russell's work is directed toward developing therapies for prostate cancer. She explained that prostate cancer has, until recently, been considered unresponsive to chemotherapies which are effective on other cancers. This may be because prostate cancer cells generally multiply much more slowly than other cancers, and so are less susceptible to the toxic effects of chemotherapy drugs.
Very recently (two to three years) it has been found that the chemotherapy drug docetaxel (Taxotere) extends the life of prostate cancer patients by a median period of a couple of months. However, only about 40% of men respond to it, and it has very unpleasant side effects for many men which can lead to the treatment being cut short.
Prof Russell then outlined approaches to the development of treatments using cancer-targeted gene-directed therapy. These have the potential to attack cancers in the prostate itself, and also to trigger a strong immune response to attack secondaries elsewhere in the body, without (unlike conventional chemotherapy) imposing toxic effects on the rest of the body.
She noted that the prostate is ideal for gene therapy as it can be accessed quite easily, so medication can be injected directly into the prostate itself rather than having to expose the whole body to it. This approach can avoid side effects to normal tissues.
Gene-Directed Pro Drug Therapy (GDEPT). One of the approaches in her research entails identifying a gene that encodes an enzyme, and injecting it into the cancerous prostate. Then a "pro drug" is injected systemically. This pro-drug has minimal effects on the body as a whole, but when it encounters the gene in the prostate, it is converted to a toxin that attacks the cancer cells that contain the gene. The effect spreads to adjacent cancer cells which do not contain the gene (the "Local Bystander" effect). In the case of some GDEPT therapies, this in turn promotes natural killer cells and T cells (that form part of the immune response) that attack the cancer elsewhere in the body (the "Distant Bystander" effect). To promote safety, a regulatory switch (promoter/enhancer) that works only in the prostate is inserted before the gene. This prevents the treatment from damaging other types of cell e.g. the liver. (As the approach starts with injection of the gene into the prostate, it is not suitable for men who have had a radical prostatectomy). Genes of interest have been identified, and promising results have been obtained with studies in mice. Prof Russell used pictures and graphs extensively throughout her presentation to illustrate the processes involved and the results obtained.
CSIRO is expected to start a preliminary gene therapy clinical trial in 2007, involving a small number of volunteers with very advanced cancers.
Prof Russell foreshadowed a number of future developments, including:
analysis of the different types of immune response, so as to improve its effectiveness;
tests on a type of mouse (called Transgenic mice) which have been engineered to get prostate cancer as they age;
enhancement of efficacy using yeast rather than bacterial genes to encode the enzymes involved in converting the prodrug to the toxins.
Yeast genes have been shown to be more efficient; enhancement of delivery using nanoparticles - work with the Department of Chemical
Engineering at UNSW has been initiated.
Sincere thanks to Prof Russell for speaking about her "leading edge" research.
(HMT)
4. GENERAL NEWS
4.1 FROM THE Prostate Cancer Foundation of Australia
4.1.1 Effect of Diet: For two informative articles by Dr Manish Patel about the possible effect of diet on prostate cancer (both the risk of getting it, and its growth once one has it) see the May 2006 and November 2006 issues of Prostate News, published by the Prostate Cancer Foundation of Australia. See web addresses www.prostate.org.au/dietrole.htm (May) and www.prostate.org.au/dietrole2.htm (Nov).
4.2 From the Cancer Council
4.1.1 Volunteer Voice: The Cancer Council NSW. December, 2006.
4.1.2 Local News: The Cancer Council NSW. December, 2006.
4.2 PUBLICATIONS RECEIVED (Copies of all of the following are available for borrowing from our Lending Library.)
4.2.1 Breakthrough: Garvan Newsletter, December 2006/Issue 03. This focuses on Diabetes.
4.2.2 Newsletter: Prostate Cancer Support Group, Sydney Adventist Hospital. December, 2006.
4.2.3 The Word Is Out: Cancer Support Centre, Sydney Adventist Hospital. Volume 6, Issue 1. Summer, 2006/2007.
5. BOOK REVIEWS
5.1 Localised Prostate Cancer: by the Australian Prostate Cancer Collaboration; 2006. 98 pages, ISBN 0-9579938-1-1;
Sponsored by the Australian Seniors Foundation. (Available from the Cancer Council Tel 13 11 20)
This little book was prepared by the Australian Prostate Cancer Collaboration, based on the Clinical Guidelines of the National Health and
Medical Research Council. The foreword states that "This book may be helpful to any man affected by prostate cancer and his family.
However, it is particularly designed for men who have localised prostate cancer (cancer that has not spread beyond the prostate gland)
and who need to make a treatment decision."
