Queensland Prostate Cancer News - Prostate Cancer Foundation of

Queensland
Prostate Cancer News
The magazine is a publication of the Queensland Chapter, Prostate Cancer Foundation of Australia.
August 2010
Letter from the Editor,
Volunteers are the lifeblood of community
organisations. There are high profile volunteer
community groups such as Rotary, Lions
and Meals-on-Wheels which are well known
but there are literally hundreds of other
voluntary associations, all doing their bit to
identify and address community problems or
complementing the efforts of paid workers
within charitable organisations. The various
Cancer Councils and the Prostate Cancer
Foundation of Australia (PCFA) fall into this
latter group and the Prostate Cancer Support
Groups are the voluntary part of PCFA.
smaller shows. Support Group volunteers
get free entry to the shows and plenty of
time to see all the exhibits. Looking after an
awareness stand is not arduous and you do
get to meet some really interesting people.
If you would like to participate in some of
these events and you live in SEQ, could
you please ‘phone Alison Bannan at PCFA
on (07) 3166 2142. Alison is setting up a
volunteers’ register but if you’re on the
register and dates, times, etc. do not suit at
the time a need arises, there’s no pressure
to answer the call.
Volunteering came to mind recently when
PCFA were trying to get a roster together to
look after an awareness booth at the Brisbane
Caravan & Camping Show (see Page 9). A
couple of new faces plus the usual suspects
made up the numbers but as the Show ran
for 7 days it took a bit of juggling. Other major
expos in SEQ where PCFA have a presence
include The International Boat Show and The
Truck & Machinery Exhibition plus many more
For those of you outside the S.E. corner of the
State, why not get in touch with your local
Conveners (details on Page 2) and let them
know that you’re available if a need arises.
Wishing You Low PSAs and Good Health.
John Stead.
Editor.
3
Aug 1-7
Continence Awareness Week www.continence.org.au.
Aug 6-8
Advancing Quality of Life National PCFA Conference
www.prostate.org.au.
Aug 18
World Cancer Congress www.cancerqld.org.au
Aug 27
Daffodil Day www.cancerqld.org.au.
Aug 27
Rumble Down Under www.rumbleriders.com.au.
Sep
International Prostate Cancer Awareness Month.
Oct 01
Register for MOvember www.movember.com.
Oct 25
Pink Ribbon Day www.cancerqld.org.au.
Nov
MOvember www.prostate.org.au.
T 1300 65 65 85
T 1800 22 00 99
Vale George Apps.
Chemo Drug Approved.
4 Dr Charles “Snuffy” Myers Presentation.
6Footenotes.
7 Focal Therapy.
Statins Reduce Recurrence.
8 Anejaculation After
Radiotherapy.
9
Caravan & Camping Show.
Women and Prostate Health.
10
11
Men and Prostate Health.
12
Open or Robotic?.
New Abiaterone Study.
Vitamin K.
13
Short Cuts.
Provenge Rationed.
Tomotherapy Arrives.
14
A Canine Analysis.
New Drugs from the Sea.
15
16
Ipillimumab Update.
www.cancerqld.org.au
www.prostate.org.au www.pcfa.org.au
2 Resources: Web Links,
Associated and Affiliated Groups.
Calendar of Events 2010
Cancer Council Queensland Prostate Cancer Foundation of Australia In this issue
A Survivor’s Story.
Online Screening.
Prostate Screen Qld.
Brisbane Program: Privacy:
Contact Us: Disclaimer.
[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.
QPCN_August_2010.indd 1
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Resources
Cancer Council Queensland
www.cancerqld.org.au
Research to beat cancer and
comprehensive community support
services.
Cancer Council Helpline
Ph 13 11 20
8am-8pm Monday to Friday
www.cancerqld.org.au/cancerHelpline
Andrology Australia
www.andrologyaustralia.org
Ph 1300 303 878
Andrology Australia is the Australian
Centre of Excellence in Male
Reproductive Health.
HealthInsite
www.healthinsite.gov.au
Your gateway to a range of reliable, upto-date information on important health
topics.
Prostate Cancer Foundation
of Australia
www.prostate.org.au
Phone 1800 22 00 99
A consumer’s view of the experience
of diagnosis and treatment for prostate
cancer.
Queensland Chapter
www.pcfa.org.au
Information, patient support materials,
and contacts for advice on living with
prostate cancer in Queensland.
Cochrane Library
www.cochrane.org
Australians now have free access to the
best available evidence to aid decisionmaking.
Lions Australian Prostate Cancer
www.prostatehealth.org.au
The first stop for newly diagnosed men
seeking information on the disease.
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.
Mater Prostate Cancer
Research Centre
www.mmri.mater.org.au
Comprehensive information for those
affected by prostate cancer, including
the latest research news.
Prostate Cancer Support Groups in the Queensland Chapter
There are 22 PCSGs in the Chapter with a total membership of approximately 3,300 men.
Peer Support Group
Contact
Beenleigh
Peter Keech
Brisbane
Peter Dornan
Bundaberg
Rob McCulloch
Capricorn Coast (Yeppoon)
Jack Dallachy
Central Qld. (Rockhampton)
Bill Forday
Far North Qld. (Cairns)
Jim Hope
Gladstone
Geoff Lester
Gold Coast Partners
Maggie Angus
Gold Coast Central (Evening Group)
Alex Irwin
Gympie and District
Norm Morris
Hervey Bay (Pialba)
Brian Henderson
Ipswich
Terry Carter
Mackay
John Clinton
Maryborough
Leoll Barron
Mount Isa
William Hilton
Northern Rivers (Alstonville)
Pat Coughlan
Northen Rivers (Lismore)
Warren Rose
Sunshine Coast (Maroochydore)
Rob Tonge
Toowoomba
David Abrahams
North Queensland (Townsville)
Bob O’Sullivan
Twin Towns & Tweed Coast
Ross Davis
Whitsunday (Proserpine)
Dave Roberts
The news sheet for any group should have the meeting details for its neighbouring groups.
