Prostate Cancer News - Prostate Cancer Foundation of Australia

Queensland
Prostate Cancer News
The magazine is a publication of the Queensland Chapter, Prostate Cancer Foundation of Australia.
June 2012
In this issue
Letter from the Editor,
Medicine and science are always
evolving. It is not that long ago that
the only test available for detection of
prostate disease was by estimating
levels of an enzyme called acid
phosphatase in the blood. The problem
Editor - Judith with this test was that an elevated acid
O’Malley-Ford. phosphatase level carried with it the
MBBS (Qld),
inherent knowledge that prostate cancer
MPH, JP(Q),
had already metastasised to the bones.
FRACGP
Then came prostate specific antigen
or PSA, which looked promising for detecting disease
earlier, but it is not a highly specific test. In addition, levels
of PSA may vary depending on a number of factors,
such as recent sexual activity, strenuous exercise, and
the presence of urinary tract infections and thus may
vary accordingly. It is important to take these factors into
consideration when looking at PSA results.
Age related levels of PSA are commonly quoted, but
in the very early stages of prostate disease, it is difficult
to know if changing levels of PSA represent cause for
serious concern.
Refinement of PSA levels has led to the estimation of the
PROSTATE HEALTH INDEX, which is now being offered
as an improvement and refinement in diagnostic ability
for prostate cancer.
Other forms of prostate assessment are available with the
advent of radiological and surgical investigation techniques
for prostate cancer detection apart from the oldest method
of examination, the DRE or digital rectal examination.
Ultrasound examination and prostate biopsy add to the
diagnostic paradigm of prostate cancer.
2
Resources: Web Links,
Associated and Affiliated Groups.
Whilst ultrasound investigation is a relatively noninvasive technique of assessment, prostate biopsy on
the other hand is a much more invasive procedure and
carries with it more inherent risk, particularly that of
post-procedure infection. In addition, prostate biopsy
often requires that multiple biopsies be taken at the
time of the procedure which adds to the potential risk
of infection.
3
Peer Support Volunteers Wanted.
Contributing Guest Editor: The
Plight of Men with Prostate
Cancer in Country Queensland.
4
Pizza Could Cure Cancer,
Study Says.
Making an early diagnosis of prostate cancer is
essential for achieving the best surgical results,
minimising the risk of spread of the disease, reducing
the likelihood of post-operative side effects and most
significantly ensuring long term disease-free survival.
Improving the yield of information from the PSA
estimation has been a positive step in the direction of
better diagnostic procedures for prostate disease and
for the wellbeing of men, especially those with prostate
cancer. This milestone is another positive step towards
better outcomes.
There will always be new ways of doing things as
long as there is continuing medical research and
development, and curious minds to challenge the
status quo and to ask the important and relevant
questions.
Editor
Calendar of Events 2012
Prostate Cancer Foundation of Australia www.prostate.org.au Cancer Council Queensland www.cancerqld.org.au
T 1800 22 00 99
T 1300 65 65 85
June 3-9
Bowel Cancer Week www.bowelcanceraustralia.org
June 10-17
Men’s Health Week www.menshealthweek.org.au
July 22-29
National Pain Week www.nationalpainweek.org.au
Anytime
BBQ for Prostate Cancer www.pcfa.org.au
Anytime
C-vivor (free sessions) www.cancerqld.org.au
Nov 19
International Men’s Health Day. Keep the day free for a celebration event.
www.pcfa.org.au
5
Spotlight on Central Queensland (Rockhampton).
6
Public System Delays Diagnosis
and Treatment of Prostate Cancer.
7
Abbott Licenses Biomarkers for use in differentiating Aggressive From Nonaggressive Prostate Cancer.
8
Radical Prostatectomy Versus
Watchful Waiting in Early
Prostate Cancer.
10
Does Smoking History Predict PDA Levels in a Clinically Significant
Manner?
11
Conference Report ‘The Oncology Nurse Community’.
New Prostate Heath Test - Prostate Health Index.
12
Men’s Health Daily Dose
Newsletter - True Story.
Problems with the PSA Test.
13
News Round Up.
14
Vale Garry Franklin.
A Urine Test to Detect
Prostate Cancer.
15
‘The Inbox’, Tell Your Story to
Readers of QPCN, Bonus for Subscribers.
16 Letters to the Editor; Forward a Copy; Thought for the Day. Brisbane
Program; Contact Us; Disclaimer; Privacy.
[email protected]
The Queensland Chapter of the Prostate Cancer Foundation of Australia is grateful for the
generous support of Cancer Council Queensland in the printing of this magazine. The content of
this magazine is selected by the Queensland Chapter of the PCFA. Cancer Council Queensland
does not necessarily endorse, or otherwise, any content contained within this publication.
Resources
Andrology Australia
www.andrologyaustralia.org
Ph 1300 303 878
Andrology Australia is the Australian Centre
of Excellence in Male Reproductive Health.
APCC Bio-Resource
www.apccbioresource.org.au
The national tissue resource underpinning
continuing research into prostate cancer.
Australian Prostate Research
Centre – Queensland
www.australianprostatecentre.org
Research, collaborative opportunities,
clinical trials, industry news.
Cancer Council Helpline
Ph 13 11 20
8am-6pm Monday to Friday.
www.cancerqld.org.au/cancerHelpline
Mater Prostate Cancer
Research Centre
www.mmri.mater.org.au
Comprehensive information for those
affected by prostate cancer, including
the latest research news.
Cancer Council Queensland
www.cancerqld.org.au
Research to beat cancer and comprehensive
community support services.
Cochrane Library
www.cochrane.org
Australians now have free access to the best
available evidence to aid decision-making.
Prostate Cancer Foundation
of Australia
www.prostate.org.au
Phone 1800 22 00 99
Assistance with the experience of diagnosis
and treatment for prostate cancer.
HealthInsite
www.healthinsite.gov.au
Your gateway to a range of reliable, up-to-date
information on important health topics.
Queensland Chapter
www.prostate.org.au
Information, patient support materials, and
contacts for advice on living with prostate
cancer in Queensland.
Lions Australian Prostate Cancer
www.prostatehealth.org.au
The first stop for newly diagnosed men
seeking information on the disease.
Prostate Cancer Support Groups in the Queensland Chapter
There are 23 PCSGs in the Chapter with a total membership of approximately 3,300 men.
Peer Support Group
Contact
Phone
Peer Support Group
Contact
Phone
Advanced (all areas)
Jim Marshall
07 3878 4567
Hervey Bay
Ros Male
07 4197 7244
Beenleigh
Peter Keech
0407 070 194
Ipswich
Terry Carter
07 3281 2894
Brisbane
Peter Dornan
07 3371 9155
Mackay
Philip Lane
07 4957 2518
Bundaberg
Rob McCulloch
07 4159 9419
Maryborough
Leoll Barron
07 4123 1190
Capricorn Coast (Yeppoon)
Jack Dallachy
07 4933 6466
North Burnett
Russell Tyler
07 4161 1306
Central Queensland
(Rockhampton)
Lloyd Younger
07 4928 6655
North Queensland (Townsville)
Clarke Berglin
07 4773 3303
Far North Queensland (Cairns)
Jim Hope
07 4039 0335
Northern Rivers (Evening)
Craig Thurgate
0412 661 942
Far North Queensland Partners
Margaret Rolfe
07 4045 1031
Northern Rivers (Day)
David Hughes
02 6687 0008
Gladstone
Geoff Lester
07 4979 2725
Northern Tablelands
Peter Martin
07 4096 6315
Glass House Country
Bob McLean
07 5496 9601
North West Qld (Mt Isa)
Yvonne McCoy
07 4743 2054
Gold Coast Central
Peter Jamieson
07 5570 1903
Sunshine Coast
Rob Tonge
07 5446 1318
Gold Coast North
John Caldwell
07 5594 7317
Toowoomba
David
Abrahams
07 4613 6974
Gold Coast Partners
Maggie Angus
07 5577 5507
Twin Towns and Tweed Coast
Ross Davis
07 5599 7576
Gympie
Robert Griffin
07 5482 4659
Whitsunday
Dave Roberts
07 4945 4886
Associated Support Groups
2
Group
Contact
Phone
Group
Contact
Phone
Brisbane Partners
Wendy Marshall
07 3878 4567
Innisfail
Desleigh Barrow
07 4061 9177
Kingaroy
Robert Horn
07 4690 5800
PEER SUPPORT VOLUNTEERS WANTED
Are you interested in making a difference for other men facing
prostate cancer diagnosis and treatment? If so, we need your
help! We are looking for men interested in becoming Peer Support
Volunteers for the Living with Prostate Cancer project, part of the
prostate cancer research program at Cancer Council Queensland.