The book takes you through what you might want to know at each stage of diagnosis and treatment. There is discussion of the PSA test; the classification of the stage the cancer has reached (T1 - T4) with illustrations; the biopsy procedure and the grades of aggressiveness of the cancer (Gleason score); and the bone scan and CT scan. This leads to a summary of how the risk from the cancer can be estimated from those statistics, and a section on the social and emotional issues that arise from a cancer diagnosis.
There is helpful advice about how to approach the first visit to the doctor, listing a number of topics that you might want to discuss with the doctor, such as: how much the cancer threatens your life; how age and other health conditions may affect what treatment you choose; and what treatment options you have. The book then discusses each of those options: "active surveillance"; surgery; external beam radiotherapy; brachytherapy radiotherapy; hormone therapy; salvage treatments; cryotherapy; and high frequency focused ultrasound (HIFU). Each is discussed fully, with the pros and cons discussed and tabulated.
There is discussion of complementary treatments (i.e. in addition to the mainstream medical treatments) and alternative treatments (instead of mainstream medical treatments). The importance of making sure your doctor knows you plan to take, or are taking, other treatments is emphasised, because the combined effect of mainstream and other treatments can be dangerous. There is the comment that, once a man has prostate cancer, being overweight increases the likelihood of it progressing.
The book sets out the information you should ask for before you decide on your treatment, and sets out a systematic approach to making that decision.
The book then looks at what happens after treatment (e.g. regular PSA tests and checkups), and what happens if your cancer returns after treatment (probably hormone therapy). It then discusses life after treatment: relationships and sexuality. It discusses some possible problems: erectile dysfunction; urinary incontinence; social and emotional issues; counselling and support; prostate cancer support groups; other support services (including the Cancer Council Helpline Tel 13 11 20).
There is a chapter of questions you may wish to ask: general questions; questions about treatment; and questions about each possible type of treatment. Appendices cover: references; "staging"; the Gleason score; clinical trials; resources; nomograms for estimating risks; a place to record information about your cancer; and a comprehensive glossary of technical terms.
The "final word" is presented inside the back cover, quoting a prostate cancer survivor:
"There can be life, good life after prostate cancer. That's the story all men need to know. In summary, I think there are three things that
are most important:
put yourself in a position of advantage: look after your diet, exercise, laugh a lot and learn to relax;
have a strong positive attitude and plan for the future, some long and short term goals. You have got some good life leftl
surround yourself with love and support of others and pass it on, you will live longer, happier and more fulfilled ……
…… Who knows what medical science will come up with in the future. They have new significant breakthroughs all the time. Yes, there are some good years yet!"
This is an outstanding little book, easy to read yet highly authoritative, and a credit to the Australian Prostate Cancer Collaboration, the Australian Cancer Network and the other agencies who prepared it, and the National Seniors Foundation who sponsored it. Thanks to them all !
My rating for prostate cancer patients: «««««
(HMT)
5.2 Cancer has its privileges: Stories of Hope and Laughter: by Christine Gifford. Penguin Putnam, New York; 2002. 158 pages, ISBN 0-399-52776-1 (Borrowed from the Cancer Support Centre, Sydney Adventist Hospital)
This is an entertaining book by a survivor of breast cancer, who found that humour was very helpful in her recovery to a fulfilled life.
One insightful observation she makes is that most people don't know what to say when a loved one or a friend is diagnosed with cancer. " … They don't want to say the wrong thing, so they often end up saying nothing. A cycle of avoidance and denial only deepens the loneliness and isolation the cancer patient feels. I found humour to be a great connector of people …" She goes on to say that when she made light-hearted remarks about her illness, those to whom she was speaking realised that it was OK to talk to her about it and other things. This enabled friendships to continue without the strain of verbally walking around and trying to ignore the most pressing subject. The anecdotes, funny stories and amateur poems in this book were collected by the author largely from members of a support group she formed. As a result, many of them relate particularly to breast cancer patients and survivors, with references to situations arising after hair loss through chemotherapy, accidents with wigs and breast prostheses and so on. However, through all these runs a strong thread of wisdom for all those touched by any form of cancer, whether as patients or carers. (The jokes and sayings alongside are from the book)
Recommended particularly for those who don't want to take themselves too seriously, or who want to cheer themselves up.
My rating for prostate cancer patients: «««
(HMT)
6. Contacts
Program Co-ordinator: Dr Peter Moore, Northern Beaches Palliative Care, Tel 9998 0222
NSW Cancer Cancer Council Support Helpline Tel 13 11 20
Prostate Cancer Foundation of Australia: Tel 1800 22 00 99
Commonwealth Carelink Centres Tel 1800 052 222
Northern Beaches Neighbourhood Service, Inc.: Tel 9982 3044
A request from the Editor. Book reviews, Letters to the Editor, etc. actively wanted (not just "welcomed"). Don't be shy! Write one today, and send it to hmarktw@bigpond.net.au