Associated Support Groups
Group
Beaudesert
Kingaroy
Contact
Carmen O’Neill RN
Robert Horn
Phone
07 5541 9231
07 4162 5552
Phone
0407 070 194
07 3371 9155
07 4159 9419
07 4933 6466
07 4922 3745
07 4039 0335
07 4979 2725
07 5577 5507
07 5569 2021
07 5482 6196
07 4128 3328
07 3281 2894
07 4942 0132
07 4123 1190
07 4743 9324
02 6622 1545
02 6684 2201
07 5446 1318
07 4613 6974
0405 274 222
07 5599 7576
07 4945 4886
Sponsor
Beaudesert Health/Gold Coast
Toowoomba/Sunshine Coast
2
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VALE GEORGE ROBERT APPS OAM
Surrounded by family including his beloved wife Doris and close friends, George Apps died on 29th. June, 2010.
George was the Convener of the Mount Isa Prostate Cancer Support Network, one of the many community roles he was passionate
about. The Mount Isa Support Group was relatively new but in “Queensland Prostate Cancer News” earlier this year George wrote,
“Our fledgling Group shares the dedication of other Groups to be part of the fight against prostate cancer and all cancer generally.
We have just begun but we intend to succeed in our endeavours.”
George’s work within the local community through Lions, Rotary and other organisations was legend and carried out with an
uncompromising commitment to assist his fellow men and women. In the Queen’s Birthday Honours of 2004 he was awarded
the Medal of the Order of Australia with the citation reading “For service to the community of Mount Isa through a range of
organisations assisting the ageing and people with disabilities.”
Former Queensland Cabinet Minister, Tony McGrady, spoke of George as being “a real gentleman. An achiever and a doer but above
all else he was a friend. He was a lovely person who did everything with great passion. Nothing was ever too much trouble for
George. He always wanted to achieve, not play the political game in organisations.”
Local Mount Isa priest, Father Mick Lowcock, had known George for about 17 years and
said that, like clockwork, George would be at Mass every Sunday, adding, “He was a
humble man who had done a giant of a job. He was a committed man of the community
and a committed man of our parish.”
Graeme Higgs, Manager of the Prostate Cancer Foundation of Australia in Queensland,
noted that prostate cancer awareness had lost a great ally and praised George’s efforts
and enthusiasm in spreading the message to the North West corner of the State. “George
touched the lives of many people and he will be sorely missed,” he said. “People of
George’s calibre are few and far between.”
The many tributes for George that flowed into Mount Isa’s newspaper, “The North West
Star”, can be summarised as “a truly magnificent man and a true community hero whose
spirit and manner helped so many”.
Our deepest sympathy is extended to George’s family and friends for their tragic loss.
FDA APPROVES SANOFI-AVENTIS PROSTATE CANCER DRUG
The Food and Drug Administration on Thursday approved the first
prostate cancer chemotherapy drug found to extend the survival
of men who are no longer being helped by other treatments.
The drug is called Jevtana and it is made by Sanofi-Aventis
in France. The FDA approved Jevtana to treat prostate cancer
that does not respond to hormone-deprivation treatments or to
docetaxel, the cancer drug most commonly used to fight prostate
tumours. Earlier this year, a study showed Jevtana prolonged
survival for those patients by 10 weeks.
Jevtana was approved for use in combination with the steroid
prednisone, which is often used in cancer treatment.
In that study, patients who received a treatment regimen
including Jevtana lived for about a year and three months after
starting treatment. Those who received standard treatment lived
for about a year and three weeks. There is hope the drug will
have a stronger effect on patients who are not as sick.
“Patients have few therapeutic options in this disease setting,”
said Richard Pazdur, director of the FDA’s Office of Oncology Drug
Products. Sanofi-Aventis said it expects the drug to be available
this summer.
Jevtana is given by injection. In the study, patients on Jevtana
were more likely to have their tumurs shrink than those who were
on standard chemotherapy. However no patients in the study
experienced a complete remission, or disappearance of all signs
of the disease.
The FDA said Jevtana’s side effects including decreased levels
of infection-fighting white blood cells and lower white blood cell
count, anaemia, lower levels of blood platelets, diarrhea, vomiting,
constipation, weakness and kidney failure.
The FDA has approved two potentially groundbreaking prostate
cancer treatments this year. It cleared Dendreon Corp’s immunebased therapy Provenge in April. The agency said prostate cancer
is the second most common cancer among men in the U.S. The
disease usually occurs in older men.
The ruling on Jevtana came more than three months early, as the
FDA was sceduled to make a decision on the drug by September
30. The drug was developed under the name “cabazitaxel”.
Jevtana is also being reviewed by regulators in other markets,
including the European Union.
Marley Seaman – Associated Press – 17JUN10.
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DR CHARLES “SNUFFY” MYERS
The St Vincents Prostate Cancer Centre and the Prostate
Cancer Foundation of Australia were honoured to welcome
Dr Myers to Australia in February. Dr Myers is a U.S.A.
medical oncologist, scientist, nutrition expert and prostate
cancer survivor. He has over 250 research papers and books
published and over 30 years of experience with this disease.
He opened the Institute for Diseases of the Prostate in 2001 to
provide men with the comprehensive care that saved his life.
4. Finally when a cancer no longer responds to traditional
hormones, it was Dr Myers’ opinion that a lot of the cancers
simply function on less testosterone or dihydrotestosterone. This
led to the theory that complete blockage of testosterone both
inside and outside the cells may be an aim for further therapy.