The Living with Prostate Cancer program delivers telephone-based
support and information to men recently diagnosed with localised
prostate cancer. It combines self-management and group peer support
to improve unmet supportive care needs about cancer and physical
activity for men with early prostate cancer. In this project, peer support
is provided through monthly telephone support group meetings for six
months that are led by two specially trained peer support volunteers.
Each group will have two peer support volunteers as leaders to help
manage the group effectively, and the peers will be supported by
a Nurse Counsellor who will also be present during the calls.
The Living with Prostate Cancer team includes psychologists, nurses
and research staff and we will provide you with all the necessary
training to take on this important role. The training will be held at the
Cancer Council Queensland Brisbane office
If it is more than 12 months since your treatment and you would like to
find out more about the Peer Support Volunteer role, please contact the
Project Manager, Anna Stiller, on (07) 3634 5356 or email
[email protected].
CONTRIBUTING GUEST EDITOR: THE PLIGHT OF MEN WITH
PROSTATE CANCER IN COUNTRY QUEENSLAND
Many of us in the support group network of the Prostate Cancer
Foundation of Australia [PCFA], as volunteers are concerned for the
public patients who live outside the city. Men in Country Qld confront
shortages of services and in some locations medical skills to deal
with prostate cancer are simply not good enough. This factor is
compounded by having to travel long distances to access doctors
and this in turn results in men tending to delay seeking help until their
symptoms or discomfort become serious.
Prostate cancer is a very difficult disease to diagnose in its early stage.
The most urgent need today, as emphasised by researchers, is the
need to find a better and more accurate method of diagnosis. Men who
are self employed, or are employed for example by a mining company
or a local council, in fact any man who lives and works well away
from health services is impacted by the time and distance factors to
access doctors and hospitals where skill shortages for dealing with this
disease are often a factor.
Some time ago, I received a phone call from a gentleman who was a
drag line operator working at a major mine. He drove to his local doctor
some 100 kilometres distance asking for a check up and blood test to
determine his PSA level. Some 12 months later he developed specific
prostate symptoms. The end result was the man had to fly to Brisbane
for treatment which included eight weeks of radiotherapy plus a long
duration of other drugs with long term side effects. As he said, with
some sense of humour, ”The new kitchen will have to wait,” as he
had to enter into a short term rent agreement to be near the medical
treatment. Think about what could have been if the doctor had been
more aware of the facts of this terrible disease. Many men seek help
in the city, which means not only time away from the family but big
costs of travel and short term rent agreements, both compromising
disincentives to care for their health.
Cancer Council Queensland is doing a fantastic job providing advice
and accommodation for some cancer patients, but the demand for
assistance far exceeds the supply of resources.
Another gentleman rang me from a hospital in North Qld where he was
about to have a prostate biopsy and the anaesthetist did not arrive. He
eventually came to Brisbane, found that he had early prostate cancer,
had the prostate removed and after a month had no side effects. Being
a public patient he borrowed the money on his family house to pay for
immediate private surgery.
Not infrequently, men in country Australia receive a delayed diagnosis
of prostate cancer for a variety of reasons which include difficulty of
access to medical services, reluctance to raise the topic of urinary
symptoms and the fear of the diagnosis itself. Often the delayed
diagnosis arises from lack of awareness regarding the possibility of the
disease, and the fear of what it might entail. Prostate cancer diagnosis
is difficult for many men in the country as it can be just luck that they
find out early or late.
It is logical that many men want to come to the city for medical
help for prostate cancer treatment because they hear a long list of
problems from others, information which is often exaggerated by
country folklore. Men hear of the good doctors in the city and about
those doctors who do nothing else except treat prostate cancer. The
problem in the city is the ever increasing load on hospital urology
departments caused by the ever increasing incidence of this terrible
disease, terrible because it can cause a state of terror in a man when
told of the diagnosis. I will remember for the rest of my life where I was
standing when the phone call came from the urologist. Men suffer a
multitude of thoughts at that instant.
I remember a phone call from a man who had just been diagnosed with
prostate cancer. He wanted to know how to achieve the best outcome,
so he came to the city and found he had advanced cancer. He cried
while he told me he had 400 people employed and would have to sell
the business because he was going to die as he had ignored the early
warning symptoms, or did not understand the significance of the signs.
He received the best treatment, finally accepted he had side effects for
Continued...
3
The Plight of Men with Prostate Cancer in Country Queensland Continued...
life, sold the business and went to Italy to see all the relations. His wife
said to him, “So you can see there can be a benefit in being a victim.
It has saved our marriage.”
Whilst access to health information is taken for granted in the city it
should not be taken for granted that the same ease of access exists
for country people, especially people in remote places in this vast
country of ours.
The Prostate Cancer Foundation of Australia has received an ongoing
grant to assist to open new support groups. I am often asked what the
benefits of a support group are. My answer is there are many answers
to that question but probably the biggest advantage is to be able to talk
to other men who have experienced the curse of prostate cancer. This,
for many men, is the first opportunity to listen and talk to other men
openly about their issues and problems. The most moving experience
for me was when a stranger came to the Brisbane Support Group and
stood up in front of the meeting and told us with tears on his cheek that
he had been told he had about five months to live. Those present were
moved and some set out to help. At the end of the night everyone knew
him and he was laughing at jokes and comments as he found himself
around friends who really cared as some had similar problems.
Support groups are not for everyone but they do provide an experience
and an opportunity to understand the disease from a different
perspective to that discussion they have with their GP and/or urologist.
Not all GPs are aware of the existence of prostate cancer support
groups, and not all men are made aware of the groups by their
urologist. There is a role here for the Prostate Cancer Foundation to
increase awareness amongst the professionals, and to encourage a
partnership in treatment and support for men with prostate cancer.
A support group is a very different place to be when compared to the
office of the GP, or indeed that of the specialist urologist or hospital
outpatient department. Each has a distinctive role and the functions
compliment each other to the benefit of the patient and his family and,
most of all, allow dialogue in the decision making process regarding
appropriate treatment.
In 1984 the Federal Government handed the responsibility for a range
of costs to the States as part of a rearrangement of the so-called
Grants Commission. This included an agreement to fund the Patient
Travel Subsidy Scheme [PTSS] and including an undertaking to
maintain the level of service with adjustments based on the inflation
rate or some similar method. Since that date there have been many
efforts by many organisations and individuals in Queensland to gain
an increase, and today it remains the same rate except for a 10 cent
increase per kilometre in the travel rate and GST on accommodation
[$30.00 plus GST]. The LNP Government has announced it will increase
the contribution by 100%. Past years have been grossly unfair to many
country patients and their families and have contributed to the fact that
many men with prostate cancer find out they have this disease when it
has reached a more advanced stage.
There is no doubt that more urologists are being trained in the
speciality and some are more than willing to go to the country where
new cancer centres are being opened, Cairns being a good example.
The travel and accommodation problems remain for many - a recent
example was it is cheaper to fly to Brisbane from Mt Isa than to go to
Townsville.
My suggestion is to make sure all new politicians are reminded
on a regular basis that $60 per day does not “buy” a bed in almost all
motels and hotels, and that patients and their families still have to travel
long distances and find accommodation to access health services
in many parts of Queensland. Why should those men who live in the
country be at such a disadvantage when compared to those in the city?
Ian Smith
Brisbane Support Group,
Deputy Chair
Queensland Chapter Council
Member Queensland Board
Prostate Cancer Foundation of Australia
PIZZA COULD CURE CANCER, STUDY SAYS
By Clarissa Wei, 1 May 2012, Categories: Health, Pizza
Can pizza be the cure to cancer? According to a new study by researchers
at Long Island University the herb oregano, a key ingredient in most pizza
sauces, can potentially be used to treat prostate cancer.
“We know that oregano possesses antibacterial as well as antiinflammatory properties, but its effects on cancer cells really elevate
the spice to the level of a super-spice like turmeric,” said Dr Supriya
Bavadekar, Assistant Professor of Pharmacology.
Dr Bavadekar’s research shows that carvacrol, a component of oregano,
induces apoptosis or “cell suicide”. Dr Bavadekar and her team are
currently trying to pinpoint exactly how the compound causes this
cancer cell suicide.
4
This isn’t the first time the Italian dish has been associated with cancercuring properties. “Some researchers have previously shown that eating
pizza may cut down cancer risk,” Dr Bavadekar said. “This effect has been
mostly attributed to lycopene, a substance found in tomato sauce, but
we now feel that even the oregano seasoning may play a role.”
Though the study is at its preliminary stage, Dr Bavadekar believes
the compound in oregano has a huge potential in being used as
an anti-cancer agent. “If the study continues to yield positive results,
this super-spice may represent a very promising therapy
for patients with prostate cancer,” she said.
SPOTLIGHT on
Central Queensland (Rockhampton)
‘Welcome’ is the first sign you see as you travel from town to
town throughout Central Queensland (CQ) and this is especially
so when arriving in Rockhampton, the hub of CQ.
Rocky, as it’s affectionately known, is famous not only for its
welcome but also for the Bulls that accompany it! There is at least
one on every main road and many of the local businesses have
been able to incorporate them into their facades and logos. The
Great Western Hotel (a local watering hole) has got an arena that
regularly hosts rodeos and bull riding competitions and, of course,
has great steaks!
The city, situated on the Tropic of Capricorn (look for the Spire at the
Information Centre), sits on the Fitzroy River which has the second
largest catchment area in Australia. No wonder it has been flood
prone in the last few years! A stroll along the river bank will take you
past many beautiful old buildings such as the Criterion Hotel (said to
have its own ghost), the Customs House and Walter Reid Buildings.
For another trip back in time head out to the Heritage Village. There
are several old houses, a school, hospital, church, fire station and
various workshops. This was the venue for a stop-over for the
Rumble Riders in past years who raised large amounts of money
for the Prostate Cancer Foundation of Australia (PCFA).
following: Blackwater
Mine Workers Club
Charity Golf Day
$16,200, Rocky Crocs
Masters Swimming Club
$2,000, Rockhampton
Correctional Centre $963,
Rockhampton Chapter
Order Eastern Star $100,
North Rockhampton
Bowls Club $2,023
(donated to prostate
cancer research),
Gracemere Croquet Club
$300, Fishing Competition
held in Moura with the
John Milne on the Hustings Creating
Awarenes
proceeds of $8,200
donated to PCFA and
Ergon Energy $3,000, also donated to PCFA. Carol Hobson and her
merry band of helpers ran two very successful charity golf days
raising $7,091.
From Rocky there are many and varied sights to be seen in our
area, the beautiful coastline around Yeppoon and Emu Park, a day
trip to Great Keppel Island, the rugged hills of Mount Morgan (known
for its old gold and silver mines) and the township of Emerald with
its cotton, beef and gemstone attractions.
The Central Queensland Prostate Support and Awareness Group has
been part of the local scene for many years. It was established in
October 1999 under the guidance of Dr Kenny P’ng. The meetings
were originally held at Hillcrest Hospital but since then we have had
a couple of moves with our current location being the Community
Health Centre.
Nowadays we have a membership of over 120 with regular meeting
attendances of 35 to 40. The Group is steered by Lloyd Younger
(Chairman), John Milne (Vice-Chair), Rita Milne (Secretary) and
Graeme Dougan (Treasurer). Until recently, John Milne and Bill
Forday were representatives on PCFA’s Queensland Chapter Council.
For several years now Lloyd has been actively promoting men’s
health issues and prostate cancer awareness. He has visited Rotary
Clubs, Stanwell Power Station and the Railway Electrical Workshops
talking, presenting and encouraging his listeners to become more
aware of male health matters, particularly prostate problems, and to
spread the message whenever and wherever appropriate.
Lloyd and John are often called upon as representatives to accept
donations. We have been very fortunate to receive help from the
Gordon Campbell, Fran Campbell, Kevin Hinchcliffe,
Jenny Leyland with fellow members John Milne, Don
Neaton in background
Our members all look forward to reading Rita’s regular newsletters
each month. She does a great job of keeping us up to date about
various members’ health, up and coming guest speakers and
reminders of meeting dates. The guest speakers are from a
variety of backgrounds, and willingly share their knowledge and
expertise with us. We have been particularly privileged to have
hosted Professor Colleen Nelson and Dr Bruce Kynaston, with local
presenters being Sherree Schnieder (Physiotherapist), Joe Keoch
(Organ Donation), Alana Richardson (Rockhampton Cancer Council
Accommodation), Peter Aylwood (Public Trustee) and Dr Peter
Reaburn (Exercise).
A regular event on the Group’s calendar is the Bunnings Sausage
Sizzle in September, International Prostate Cancer Awareness
Month. This is always well supported by the members and is a
Continued...
5
SPOTLIGHT on
Central Queensland (Rockhampton) Continued...
major fundraiser for the Group. It’s a very busy day with lots of
laughter and camaraderie. Last year we raised $1,055.
collaboration and innovation. This was an excellent opportunity for
us to reach out to the “Man on the Land.” We had a booth as usual
and many busy support group members donated their time to talk
and hand out information pamphlets. A great time to fly the flag!
Every group enjoys a social outing and ours is no exception. We
usually have a couple of luncheons during the year and run a very
popular Multi-Draw. With over 40 prizes (wine, chocolates, scratchits, novelty items) it is always well supported and many people
leave with something tucked under their arm!
Lloyd Younger, Betty Hinchcliffe, Kevin Hincliff,
Bill Forday, Len Mahon, Fran Campbell and,
Marie Mahonenjoying at the mid-year luncheon
at Suzies CQU
Rocky is known as the Beef Capital of Australia and hosted BEEF
AUSTRALIA in May 2012. The BEEF Expositions are one of the
world’s great cattle events and are held triennially in Rockhampton.
The organisers expected over 75,000 international, interstate
and local visitors to attend the latest in beef cattle production,
During the winter months Central Queensland is a destination for
the “Grey Nomads”, with caravans, recreational vehicles, boats and
bikes in tow. We have great weather and lots to see and do!
The Central Queensland Prostate Support and Awareness
Group meets on the third Thursday of the month and like the
sign says “VISITORS WELCOME!” So if you are holidaying in the
area please join us.
Lloyd Younger 07- 4928 6655
John Milne 07- 4936 3434
PUBLIC SYSTEM DELAYS DIAGNOSIS AND TREATMENT
OF PROSTATE CANCER
Press release CCQ, 14 March 2012. Gemma Ward, Media
Manager, Cancer Council Qld (07) 3634 5372.
Research has found differences in waiting times for diagnosis and
treatment of prostate cancer between the public and private health
systems, with public health patients likely to wait longer than private
patients. The study by Cancer Council Queensland is the first of
its kind to demonstrate the link between delayed diagnosis and
treatment for prostate cancer and the Queensland health service
system. Lead researcher, Associate Professor Peter Baade, said
targeted strategies were needed to address the inequity.
“The results of our study show that there are systematic differences
in men’s prostate cancer management, both for diagnosis and
treatment,” he said.