Hormone therapy.
Dr Myers felt that total androgen ablation had some
advantages over single LHRH agonists. He also felt that there
are many patients who have hormone therapy where the
testosterone is suppressed but the dihydrotestosterone is not
suppressed and he believes that further suppression of the
dihydrotestosterone in people who are not fully responding
may be useful. This would involve the use of “Proscar” or
“Avodart”.
Second line hormone therapy.
Dr Myers strongly believes that the attempt to get a full
remission is worthwhile as he believes this is more likely to
give one a more durable result. A full remission means no
evidence of cancer on all forms of imaging and a PSA of less
than 0.01.
Dr Charles “Snuffy” Myers in
Brisbane, February 2010.
Members attending the June meeting of the Brisbane Prostate
Cancer Support Network were treated to a film of Dr Myers’
presentation to a Sydney audience during his Australian visit.
The Sydney presentation was given at the Garvan Institute
and was summarised by Associate Professor Phillip Stricker of
the St Vincent’s Prostate Cancer Centre. This summary, which
appears below, first appeared in the LIFEBUOY, Issue 1,
2010.
Understanding principles of cancer.
1. It is very clear that in 2010 we have a very poor understanding of the method by which cancer is spread.
Within any cancer there are cells which cannot spread,
cells that generate other cancer cells and stem cells which
generate all the cells, which are less than 1% of the overall
population.
2. Dr Myers believes that it is necessary to induce a full
remission and maintain that remission to gain long-term
durable results. This has been seen with other cancers such
as leukaemia, testicular cancer and lymphoma.
3. Dr Myers also suggested a long-term remission was still
possible if the cancer was not too wide spread – a concept
called “oligo metastasis”.
His own second line hormone therapy at this stage is a
combination of “Ketoconazole”, high-dose estradiol and
“Leukine”. The last one unfortunately is very expensive
and not available in Australia. He also mentioned that
when “Abiraterone” becomes available, this drug has the
potential to be safer and have equal, or better, efficacy than
“Ketoconazole”. The problem with using “Ketoconazole” is
that it needs to be carefully utilised with particular care to
druginteractions and the affect on the liver and the need to
gradually introduce it and take it regularly every 8 hours.
Under the careful supervision of a medical oncologist or
urologist this, however, in experienced hands, is safe.
High-dose estradiol is also effective but unfortunately
increases the risk of DVT and pulmonary embolus and
therefore one would need to take Warfarin. Again one would
have to be under a careful supervision program of a medical
oncologist. With regard to “Leukine” there is evidence from
Eric Small, a medical oncologist and researcher from America
that this is synergistic and this adds to the treatment of
“Ketoconazole” but at this stage unfortunately it is unavailable
in Australia and is expensive.
“Abiraterone” which is currently in trial in Australia and
worldwide appears to have less interactions with other drugs
and is a once a day dosage with less side effects. There is
hope that if this proves successful in Phase III trials, it will be
available in the next couple of years.
Side effects of hormone therapy.
The following is a list of the possible side effects of hormone
therapy:
Continued...
4
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• Hot flushes.
• Depression.
• Decreased libido.
• Lethargy.
• Osteoporosis.
• Abnormal liver function tests.
• Increased breast size (gynaecomastia).
• Hypertension.
• Diabetes.
• Hypercholesterolemia.
Clearly, many of these side effects can be anticipated and
managed. It is mandatory that the general practitioner for
patients on hormone therapy monitor their blood pressure,
blood sugar, bone mineral density, cholesterol, lipids and
liver function tests regularly. Furthermore it is important
that specific questioning about hot flushes, depression,
gynaecomastia, lethargy and libido are asked and addressed.
General supportive care.
At all stages of prostate cancer it is important to do the
following:
• Be positive and optimistic.
• Use appropriate supplements such as pomegranate, fish oil, lycopene and possibly
resveratrol.
• Eat a Mediterranean type diet and avoid obesity.
• Have regular exercise.
• Eliminate vitamin D deficiency.
• That any side effects of therapy are addressed such as abnormal liver function tests, osteoporosis and hot flushes.
• Ensure that hypertension, diabetes and hypercholesterolemia are well controlled.
Locally advanced disease.
Generally many of these can be controlled by diet, exercise
and counselling whilst others such as hot flushes require
treatment such as estradiol topical patches. Other treatments
include tablets to prevent or treat abnormal liver function tests,
tablets to prevent gynaecomastia, anti-depressants in more
extreme forms of depression, ace inhibitors or angiotensin
blockers or diuretics to treat hypertension and general
emotional supportive and optimistic care.
There have been improvements in both the staging techniques
and treatment of locally advanced disease. Examples of
advances are:
Maintenance therapy.
3. Combidex MRI and choline CT/PET fusion to more
accurately locate the site of lymph node metastases.
Dr Myers believes that once a full remission is achieved in
patients with advanced prostate cancer that this needs to be
maintained. This can be achieved in his view with the use of
eliminating Vitamin D deficiency, a Mediterranean diet, regular
exercise, decrease in stress and various supplements such as
pomegranate, lycopene, fish oil and possibly resveratrol (the
active component of red wine).
In the high risk situation he has also trialled the use of
“Avodart” or “Dutasteride”, using higher dose resveratrol and
even periodic uses of “Leukine”. Much of this data has limited
evidence at this stage though is supported by some Phase
II trials. In the higher risk situation this would need careful
supervision by an experienced physician.
1. IMRT (Image Modulated Radiotherapy) to more accurately
target primary and secondary prostate cancer.
2. MRI to better image the extent of the cancer in the prostate.
Conclusion.
Dr Myers has shown that in many of the patients he has
treated, they have performed much better than expected.