“These differences are predominately related to access to private
hospital care, suggesting that there are inequities in health-care
service provision that are system based.
“Without acknowledgment and targeted strategies, these inequities
are likely to persist and widen as health-care budgets tighten and
prostate cancer incidence increases, and indeed there is ecological
evidence that this is occurring.
6
“It is hoped that the results of this study will increase the
motivation of Government and health care planners to act.” The
study found men without private health insurance were twice
as likely to wait more than 70 days for a definitive diagnosis and
nearly three times as likely to wait more than 70 days between
diagnosis and treatment.
“While the clinical implications of delay to diagnosis and treatment
for prostate cancer are unclear, longer time intervals before and
after diagnosis mean greater uncertainty and accompanying
anxiety,” A/Prof Baade said.
“With its high and increasing incidence and substantial treatment
burden, the management of prostate cancer is a critical issue.”
Prostate cancer is the most common cancer diagnosed in
Queensland men.
“Importantly, the findings suggest that greater funding and
resources is urgently required to improve clinical care for men
with prostate cancer by ensuring men receive better education
and decision support about diagnosis and treatment at the
primary care level.”
ABBOTT LICENSES BIOMARKERS FOR USE
IN DIFFERENTIATING AGGRESSIVE FROM
NONAGGRESSIVE PROSTATE CANCER
Reference. BIORESEARCH ONLINE - Company’s website at
http://www.abbott.com/, 17 April 2012
Detection of Gene Abnormalities May Help Men Determine
the Best Approach to Treatment
Abbott Park, Ill/PRNewswire/ - Abbott announced today it has
acquired an exclusive license for several novel biomarkers from
Stanford University for use in developing a molecular diagnostic
test that could satisfy a longstanding unmet medical need:
differentiating aggressive from nonaggressive prostate cancer.
Recent data point to certain genetic biomarkers that may identify
which patients have fast-growing malignancies and should be
treated aggressively versus those who can be directed to “active
surveillance” or close monitoring. The National Comprehensive
Cancer Network prostate cancer treatment guidelines were also
recently updated to include recommendations for patients who
fall into these categories.
“Developing a clinically validated prostate cancer prognostic assay
with actionable data represents the ‘holy grail’ in improving disease
management,” said James Brooks MD, Associate Professor and
Acting Chair, Department of Urology, Stanford University Medical
Center. “It clearly would fulfill an unmet medical need to help men
with prostate cancer know which treatment options will yield the
best outcomes for their long-term survival and best quality of life.
Certain men found to have slow-growing cancers could safely
opt for no treatment and avoid life-altering side effects.”
Prostate cancer, the second most common cancer in men, with
an estimated US prevalence of 2.3 million, is usually diagnosed
with a biopsy of prostate tissue. If cancer is found, the patient
and physician must decide on treatment options, ranging from
no treatment to aggressive management with radiation and
chemotherapy or surgical removal of the prostate. Because prostate
cancer treatments may have side effects like erectile dysfunction
and urinary incontinence, treatment decisions may focus on
balancing therapeutic goals with a patient’s age and other factors
such as diet, exercise and lifestyle. In most cases, decisions rest
on health-adjusted life expectancies.
In certain men, prostate tumors may grow so slowly that no
treatment is required. However, there is no test or procedure
available at this time that can optimally discriminate benign from
aggressive disease. Fearing the worst outcomes, many men opt
for aggressive treatment even though it might not be needed.
Abbott will develop a molecular assay based on its proprietary
FISH (fluorescence in situ hybridization) technology to detect
rearrangements of the ERG and ETV1 genes and measure loss of
the PTEN gene. A study published in the British Journal of Cancer
evaluated 308 men diagnosed with prostate cancer who were
treated conservatively. Those who did not show ERG/ETV1 genetic
aberrations with no PTEN gene loss had excellent prognosis,
evidenced by an 85 percent survival rate after 11 years. Men who
showed PTEN gene loss in the absence of the gene rearrangements
had a poor survival rate of 13.7 percent. The study showed the
promise of the new biomarkers to identify patients who would
benefit most from intensive therapies.
Abbott’s FISH probes to detect the ERG/ETV1 gene and measure
PTEN gene loss will be evaluated as part of scientific research
starting some time later this year. “This is a meaningful
breakthrough for men who have to make the agonizing decision
regarding treatments for prostate cancer,” said Stafford O’Kelly,
head of Abbott’s molecular diagnostics business. “Without knowing
if the cancer is life threatening, men have no way to know if
prostate surgery or chemotherapy is the right option. This newest
advance in personalised medicine will provide individualised
genetic evidence for informed clinical decision making in choosing
the right approach to prostate cancer treatment.” Abbott is a
leader in personalised medicine through its ongoing development
of molecular diagnostic tests for use in new drug research and
targeted cancer therapies and treatments.
About Abbott Molecular
Abbott Molecular is a leader in molecular diagnostics the analysis of DNA and RNA at the molecular level. Abbott
Molecular’s tests can also detect subtle but key changes in
patients’ genes and chromosomes and have the potential for
earlier detection or diagnosis, provide information relevant to the
selection of appropriate therapies, and may improve monitoring
of disease progression.
7
RADICAL PROSTATECTOMY VERSUS
WATCHFUL WAITING IN EARLY
PROSTATE CANCER
Anna Bill-Axelson MD PhD, Lars Holmberg, et al
N Engl J Med 2011; 364:1708-1717 5 May, 2011.
The randomised Scandinavian Prostate Cancer Group Study
Number 4 (SPCG-4) showed that radical prostatectomy decreased
the risk of metastases, the rate of death from prostate cancer,
and the rate of death from any cause. Although the participants in
SPCG-4 were predominantly men whose cancers were detected
on the basis of symptoms, rather than by elevated prostate-specific
antigen (PSA) levels, prostate-cancer events have also accumulated
during an extended follow-up period in a subgroup of men with
low-risk disease. Determining whether there is a survival benefit
for men with low-risk disease is relevant in light of the risk of
over diagnosis resulting from PSA testing and the adverse events
associated with therapy. Whether the previously observed lack
of benefit in men older than 65 years of age and the absence
of increased benefit after 9 years of follow-up persist is also of
interest. We now present estimates of 15-year results, with
a median follow-up period of 12.8 years.
Methods
Subjects
Between October 1989 and December 1999, at 14 centers in
Sweden, Finland, and Iceland, we randomly assigned 695 men
with newly diagnosed, localised prostate cancer to radical
prostatectomy or watchful waiting, as described in detail in a
previous report and in the study protocol (available with the full
text of this article at NEJM.org).
Men were eligible for inclusion in the study if they were younger
than 75 years of age and had a life expectancy of more than 10
years, had no other known cancers, and had a localised tumor
of stage T0d (later named T1b), T1, or T2, as assessed according
to the 1978 criteria of the International Union against Cancer.
After revision of the staging criteria in 1987, T1c tumors were
also included starting in 1994. On the basis of the results of a
core biopsy or fine-needle aspiration, the tumor had to be well
differentiated to moderately well differentiated according to the
World Health Organization (WHO) classification. All patients included
in the study were required to have a serum PSA level of less than
50ng per milliliter and a negative bone scan.
Results
A total of 347 men were assigned to the radical-prostatectomy
group, and 348 to the watchful-waiting group. The baseline
characteristics of the two groups were similar; the mean age of the
men in both groups was 65 years. Only 12% of the patients had nonpalpable T1c tumors at the time of enrollment in the study. The mean
PSA level was approximately 13ng per milliliter. By 31 December
2009, a total of 294 men in the radical-prostatectomy group had
undergone a radical prostatectomy, and 302 men in the watchfulwaiting group had not undergone curative treatment. The median
follow-up time was 12.8 years (range 3 weeks to 20.2 years).
Histopathological Characteristics in the RadicalProstatectomy Group
Positive surgical margins, which were present in 99 of the 283
prostatectomy specimens that could be evaluated, were associated
with a poor prognosis in a model that adjusted only for age.