This may well be due to his therapy. There was enormous
enthusiasm from the public at all three meetings throughout
Australia and one of the strong points he made was to
generate a sense of optimism in all patients and show patients
what they can do for themselves to give patients a sense of
power over their own disease. He was also very optimistic
about the future and some of the new developments and
understanding that are occurring.
DR CHARLES “SNUFFY” MYERS DVD
Dr Charles Myers Sydney presentation at the Garvan Institute was filmed and is available on DVD. Apart from the presentation the
DVD includes an introduction by Associate Professor Phillip Stricker from the St Vincent’s Prostate Cancer Centre in Sydney and a
question-and-answer session following the presentation.
The DVD is available for $15-00, which includes postage and packing, by going to www.menshealthmatters.com.au.
Other “Snuffy” Myers’ publications are available from the Prostate Cancer Foundation of Australia. Contact details are on Page 2 of
this magazine.
5
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FOOTENOTES
It is with a degree of sadness that I write this, my last
FOOTENOTES as Chair of the Queensland Chapter Council (QCC).
Over the past six months I have experienced some side-effects
from my medications (Cougar Trial Phase II) which have made
me extremely tired and lethargic and I am finding it difficult to
focus on the tasks ahead. In addition there have been some
family matters which have resulted in the loss of a loved one so
I’ve came to the conclusion that I need to “step back” and “have
some time for myself”.
The Council has accepted a recommendation that Leon
Matigian act in a caretaker role of Chair until the end of the
2010. Both Daryl Hyland and I have stood down as Queensland
representatives on the Support and Advocacy Committee of the
Prostate Cancer Foundation of Australia and Leon and Bruce
Kynaston were duly elected as our replacements. I will stay
on as a Council member and, together with Daryl, will focus on
the planning of the Queensland Chapter Conference on 7, 8 & 9
October, 2010.
As I reflect back over my time as Chair of the Chapter Council, I
do so with a degree of pride. When I first stepped into the position
I asked the question “What is the role of the Chapter Council?”
Although I had no involvement in the final outcome, I am happy
to say that this has now been documented together with the
role of the Support and Advocacy Committee (SAC) and SAC
Representatives.
From day one my vision was to have the Chapter Council become
a more efficient and effective body and to strive to have a greater
level of accountability, transparency and consultation. In a paper
I presented to the Council, “My Vision for 2008”, I highlighted the
following:
1. Introduce a framework for the effective operation of the
Chapter (a) Roles and responsibilities, (b) Procedures and
guidelines.
2. Improve communications to Support Groups and utilize
Queensland Prostate Cancer News. (QPCN) as an avenue to
keep our members informed about QCC happenings.
3. Identify outreach areas not covered directly by Support
Groups and initiate a minimum of 3 new Support Groups
every year.
4. Develop a support mechanism including resources and
financial assistance for new Support Groups.
5. Provide training to all Support Group co-coordinators and
their assistants to better equip them for their role within their
Groups.
6. Ensure at least six outreach visits to Support Groups are
completed and analysed each year.
7. Awareness - Visit outreach areas to provide information and
support for people with prostate cancer, their families and
friends.
I am pleased to say that most of these areas have been
addressed, most with positive outcomes.
My view has always been that we represent the members of
the Support Groups in Queensland and to carry out our tasks
effectively we need to be aware of the views of all stakeholders.
Through surveys and Conference Workshops, I believe that we
were able to identify those areas that the members considered
we should focus on. We set up a number of Task Groups to
address such issues as Awareness, Targeting Younger Males
and Lobbying, Availability of Speakers for Support Groups,
Better Access to the Medical Profession, Research and Vetting
of Technical Data, Support Group Teleconference (to maintain an
effective communication link to the Support Groups), Chapter
Administration, QPCN and Web Administration. All of these Task
Groups are functioning and producing outcomes.
There has been a great improvement in our communication with
the Groups. One area where this is evident is with Daryl Hyland,
Deputy Chair of the Queensland Chapter Council and Queensland
Support Group Services Coordinator. Through his efforts Daryl
has brought a greater togetherness to the Groups, the Chapter
Council and the Prostate Cancer Foundation of Australia (PCFA).
Likewise, utilizing QPCN by including articles (FOOTENOTES) to
communicate with our members has allowed Council and PCFA
to inform Groups of the happenings and opportunities that are
occurring.
I have always fought for the right to plan for our own destiny
and the Chapter has now developed its Strategic Plan for the
next 3 years. To implement this plan the Chapter has also been
granted the right to prepare its own budget and the Strategic Plan
provides a framework for that process. Frustratingly, a successful
application for a Government Grant that was prepared by others
has caused the Chapter to rethink its activities for 2010.
Providing support and training to members of the Support Groups
has always been high on the agenda. We are very appreciative
of the amount of support we receive from Cancer Council
Queensland (CCQ) and to ensure that this support is used in a
meaningful and timely manner, we have regular meetings with
CCQ to plan activities.
I have enjoyed my time as Chair of the Council and I hope
that I have contributed in some positive way to ensuring that
we provide that much needed support to our members of the
Prostate Cancer Support Groups in Queensland as well as
nationally. I would like to make special mention of my mate Daryl
who has been a tower of strength to me over this time. Often
we hear the comment “you are not alone” and Daryl has really
fulfilled that role for me.
In conclusion, I would like to acknowledge the ongoing support
that I have always received from my wife and family. Without
them I would not have been able to accomplish my goals.
May I wish all of you the very best of health for the future.
Lionel I. Foote.
Retiring Chair, Queensland Chapter Council.
Prostate Cancer Foundation of Australia.
6
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PROSTATE: FOCAL THERAPY IS POSSIBLE
The following is an extract from “Major Advances in Surgical Technique for the Treatment of Genitourinary Cancers”
which was published in Cancerforum Vol. 34 No.1 March 2010. The article was prepared by Manish I. Patel (Discipline of
Surgery, University of Sydney and Westmead Hospital) and Mark Frydenberg (Department of Surgery, Monash University
and Department of Urology Southern Health, VIC) Ed.
With increasing screening, the burden of prostate cancer disease which may not pose a significant risk to life expectancy is increasing
(1). The therapeutic dilemma for a man diagnosed with low risk prostate cancer lies between the extremes of radical therapy on the one
hand and active surveillance on the other. The former maximises the chances of cure at the expense of urinary and sexual morbidity. The
latter preserves genitourinary function at the expense of psychological burden, potential for disease progression and economic burden of
intensive surveillance.
Traditionally, treatment of the whole gland has been the standard of care as there is no natural surgical plane to allow partial treatment.
Prostate cancer has also been regarded as a multifocal disease requiring treatment of the whole gland. Recent studies show that between
10% and 40% of men who undergo ORRP have unilateral disease (2). This raises the concept of focal ablation of the tumour focus. It has
also been shown that in men with multifocal disease, approximately 80% of tumour foci have a volume of less than 0.5cm, which may
represent clinical insignificant disease (3).
Active surveillance appears to be a very suitable therapy for men with low risk disease, however, the major limitation is the ability to
accurately identify men with significant disease that is going to progress clinically. As a result, the failure rate or intervention rate is
approximately 20% in active surveillance series (4). The oncological safety of active surveillance is also not well established, as the
follow-up in cohort studies is still relatively short, although recent publications suggest that of those who come to definitive treatment,
50% may subsequently develop biochemical faiure. In addition to this, the potential psychological burden and increased cost of close
surveillance may make it less desirable than whole gland treatment by surgery or radiotherapy.
Major technological advances allowing focal treatment of the affected parts of the prostate include cryotherapy, high-intensity focused
ultrasound (HIFU) and photodynamic therapy. This addresses the dilemmas of the untreated prostate in active surveillance, and does so
with minimal side effects, which is the major disadvantage of whole gland therapy. To date only early results of small series from single
institutions have been reported. Most series used extended or saturation TRUS biopsy to accurately localise the lesion(s) and exclude
contralateral disease (although even with these techniques understaging and undergrading can occur in 20-25% of patients). In a report
of hemi-ablation using cryotherapy in 55 men with at least one year follow-up, 95% had stable PSAs and 86% remained potent (5),
however seven men had to be retreated due to cancer in the contralateral half of the prostate.
Another series of hemi-ablation with cryotherapy, with a mean follow-up of 70 months, reported 93% disease-free survival and
48% potency rate (6). A report on hemi-ablation by Muto, using the Sonoblate 500 HIFU device in 29 men with unilateral disease,
demonstrated that at six months, 10% had positive biopsies, however a further 23% had positive biopsies at 12 months (7).
There was no significant change in urinary symptom scores measured with the validated International Prostate Symptom Score
questionnaire. Erectile dysfunction was not measured in this cohort.
Photodynamic therapy involves administration of a photosensitising drug followed by delivery of a specific wavelength of light into the
appropriate region of the prostate by transperineal needle, resulting in ablation similar to cryotherapy. It is currently in its infancy, however
multicentre trials of focal ablation are being planned. Radiofrequency ablation is also a technology which has been used in ablation of
solid organs such as kidney and liver. It is currently in early studies for prostate but will soon be studied for focal ablation.
In summary, focal ablation appears to be the middle ground between the untreated tumour of active surveillance and the excessive
side effects of whole gland treatment. Cryotherapy and HIFU in very small series, with limited follow-up, do demonstrate some promise,
however further studies of all ablation methods are required to determine their real place in prostate cancer treatment. The main barrier
preventing adoption of these techniques is effective cancer localisation at the time of biopsy, to ensure that the focal therapy is indeed
treating all the cancer present in the gland.
1. Schroder FH, Hugosson J, Roobol MJ, et al, Screening and prostate cancer mortality in a randomised European study. N Engl J Med 2009;360:1320-82.
2. Ahmed HU,Emberton M. Active surveillance and radical therapy in prostate cancer: can focal therapy offer the middle way? World J Urol 2008;26:457-67.
3. Villers A, McNeal JE, Freiha FS, Stamey TA. Multiple cancers in the prostate. Morphologic features of clinically recognised versus incidental tumours. Cancer
1992;70:2313-8.
4. Klotz L. Active surveillance for prostate cancer: for whom? J Clin Oncol 2005;23:8165-9.
Hardie C, Parker C, Norman A, et al. Early outcomes of active surveillance for localised prostate cancer. BJU Int 2005;95:956-60.
5. Onik G, Vaughan D, Lotenfoe R, Dineen M, Brady J. “Male lumpectomy”: focal therapy for prostate cancer using cryoablation. Urology 2007;70:16-21.
6. Bahn DK, Lee F, Badalament R, Kumar A, Greski J, Chernick M. Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate
cancer. Urology 2002;60:3-11.
7. Muto S, Yoshii T, Saito K, Kamiyama Y, Ide H, Horie S. Focal therapy with high-intensity-focused ultrasound in the treatment of localised prostate cancer. Jpn J
Clin Oncol 2008;38:192-9.
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Statins May Influence Prostate Biology
In men with prostate cancer undergoing prostatectomy the use
of statins reduces the disease recurrence rate by 30%, research
shows.“Our findings require confirmation in other settings and
in particular to determine whether statins are associated with
a reduction in metastases and/or prostate cancer specific and
overall mortality,” the researchers wrote in Cancer.
The study assessed over 1,300 men treated with radical
prostatectomy, of whom 18% were taking statins.The authors
found significant differences between statin users and
nonusers at presentation.