However in a multivariate analysis that included extra-capsular
tumour growth, PSA level at randomisation, and Gleason score,
the relative risk associated with positive surgical margins was not
significantly increased (data not shown).
Extra-capsular tumour growth was found in 132 of the 284 radicalprostatectomy specimens (46%); tumours with extra-capsular
growth, as compared with those without extra-capsular growth,
were associated with a risk of death from prostate cancer that was
increased by a factor of 7 (relative risk, 6.92; 95% CI, 2.6 to 18.4).
Gleason score was also highly predictive of the risk of death from
prostate cancer; among 129 men who had tumours with Gleason
scores of 2 to 6, only 5 died from prostate cancer (data not shown).
Discussion
As of the current follow-up analysis, there continues to be a
significant reduction in the rate of death from any cause, the rate
of death from prostate cancer, and the risk of metastases in the
radical-prostatectomy group as compared with the watchfulwaiting group. The benefit is obvious among men younger than
65 years of age, but it is still unclear whether the benefit extends
to older men. The risk of death from prostate cancer after radical
prostatectomy among men who had tumours with extra-capsular
growth, as compared with men who had tumours without extracapsular growth, was increased by a factor of 7. We also observed a
benefit of radical prostatectomy among men with low-risk tumours.
The data on mortality are in accordance with our previous follow-up
reports. However, in the current analysis, the number needed to
treat to avert one death was 15, as compared with 19 in a previous
analysis, in the case of the whole cohort, and the number was 7 in
the case of men younger than 65 years of age. A previous analysis
Continued...
8
indicated that the difference between the two groups remained
constant after 9 years. In the current analysis, a continuing benefit
with radical prostatectomy was observed also after 9 years of
follow-up.
The finding that the effect of radical prostatectomy is modified
by age has not been confirmed in other studies of radical
prostatectomy or external-beam radiation. The SPCG-4 data show
that men younger than 65 years of age in whom the tumor is left
in situ have a worse outcome than do all other subgroups. The
apparent lack of effect in men older than 65 years of age should
be interpreted with caution because, owing to a lack of power, the
subgroup analyses may falsely dismiss differences. At 15 years,
there was a trend toward a difference between the two groups in
the development of metastases, and more men in the watchfulwaiting group than in the radical-prostatectomy group died from
causes other than prostate cancer, but with metastases present.
Current hormonal treatments might induce remissions long enough
for older patients to die from other diseases. Therefore, competing
risks of death may blur the long-term effects of treatment, and
different classification rules of disease-free survival will influence
survival estimates.
The cumulative incidence in our study of death from prostate
cancer among men treated with radical prostatectomy was high
as compared with the incidence in other studies; nearly 80% of the
men enrolled in our study had palpable tumors, with extra-capsular
tumor growth in 46% of the radical-prostatectomy specimens.
All but five men who died of prostate cancer in the radicalprostatectomy group had extra-capsular tumor growth. Although
extra-capsular growth is not a perfect predictor of lethal disease,
our findings indicate that these men could be a group for which
adjuvant local or systemic therapy would be beneficial. In studies
of active surveillance, a high proportion of patients with extracapsular growth among those who were switched to radical
prostatectomy could be an indication that the trigger point for
active treatment is too late.
In men with low-risk disease, the absolute benefit of surgery with
respect to death from prostate cancer and the risk of metastases
was similar to that in the whole cohort. We caution that our low-risk
group cannot be compared directly with men who are currently
included in active-surveillance protocols because few of the men
in our low-risk group had a tumor that was detected by means
of a screening test. Furthermore, the biopsy protocol in this study
entails a lower sensitivity for diagnosing high-risk disease than
the extensive protocol in a more recent study; the lower sensitivity
in our study is highlighted by the reclassification of the diagnostic
Gleason score in the radical-prostatectomy specimens. However,
our findings show that some tumors that are considered to be lowrisk at diagnosis do pose a threat to life, especially if they are not
surgically removed.
The cumulative incidence of side effects of surgery reflects a
situation in which, historically, the need for radical excision of the
tumor dictated extensive surgery more often than is the case today.
Furthermore, the surgical techniques were not as well developed,
and the number of surgeries performed was far from today’s
levels. The data in the current analysis are based on information
from medical records. We have previously shown that a complete
understanding of the complex balance in effects between surgery
and watchful waiting also requires obtaining patient-reported
data on the severity of symptoms and on how much the patient is
bothered by them.
The strengths of our study include the randomised design, the
completeness of follow-up, and the independent and blinded
evaluation of the cause of death. Adherence to the assigned
treatment was high despite the diversity of the two interventions.
Our interpretation relies on stable long-term quantitative estimates,
as illustrated in the cumulative-incidence curves and the
consistency of the results over an extended follow-up period. The
subgroup analyses were not pre-specified in the protocol and lack
the power to rule out a treatment difference. We emphasise that
these results should be interpreted with caution and should be
viewed as hypothesis-generating for other studies.
The current analysis adds to our knowledge in several areas.
The benefit of radical prostatectomy continued to be seen beyond
9 years, which contradicts the notion that there is only a distinct
subpopulation that responds to radical surgery with an early
reduction in risk. The accruing numbers of events for the older
age group indicate that in our study, a reduction in disease-specific
mortality is unlikely ever to become apparent in this age group,
owing to competing causes of death. The finding that some lowrisk tumours will progress and become lethal emphasises the
importance of protocols with well-defined end points at which men
in active surveillance switch to curative treatment. With continued
follow-up, data from the SPCG-4 study may allow us to identify
prognostic markers in men assigned to watchful waiting that can
serve as trigger points for active treatment; the prognostic value
of these markers can then be validated in cohorts that are under
active surveillance.
9
DOES SMOKING HISTORY PREDICT PSA LEVELS
IN A CLINICALLY SIGNIFICANT MANNER?
Reference. The New Prostate Cancer Infolink, 21 Feb 2012
A new paper published online in the Journal of Urology
suggests that the PSA and %free PSA levels of current
smokers and former smokers may be statistically significantly
impacted compared to those of men who have very rarely or
never smoked.
Li et al. were able to examine data from 3,820 men, all aged
40 years or older, who had previously participated in the
National Health and Nutrition Examination Survey (NHANES)
between 2001 and 2006.
The men were divided into three groups:
• Men with serum cotinine levels >10ng/ml or who had
smoked at least 100 cigarettes during their lifetime and, at
the time of interview, reported smoking every day or some
days (“current smokers”)
• Men with serum cotidine levels <10ng/ml who had
smoked at least 100 cigarettes during their lifetime and
who responded “not at all” to the question about whether
they smoked now, at the time of their interview, were
classified as (“former smokers”)
• Men with a serum cotidine level <10ng/ml who stated that
they had smoked fewer than 100 cigarettes in their lifetime
(“never smokers”)
*Note that a serum cotidine level of >10ng/ml is associated with
active smoking within the immediately preceding few days.
The core findings of this study were that:
• For all ages and all patients combined
o The average (median) total PSA level was 0.90ng/ml
(range, 0.81–0.90ng/ml).
o The median free PSA level was 0.26ng/ml
(range, 0.25–0.28ng/ml).
• For all “current smokers” (n= 1,188)
o The median total PSA level was 0.80ng/ml
(range, 0.80–0.90ng/ml).
o The median free PSA level was 0.24ng/ml
(range, 0.23–0.25ng/ml)
10
• For all “former smokers” (n= 1,359)
o The median total PSA level was 0.95ng/ml
(range, 0.83–1.01ng/ml).
o The median free PSA level was 0.28ng/ml
(range, 0.27–0.30ng/ml).
• For all ”never smokers” (n= 1,270)
o The median total PSA level was 0.9ng/ml
(range, 0.80–0.94ng/ml).
o The median free PSA level was 0.27ng/ml
(range, 0.25–0.29ng/ml).