Men taking statins were more likely to be older (P<.001), have
a lower median PSA (P=.04), were more likely to be white
(P<.001) and have a higher BMI. Statins reduced disease
recurrence rate by 30% (P=.05). However, they were also
more likely to have a higher biopsy Gleason score (P=.002).
At a median follow-up for statin users of 24 months and 38
months for non-users, biochemical recurrences occurred among
23% of men – 16% of whom were statin users and 25% were
non-users. After adjusting for the pathological and clinical
factors that differed between the two groups, the researchers
found that men who used statins had a 30% decreased risk of
PSA recurrence and the association was dose-dependent.
“Mounting evidence suggests that statins may influence
prostate biology, and although controversial, statins may
reduce the risk of advanced prostate cancer,” the study
authors said.
Given that statins appear to lower PSA levels, one potential
explanation is statins merely delay the diagnosis of
recurrence, they suggested.
They concluded that a randomised controlled trial placing
men undergoing radical prostatectomy on statins may be
warranted.
Cancer 2010;doi:10.1002/ cncr.25308.
Nicola Garrett – Oncology Update.
Anejaculation Is Likely After Radiation Therapy For Prostate Cancer
"Patients frequently present to us after RT for localized
prostate cancer with a complaint of anejaculation, and they
are often surprised by the onset of this side effect," Doron
Stember, MD, a urology fellow at Memorial Sloan-Kettering
Cancer Center in New York City, told Medscape Urology.
Although anejaculation after RT has not been widely
discussed in the medical literature, clinical experience has
shown that it is a common complaint after pelvic RT. The
scant published data on post-RT ejaculatory function are
inconsistent, Dr. Stember noted. For example, a prospective
study that used the Brief Sexual Function Inventory (BSFI)
found that ejaculatory function sharply decreased to its
nadir six months after RT. Ejaculatory function recovered
somewhat after this point, but not to its pre-RT level, when
the patient was assessed at two years.
"While radical prostatectomy is commonly associated with
loss of ability to ejaculate, we have shown that, with time,
RT also causes anejaculation in a majority of patients. It is
important that patients be counselled accordingly prior to
treatment."
Another study that used the BSFI in post-RT patients found
that a significant decrease in ejaculatory function occurred in
the first two years after RT, but was found to have stabilized at
the four-year assessment point. The BSFI is a popular tool for
assessing male sexual function, Dr. Stember noted.
Dr. Stember presented the results of a study that examined
the ejaculation profiles of men who underwent RT for prostate
cancer. John P. Mulhall, MD, is senior author of the study. He
is the director of the Male Sexual and Reproductive Medicine
Program at Memorial Sloan-Kettering Cancer Center. The
study involved 364 consecutive men who provided information
regarding their ejaculatory function and orgasm as a routine
part of their sexual health evaluation for post-RT sexual
problems.
Patients completed the widely validated International Index
of Erectile Function (IIEF) questionnaire at follow-up visits,
starting with the first post-treatment visit, and attention was
paid to the orgasm domain on the IIEF.
"Anejaculation is an inevitable and well-recognized sequela of
radical prostatectomy and may represent a significant source
of bother and sexual dissatisfaction," he pointed out. "Loss
of ejaculation or a severe decrease in ejaculate volume has
been associated with a self-reported deterioration in sexual
activity."
Overall, 72% of men lost their ability to ejaculate in an
antegrade fashion after prostate RT by their last visit. A total of
16% reported anejaculation at one year, 69% at three years,
and 89% at five years. "The proportion of men experiencing
this side effect increases over time, and men do not recover
their ability to ejaculate," Dr. Stember said.
Continued...
Nearly 90% of men who undergo radiation therapy (RT)
for prostate cancer will eventually develop anejaculation,
researchers reported here at the American Urological
Association 2010 Annual Scientific Meeting.
Of the study cohort, 252 men underwent external-beam
radiation therapy and 112 underwent brachytherapy. The
mean age of the study population was about 65 years, and the
mean length of follow-up after RT was about 6.5 years.
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Risk factors for anejaculation at three years included higher RT
doses, older age, exposure to androgen-deprivation therapy,
and smaller prostates at the time of RT. Further analysis
revealed that orgasm domain scores on the IIEF questionnaire
decreased markedly during follow-up.
"Since radical prostatectomy always causes anejaculation,
some men may choose RT with the false expectation that
they will retain their ejaculatory function. That's why we need
to inform them beforehand of this potential side effect, just as
we do with men undergoing surgery."
"It's important that men who are selecting a treatment
for prostate cancer be aware of the high likelihood of
anejaculation with RT," Dr. Stember advised.
Jill Stein – Medscape.com – 10JUN10.
QUEENSLAND CARAVAN CAMPING & TOURING HOLIDAY SHOW
From the 9th. to the 15th. June the Queensland Caravan Camping & Touring Holiday Show was the happening event at the RNA
Showgrounds in Brisbane. Prostate Cancer Foundation of Australia (PCFA) was there to spread the word about prostate cancer
awareness to the approximately 80,000 show visitors, including the many “grey nomads” who are entering or are in the prostate
cancer problem age and are increasingly taking that “round Australia” adventure in retirement, by either caravan or motorhome.
To give an idea of the camping and caravanning surge in Queensland, this year’s show recorded sales by exhibitors of about
$50 million. It’s a growth industry and expected to keep on growing as the percentage of the population in the older age groups
increases.
For PCFA, having adequate staff on hand during the 7 days of the Show to
answer questions and distribute information leaflets could not have happened
without the support of volunteers and, in this regard, the staff of PCFAQueensland were ably assisted by John Cummins, Ross Davis, Bill McHugh, Bob
Perren, Euan Perry, Ian Smith, Bob Adamson John Stead, Garth Stephens and
Paul Travers.
Over the seven days of the show the PCFA “Shop” gave out countless numbers
of prostate cancer information sheets and conducted hundreds of face-to-face
discussions about this disease.
Bob Adamson (l) and Ross Davis mind the
“shop”.
TOP 10 THINGS WOMEN SHOULD KNOW ABOUT PROSTATE CANCER
Women Against Prostate Cancer (WAPC), a prostate cancer support group geared towards helping women and families affected by
prostate cancer, wants to make sure every woman knows the facts about the disease.
Below are the top 10 things women should know:
1. What is a prostate? The prostate is a walnut-sized male gland that contributes to the fluid that carries sperm. It is located just below
the bladder.
2. What is prostate cancer? Prostate cancer occurs when a group of cells begins growing abnormally out of control in the prostate and
invades healthy tissue. The cancer cells may also spread from the prostate to other parts of the body.
3. Who does it affect? Prostate cancer does not only affect men; the disease can have a devastating effect on entire families, especially
wives and partners.
4. Who is at risk? According to the National Cancer Institute, one in six men will be diagnosed with prostate cancer in their lifetime. About
20,000 Australian men will be diagnosed this year and around 3,300 will die from the disease.
5.What are the risk factors? While the exact cause of prostate cancer is still unknown, there are dynamics that can increase a man’s
risk of getting prostate cancer including:
Age: A man’s chance of developing prostate cancer increases quickly after age 50.
Family History: Those with a father, brother, uncle or other male blood relative who has had prostate cancer are at increased risk.
Continued...
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TOP 10 THINGS WOMEN SHOULD KNOW ABOUT PROSTATE CANCER Continued...
6. What are the sign and symptoms? Early-stage prostate cancer typically has no symptoms. Therefore, in addition to regular checkups,
a man should see a health care provider if he experiences persistent hip or back pain, has difficulty urinating, feels pain and/or a burning
sensation during urination, or has blood in his urine.
7. How is it caught early? The most common early detection methods include a digital rectal exam and a prostate-specific antigen (PSA)
blood test. Abnormalities may indicate the need for further testing. WAPC recommends that at age 40 (35 for high-risk men) men receive
a baseline PSA and digital rectal exam, and speak with their physician about annual screening thereafter.
8. What are common treatment options? Depending on the individual, there are several possible treatment options, each with a
different side-effect profile. The most common treatments include prostatectomy (surgical removal of the gland), radiation therapy,
hormone therapy and active surveillance among others.
9. What can women do to help? Gently remind him to get a prostate screening. If that doesn’t work, pick up the phone and make
an appointment. Early detection leads to the greatest outcomes and an improved quality of life.Stand by your man. If your husband or
partner is diagnosed, show support by attending doctor’s appointments or support group meetings with him.Research. As mentioned
above, when it comes to treatment options, the choices are numerous. Learn all you can about each treatment, its side-effect profile and
expected outcomes, and share what you learn with your partner.Seek support. Connect with other women who are facing the same
challenge. Join a local Partners of Men With Prostate Cancer Group for support, and to continue the fight against prostate cancer.
10. What is the survival rate? While there is much work to be done to end this disease, there is hope. If detected early, prostate cancer
is highly treatable. To that end, according to the American Cancer Society, the five-year survival rate is nearly 100%.
CancerTreatmentPro.com 22FEB10.
WHAT EVERY MAN NEEDS TO KNOW ABOUT PROSTATE HEALTH
While it may be a sensitive subject for many men, prostate health
is one of the keys to their overall well-being, not to mention their
families’ future.
According to the American Cancer Society, about one in six
American men will be diagnosed with prostate cancer, the most
commonly diagnosed cancer (other than skin cancer) among this
group.
Fortunately, there are several ways men can keep their prostates
healthier, minimise the risk of prostate cancer, detect it earlier
and treat it more effectively.
“At no point in the past decade have there been more options
for the diagnosis, treatment or management of prostate cancer,”
says Virgil Simons*, founder and president of the “The Prostate
Net”, an organisation educating men about prostate health. “Most
prostate cancer-related deaths are due to advanced disease,
which can be minimised through early detection and targeted
educational efforts.”
Just a few simple tips can help men stay healthier:
Get Tested – Every man over the age of 50 should have his
prostate examined regularly and receive an annual PSA test, an
exam that detects antigen in the blood. High levels of this antigen
could indicate a prostate problem that isn’t necessarily cancer,
necessitating further study. Those with a family history of prostate
cancer or who are at higher risk should begin testing earlier.
“Despite the recent controversy regarding the PSA test, no other
protocol is available to help measure the potential diagnosis or
disease progression of prostate cancer,” stresses Simons.
Keep a Family Medical History – Collecting information about
the health of family members can show your doctors which
ailments to look out for. You should record things like gender,
date of birth, diseases or medical conditions and the age when
conditions were diagnosed. This information also can be collected
through family trees, old letters and obituaries.
Watch That Diet – The American Association for Cancer
Research has established that weight gain and obesity, especially
among inactive men, can increase the risk of prostate cancer
occurrence. So, proper diet and exercise are critical.
Experts recommend five or more servings of fruit and vegetables
a day, particularly greens high in vitamin C content like bell
peppers, broccoli, snow peas or cauliflower. Foods high in zinc,
like oysters, crab, duck, lamb and lean beef, also can help.
Lycopene-containing foods such as tomatoes and watermelon
have many cancer fighting properties, as do fish, like salmon, that
are rich in Omega-3 oils.
Get Educated – Despite having so much information about
health, there is still misunderstanding about disease, particularly
cancer. In Australia there is a wealth of free information about
prostate cancer, cancer generally and men’s health, available
from such organisations as the Cancer Council, the Prostate
Cancer Foundation of Australia (PCFA) and Andrology Australia.