• Multivariate linear regression analysis showed that, compared
to “never smokers,”
o The median total PSA level was 7.9 percent lower among
“current smokers”
o The median total PSA level was 12.2 percent lower among
“former smokers.”
• 34.2 percent of all participants had a %free PSA level of
<25 percent.
• “Current smokers” had a significantly lower %free PSA level
than former smokers.
• High body mass index and a diagnosis of diabetes were also
significantly associated with a lower total PSA level.
Exactly what impact such data may have on the interpretation of
PSA levels and the need for a man to have a biopsy cannot be
determined on the basis of a single study like this. It would be
interesting to know if a larger, prospective study could give greater
insight into any association between smoking, PSA level and risk
for diagnosis with relatively indolent or clinically significant forms
of prostate cancer. It should be noted that an 8 to 10 percent drop
in PSA level is small (say from 4.0ng/ml to 3.6ng/ml). It is hard
to believe that the clinical significance of such a change in value
could be accurately determined in a specific individual on the basis
of a single PSA test result - or that it would be likely to make much
difference to whether a primary care physician did or did not refer
the patient to a urologist for further work-up.
CONFERENCE REPORT ‘THE ONCOLOGY
NURSE COMMUNITY’
The data, part of the AFFIRM study, was presented by Dr Howard
I Scher, chief of the genitourinary oncology service at Memorial
Sloan-Kettering Cancer Center, a late-breaking presentation at
the 2012 American Society of Clinical Oncology Genitourinary
Cancers Symposium.
Novel Drug, MDV3100, Will Likely Have a Major Role in Prostate
Cancer Treatment
By Anna Azvolinsky, PhD | 15 February 2012
The new drug, MDV3100, extended overall survival by 4.8 months
(P < .001) in men with castration-resistant prostate cancer who
had progressed after treatment with docetaxel (Drug information on
docetaxel). It also reduced the risk for death by 37% as compared to
placebo. This is an impressive feat. Currently, there is no standard of
care for this group of patients.
MDV3100 is an oral, androgen receptor signaling inhibitor that
competitively inhibits the binding of androgens to the androgen receptor,
and uniquely inhibits the receptor from translocating to the nucleus
and binding DNA. MDV3100 was chosen for development based on
robust prostate cancer model systems and activity in early stage trials
in both chemotherapy-treated and chemotherapy-naive prostate cancer
patients. It is the first in a new class of agents and different from the
mechanism of action of currently available treatments.
In total, 1199 patients were randomised over a 1-year time period
starting in 2009. Patients had advanced disease, about 90% with bone
metastases and 70% with soft tissue metastases.
The estimated median overall survival was 18.4 months for the
MDV3100-treated patients compared to 13.6 months for patients
treated with placebo. MDV3100 treatment was also associated
with a 50% reduction in prostate-specific antigen (PSA) levels in
54% of MDV3100-treated patients compared with 1.5% of placebo
patients. The median time to PSA progression was 8.3 months in the
experimental group compared to 3 months in the untreated group.
Safety was also favorable, with mild adverse events, mostly fatigue,
diarrhea and hot flashes, which were reported in about 2% of patients
in both the experimental and placebo arms. One potential concern is
a rare incidence of seizure seen in 5 patients in the MDV3100 arm.
According to the trial authors, these cases were studied carefully and
could be due to confounding events including brain metastases.
The drug is made by Medivation in collaboration with Astellas. There
is an ongoing clinical trial testing the efficacy of MDV3100 in prostate
cancer patients who have not yet received docetaxel.
Abiraterone (Zytiga) and cabazitaxel (Jevtana) have also recently
showed a benefit in survival in phase III trials among prostate cancer
patients after a docetaxel regime. Cabazitaxel, a microtubule inhibitor,
was approved by the Food and Drug Administration in 2010. The trial
that led to the approval showed a 30% reduced risk of death and
improved overall survival by 2.4 months for cabazitaxel combined
with prednisone. Abiraterone, a steroidal compound with antiandrogen
activity, was approved this April, in combination with prednisone,
demonstrating a survival benefit of 3.9 months.
NEW PROSTATE HEALTH TEST - PROSTATE HEALTH INDEX
Reference source. Dr David Kanoski.
Sullivan Nicolaides Pathology
Sullivan Nicolaides Pathology has introduced the next generation in
prostate health assessment – Prostate Health Index (phi) combines
the results of three blood tests into one index that estimates the
likelihood of histologically confirmed cancer diagnosis on biopsy.
diagnostic accuracy of phi (~75%) over total PSA (~55%) and free/
total PSA ratio (~65%) may provide patients and doctors with better
information to assist in the decision about proceeding with a biopsy.
It is important to note that a Medicare rebate is not available for
phi. The fee for phi is $95 and the patient will be unable to claim
a Medicare rebate towards the cost of the test.
The composite score involves the measurement of 3 proteins;
total PSA, free PSA and p2PSA, an isoform of PSA. The improved
11
MEN’S HEALTH DAILY DOSE NEWSLETTER
- TRUE STORY
(Men's Health Daily Dose Newsletter Editor's note: Men's Health
Daily Dose Newsletter was awarded a 2011 American Society
of Magazine Editor's award for personal service, honoring the
superior and consistent use of print to serve readers' needs and
aspirations, for this article.)
It's June 20th, the first day of summer in 2008. I'm knocked out on
an operating table and a robot is removing my prostate gland. In
April I learned I had stage II prostate cancer, and after questioning
experts and survivors, I've decided surgery is the way to go. Let's
git 'er done. My mom died of cancer, but not me. No way.
Now, almost 2 years later, I'm not going to say, "thank god they caught
it in time...I'm so blessed, each new morning is a miracle...Blah blah
blah blah."
No, what I'm thinking is more along the lines of: I want my
prostate back.
Your prostate gland labors in obscurity. The size of a golf ball, it's tucked
away under your bladder, biding its time until you and your reproductive
system decide to emit the sacred seed. Then the semen assembly line
kicks in: The sperm swim up from your testicles to the seminal vesicles,
and there they are mixed in a happy bath of fructose, vitamin C, and
prostaglandins. This brew then proceeds to your prostate, which tops it
off with enzymes, citric acid, and zinc before your man milk is propelled
out of your body and into hers with rather pleasant smooth-muscle
contractions. This long bomb triumphantly delivers your DNA into the
end zone.
Ah, glory days.
But around the time in your life when you start to think more about
your 401(k) than foreplay, your prostate starts to misfire. It swells in
size, and the swelling clamps your urethra in a vice grip. If the cause of
the swelling is benign, you're lucky. That's what those running-to-themen's-room commercials for Flomax are all about. But some of the
very same symptoms can also be caused by a prostate-cancer tumor.
Prostate cancer is the second most common cancer among men; only
some skin cancers are more rampant. In 2009, it caused an estimated
27,360 deaths - long, slow, embattled deaths, as the cancer spread
beyond men's prostates to nearby bones, notably their spines. Once
the cancer advances past your prostate, you have only a 30 percent
chance of surviving 5 years. But catch it early, before the cancer cells
escape, and your chance of surviving 5 years is 100 percent.
Here's the good news about prostate cancer: Deaths are down
because it is being diagnosed much earlier. In fact, 94 percent of all
diagnoses these days peg the malignancy at stage I or stage II, before
it metastasises beyond the prostate. (Stage III cancers have begun to
break out of the prostate; stage IV cancers have invaded nearby tissue
and bone.) That has resulted in a steadily declining death rate of 4
percent a year since 1994. The declining mortality has generally been
attributed to the widespread use - starting in the 1990s - of a simple
test for the prostate-specific antigen, or PSA.
THESE DAYS, THE PSA TEST IS SO ROUTINE for middle-aged men
that your doctor might order one for you without even asking. My
internist did that for me in the summer of 2007, as part of a regular
physical. Mostly he was worried about my cholesterol levels. The
results showed mildly troubling cholesterol - but a very troubling PSA
number. Standards in place at the time held that it should be less than
4; some evidence has suggested that it should be less than 2.5 if
you're younger than 50. Mine was 12.6.
Read more at Men's Health: http://www.menshealth.com/health/
coping-prostate-cancer#ixzz1oQWWYUVb
PROBLEMS WITH THE PSA TEST
- “PSA screening for early detection of prostate cancer has more
harms than benefits,” USPSTF co-vice chair Michael LeFevre MD,
a professor of family and community medicine at the University of
Missouri, told menshealth.com.
The risk for false-positives looms large: PSA levels can increase
due to an enlarged or inflamed prostate—both benign conditions.
According to the American Cancer Society, only 25 to 35 percent of
men who have a biopsy due to an elevated PSA level actually have
prostate cancer. And unnecessary biopsies are needlessly invasive,
expensive, and carry an acute risk of prostate infection in about 1
percent of patients. There is also the risk of temporary problems
using the bathroom.
12
More Testing Leads to Unnecessary Treatment
“Most prostate cancers are not fast growing and many men are
being treated for cancers that would never cause them harm,” Dr
LeFevre says. Otis W Brawley MD, Chief Medical Officer of the ACS,
noted earlier this year, “Many prostate cancers are cured, but do not
need to be cured.” Then there are the undesirable treatment side
effects: Dr LeFevre says that for every 1000 men surgically treated
for prostate cancer, 200 to 300 will suffer urinary incontinence,
impotence or both; 10 to 70 will experience serious post-operative
complications and five will die within 30 days from complications.
One man’s experience tells how, ‘I want my prostate back.’
NEWS ROUND UP
7 Steps To Prevent Prostate Cancer - It’s one of those weird anatomical-arboreal coincidences: The human prostate is about the size and shape of a
walnut. But what if it really were a walnut? For one thing, you’d never get prostate cancer. Which sounds great, until you realize that you could get “walnut
curculio” or “walnut-husk maggot” instead. Better to deal with the devil you know. And what a devil it is. Last year, 221,000 men (one of them Robert De
Niro) were diagnosed with prostate cancer; that’s more than lung, colon, and brain cancers combined. And nearly 29,000 men died of it last year. These are
grim statistics, but there’s reason to be optimistic. Make that seven reasons. Here is the latest, hot-out-of-the-lab research on how you can prevent, detect,
and treat the disease. Putting this science into action (read: more sex, more wine) won’t confer absolute immunity, but it will make your prostate one tough
nut to crack. TAKE CHARGE OF YOUR HEALTH, BODY, AND LIFE!
1. Love Thyself - As if masturbation didn’t already provide enough of a payoff, a recent Australian study found that DIY sex may also help prevent prostate
cancer. The study of 2,338 men showed that the guys who masturbated five or more times a week were 34 percent less likely to develop prostate cancer
by age 70 than those who handled matters less often. “Seminal fluid contains substances that are carcinogenic,” says Graham Giles, PhD, the lead study
author. “Regular ejaculation may help flush them out.” And in case you’re wondering, no, masturbating more than once a day won’t offer more protection,
and yes, straight-up sex works, too. But before you have unprotected nookie with your partner, be sure she’s been tested for cytomegalovirus, a type of
herpes recently found in cancerous prostate tissue.
2. Be Happy You’re Going Bald - Turns out the hair-loss drug Propecia has one impressive side effect. In a National Cancer Institute (NCI) study of 18,882
men, researchers found that the men who took 5 milligrams (mg) of Propecia, aka finasteride, daily for 7 years had a 25 percent lower risk of prostate cancer
than those taking a placebo. Finasteride blocks production of dihydrotestosterone, a hormone that triggers hair loss and prostate growth. “It’s the first study
to prove that prostate cancer is preventable,” says Peter Greenwald MD, the NCI’s director of cancer prevention - and one of those 18,882 men. “My prostate’s
normal,” he adds. One caution: Men on finasteride had a slightly greater chance of being diagnosed with a more aggressive form of the disease than did the
placebo takers. More research on the drug is needed, but if you’re concerned about prostate cancer, discuss these findings with your doctor.
3. Wine and Dine - There’s a good reason Western European men have lower prostate-cancer rates than we do. And it has nothing to do with Speedo
thongs. New research suggests that certain staples of the Mediterranean diet have prostate-cancer-fighting properties. For starters, a recent study
published in the Journal of the National Cancer Institute shows that men who eat more than 10grams (g) of garlic or scallions (about three cloves of garlic
or 2 tablespoons of scallions) daily have a 50 percent lower risk of prostate cancer than those who eat less than 2g. (Give credit to organosulfur compounds,
which are common to both vegetables.) Then there’s red wine; red grapes are flush with resveratrol, an antioxidant found in some plants that may help
inhibit the growth of prostate cancer, according to a report from the MD Anderson Cancer Center at the University of Texas. A glass or two of red wine daily
should suffice. “If you drink too much,” says Catherine O’Brian PhD, the lead study author, “you can neutralize the beneficial effects.”
4. Lower the Bar - Here’s a PSA (public-service announcement) regarding your PSA (prostate-specific antigen): Using a score of 4.1 or greater as the alarm
for prostate cancer could prove fatal. A recent study of 6,691 men, published in the New England Journal of Medicine (NEJM), showed that this traditional
threshold for ordering a follow-up biopsy may be missing 82 percent of prostate-cancer diagnoses in men under 60. “The threshold of 4.1 that’s being used
has never been rigorously studied,” says Karen M Kuntz, ScD, one of the study’s authors. And while critics say a lower threshold will lead to unnecessary
biopsies, Rinaa Punglia, MD, another of the study authors, believes that the broader standard could be worth it. “It’s a trade-off,” she admits. “But it could
save lives.” So how low should you go? Dr Punglia recommends that when you have your PSA level checked (annually beginning at age 50 - or 45 if you
have a family history or are African-American), you observe a threshold of 2.6, especially if you’re under age 60; according to the NEJM study, following this
guideline doubled the cancer-detection rate, from 18 percent to 36 percent.
5. Calculate Your Risk - Let’s say your PSA is 2.6. You still may not need a biopsy. Instead, ask your doctor to use a nomogram. This needle-free analysis
turns a patient’s age, PSA density (PSA divided by the volume of the prostate), digital-rectal-exam result, and transrectal-ultrasound result into a score that
helps determine whether a biopsy is really warranted. “We can say whether or not, for your prostate, that’s a high PSA,” says Mark Garzotto, MD, Director
of Urologic Oncology at the Portland VA Medical Center. In a study of 1200 men, Dr Garzotto found that if a nomogram had been used in every case, it would
have spared 24 percent of the men from unnecessary biopsies. If your doctor can’t crunch the numbers, ask for copies of your test results; you can find and
print out the same nomogram here, and do the math yourself.
6. Hit the Spice Rack - Researchers at the Center for Holistic Urology at Columbia-Presbyterian Medical Center in New York City recently found that a blend
of herbs including ginger, oregano, rosemary, and green tea reduced prostate-cancer cell growth by 78 percent in the lab. Sold as Zyflamend, it’s thought to
inhibit the activity of COX-2, a protein linked to the progression of the disease. “We’re using it with promising results in some of our patients,” says Aaron Katz,
MD, the center director. Another herbal option is FBL 101. When researchers at the National Cancer Institute gave FBL 101 to mice with prostate cancer, they
found that it decreased a tumor blood-vessel growth factor called VEGF to undetectable levels. Crimp the blood supply and cancer can’t survive, says William
Figg PharmD, the principal investigator. “Men who want to delay the time before they begin traditional treatment should check this out,” he says.
7. Use a Computer-Assisted Doctor - The radical prostatectomy recently became a lot less radical, thanks to a new robotic version of the
procedure. With the da Vinci system, doctors use three-dimensional imaging to direct two nimble robotic hands through a few small slits in the
patient’s abdomen to remove the cancerous prostate. According to data from the Vattikuti Urology Institute at the Henry Ford Health System in
Detroit, 90 percent fewer men became incontinent and 50 percent fewer became impotent with the da Vinci system than with manual gland removal.
“It’s like playing golf with a titanium driver versus a wooden driver,” says chief of urology Mani Menon, MD Another plus: Patients spent an average
of 1.5 days in the hospital, compared with 2.3 days for open surgery.
Above Information Sourced from Cancer Daily News
13
VALE GARY FRANKLIN
by PCFA-Q Manager Graeme Higgs
Much of what is good in life is the people you share it with. In the
Rumble Rides completed so far, it was PCFA’s very great pleasure
to know Gary Franklin. Gary was also instrumental in leading the
fundraising in the country towns the riders visited. So much so that
at the end of the last ride he was awarded the inaugural Spirit of
Rumble Down Under 2010.
Sadly, on Friday 17 February 2012 Gary passed as a result of an
accident on his Gold Wing.
Gary was a quiet gentleman who will be sorely missed. His funeral
was by invitation only. However a memorial ride was held on
Saturday 25 February. Assembling at the Kalbar Hotel participating
mourners travelled to Gary’s Boonah property to pass their
condolences to his family.
Rumblers’ gather in the Royal Albert Hotel at Kalbar on
a rainy Saturday afternoon in February, to remember
Gary Franklin
Gary Franklin is third from the left in this photo, standing
slightly in front of and to the right of PCFAs Queensland
manager, Graeme Higgs. The occasion was the cheque
presentation ceremony for monies raised in the 2010
Rumble Ride.
A URINE TEST TO DETECT PROSTATE CANCER
Source. Reference. Men’s Health News, March 2012
Catching prostate cancer before it progresses could soon be as
easy as a trip to the urinal. Scientists at the University of Parma in
Italy have developed a chip that’s able to detect a suspected marker
of aggressive prostate cancer, called sarcosine, in urine.
Previous research has linked elevated levels of sarcosine - an amino
acid produced by the metabolism of creatinine in muscles - to more
aggressive forms of the disease. “If true, the detection of sarcosine in
urine opens the door to the early stage detection of prostate cancer
using a non-invasive method,” says Enrico Dalcanale, a researcher
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at the University of Parma involved with developing the chip.
The chip is a special receptor grafted onto a silicone-based wafer.
Testing revealed that it was able to detect sarcosine in urine while
ignoring other compounds not linked to cancer.
How does this compare to the hotly debated prostate-specific
antigen (PSA) blood test typically used to screen for prostate
cancer? The researchers can’t say yet. Dalcanale says he and his
colleagues are working on an updated version that will allow testing
for sensitivity and ease of use. You might also be able to combine
these results with your PSA levels for a better estimate of your risk.
Down the road, the same science could be used to detect other
biologically similar compounds found in drugs, neurotransmitters,
painkillers, and antidepressants. And, Dalcanale says, the cost of
the chip would be comparable to a PSA screening.
For decades, men have dutifully shown up at their doctor’s office
sometime around their 50th birthday for a baseline PSA (prostatespecific antigen test). As PSA levels rise, the theory went, so do
your odds of having prostate cancer.
“THE INBOX”
Once again, you have put out a marvelous newsletter –
congratulations. Between you and John (and others), you’ve
maintained the high tradition and standard which the men
(and their partners) need. It’s healthy for us to see the changes
But now, the US Preventive Services Task Force - the same group
of medical experts who made 2009 headlines by proposing that
women under age 50 forego mammograms - has drafted a
recommendation that men no longer receive the PSA test. The new
recommendation applies to men both with and without risk factors,
such as being of African-American heritage or having a family
history of prostate cancer.
The prostate cancer death rate has dropped since PSAs became
common in the early 90s, but it’s unclear whether this drop is a
direct result of screening or due to improvements in treatment.
over the years in the support group and the contribution they
make, and to hope for improvements in years to come.
Full name and address provided
TELL YOUR STORY TO READERS OF QPCN
(Anonymity preserved if requested)
The Queensland Writers’ Group (QWG) is located in the Queensland
State Library and offers seminars and advice to budding writers
and authors. If you need assistance with telling and expressing your
story, contact the experts at the Queensland Writers’
Group [email protected]. The QWG offers regular advice to wouldbe authors. Some tips from Imogen Smith’s recent article in the
QWG March edition of the magazine include:
•
Listen to your inner self
•
Read the work aloud
•
Find your writing voice
•
Bring your characters and story to life
•
Don’t be shy in telling your story
BONUS FOR SUBSCRIBERS
Special bonus for e-mail subscribers to the newsletter. Copy the following details into your search engine:
http://www.brl.ntt.co.jp/people/hara/fly.swf
See if you can put this puzzle together. Say goodbye to Alzheimer’s!
15
FORWARD A COPY
THOUGHT FOR THE DAY
Forward a copy of QPCN to a friend, a neighbour or relative.
The key to conquering prostate cancer is prevention, greater
awareness and early diagnosis.
The journey of a thousand miles starts with a single step.
Chinese proverb.
Contact details:
Queensland Prostate Cancer Foundation News (QPCN)
Mail: PO Box 201, Spring Hill Qld 4004
E-mail: [email protected]
Phone: via Cancer Council helpline 13 11 20
LETTERS TO
THE EDITOR
May be forwarded to the QPCN at the above address or e-mail.
As the editor of your newsletter I encourage your feedback,
and will attempt to address areas of your concern.
Brisbane PCSG - 2012 meeting program
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley.
Evenings at 7.00pm (Even months).
Mornings at 9.30am (Odd months)
June 13
July 11
TBA
Troy Gianduzzo, urologist, “Where does the bar sit
- in relation to brachy therapy”?
Partners of Men with Prostate Cancer meet on the 4th Wednesday of each month between 6pm and 8pm at Cancer Council Queensland’s
Gregory Terrace building. Members come together to share, learn and support each other in a warm open environment. Light refreshments
are provided and there is parking underneath the building. For more information phone Karen Ward on (07) 3356 8106.
Contact Details
Queensland Prostate Cancer News
Mail: PO Box 201, Spring Hill Qld 4004 Email: [email protected] Phone: via Cancer Council Helpline 13 11 20
Prostate Cancer Foundation of Australia and Queensland Chapter Council Mail: (PO Box 10444) Adelaide Street, Brisbane, QLD 4000
Email: [email protected] Phone: 07 3166 2140.
Disclaimer
Council (ie. the Council of the Queensland Chapter) accepts no responsibility
for information contained in this magazine. Whilst the information is
presented in good faith, it may contain information beyond the knowledge of
Council and therefore cannot be taken to be the opinion of Council.
Important privacy information
You have received this magazine because you have provided your contact
details to Cancer Council Queensland or to a Prostate Cancer Support Group
(PCSG). The primary purpose of collecting your contact details was to enable
support, resources and information to be offered to you as a person affected
by or interested in prostate cancer. Your contact details are held in the local
office of Cancer Council Queensland. Cancer Council Queensland ensures
compliance with the Privacy Act, and does not use or disclose your details
except as you might reasonably expect. You may access your details and you
may request that we correct or amend (ie. update) or delete your details.
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The information in this magazine is not intended to be a substitute for
professional medical advice, diagnosis, or treatment. Always seek the
advice of your qualified health provider with any questions you may have
regarding a medical condition. Never disregard professional medical
advice or delay in seeking it because of something you have read here.
If you are a member of an affiliated PCSG you will initially receive by post
or email your local group’s news-sheet, the monthly Queensland Prostate
Cancer News (QPCN), and the national quarterly Prostate News. You may also
receive other communications from time to time such as advice on upcoming
symposia, news or surveys from research establishments, details of open
clinical trials, and guidelines being reviewed. You may ‘opt-out’ of any of these
services at any time, ie. you will no longer receive any material of that type, by
letting us know your wishes. QPCN is available online at http://www.pcfa.org.
au/qld/newsletter.htm. Should you receive multiple copies, please let us know
which address(es) to remove from which mailing list(s).