Contact details are on Page 2 of this publication.
State Point Media / Hernando Today / 13MAY10.
*Virgil Simons was a speaker at the inaugural PCFA National
Conference in November 2008 and will be giving a presentation
at the second National Conference in August this month.
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A SURVIVOR’S JOURNEY
I’m sure that most people, male or female, when told after their
annual medical that there’s a strong possibility of cancer being
present, regardless of the type of cancer, would have a very similar
response to myself.
All my life I have been involved in more than my fair share of physical
sports, both socially and at a representative level. For the past 35
years I’ve taken a host of vitamins, eaten all the healthy foods that
you are supposed to eat and generally taken care of the body and
mind. So when I had my annual medical, including various blood
tests, a month before retiring in December 2005 and the results
showed that my PSA was greatly elevated compared to the previous
year’s figure, I was disturbed to say the least. Further testing
confirmed the diagnosis of prostate cancer and the results actually
scared the piss out of me. “WHAT RIGHT HAS CANCER GOT INVADING
MY BODY”, “THERE IS JUST NO WAY I AM HAVING ANY PART OF
THIS”, “YOU NEED TO DO ANOTHER TEST”, etc. etc. These are the
sorts of things that passed through my mind and I was having trouble
coming to grips with the whole testing procedures and outcome.
On retirement in February 2006 my wife and I had everything
planned and organised to head off on our trip of a lifetime around
Australia in our vehicle and caravan. With cancer raising its ugly
head we discussed either re-organising our plans or “BUGGER THE
CANCER” and continue on with our trip. I had the final call and it
was “BUGGER THE CANCER”, we’re going to head off. So armed
with a supply of hormone therapy to take whilst traveling and with
instructions to monitor my PSA levels every 3months while we were
on the road, which I did, we set off.
We traveled for 10 months and had a most enjoyable and memorable
trip, perhaps slightly dampened by the knowledge that when we
got home I had to deal with a problem and make decisions in an
area I was unfamiliar with. Choosing a preferred surgeon, method
of treatment, side-effects following treatment, how long would
the chosen treatment last, what happens to my wife and family if
everything goes pear shaped. Both during and after treatment my
mind was in overdrive and making the so-called “correct decision”
was extremely difficult. With insistence and assistance from my wife,
our son and both daughters the radical was the chosen therapy but
even with this treatment I had to get my head around the fact that
“erectile dysfunction” would possibly become the norm.
there were procedures available to overcome possible side-effects
which could be carried out post-radical didn’t help. At that time I felt
both extremely angry and disillusioned. Nevertheless the radical it
was to be and that was carried out prior to Christmas 2006, with the
outcome a resounding success, thanks to an exceptional surgeon.
Eighteen months on all was well except for one thing. It became time
to address my concerns about erectile dysfunction.
Like many others in this situation I had tried medication without
success and then a vacuum pump which was only marginally
successful. Injections were the next step, an idea I found very
daunting to say the least. After getting over the psychological hurdle
injections posed I eventually tried but, again, had only marginal
success.
I had further discussions with the original surgeon and it was decided
to opt for a “penile implant”. This was carried out in July 2009 and
the operation went well. As would be expected, post-op my nether
regions were a bit tender for a couple of weeks but the initial pain
and discomfort soon disappeared and all was well. To date the
implant has been a great success.
Since having the implant I’ve discussed the operation and results
with a number of other men who have had this procedure and all
of them talk in positives. All are happy that they had the implant
which has enabled them to put physical intimacy back into their
relationships with their partners.
In December it will be five years since my diagnosis and my progress
has been monitored with annual PSA tests – SO FAR SO GOOD!!
FELLAS – do not hesitate in having your annual PSA tests, preferably
accompanied by a DRE. Without having these tests you may never
know that you have Prostate Cancer - UNTIL IT IS TOO LATE!!
John Cummins.
(John Cummins was one of the founders of the Gold Coast Central
Prostate Cancer Support Group. For any man considering a penile
implant to correct erectile dysfunction who would like to speak to a
“user” prior to taking the plunge, John would be happy to talk to you.
He can be contacted by ‘phone on 0418 893 850 – Ed.).
Although the cancer would probably be eradicated the final outcome
had my head spinning. Assurance from my chosen surgeon that
Men Prefer Online Screening Decision Aids
Most men with a family history of prostate cancer prefer an online form of screening decision aid (DA), research shows. While acknowledging
the current controversy surrounding the benefits and harms of prostate cancer screening - mainly the high risk of false positive PSA test results
and over–detection of prostate cancers - the present study noted that research indicated that men with a family history of prostate cancer had
“significant unmet information needs”.The study authors and designers of the DA, from centres around Australia, recruited eligible men through
relatives attending urology outpatient clinics and asked them to appraise a paper-based version of the questionnaire (n=22).
The same men were then asked to reflect on an interactive web-based version via a semi-structured phone interview (n=20). The researchers
found that both forms of the DA were evaluated positively and all participants found the online DA easy to use and navigate. Most participants
(70%) reported that the website was their preferred mode of receiving prostate cancer screening information.
“DAs are designed to assist patients with decision making and or risk management options... online DAs have the additional advantage of being
able to be tailored to the individual: this is particularly important when risk estimates depend on the number and age of relatives with prostate
cancer,” the authors concluded.
Patient Education and Counselling 2010 published online before print.
Laura Macfarlane – Oncology Update.
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SHOULD EXPERIENCED OPEN
PROSTATIC SURGEONS CONVERT
TO ROBOTIC SURGERY?
The Real Learning Curve for One
Surgeon Over Three Years
Department of Urology, St Vincent's Private
Hospital, Darlinghurst, Sydney, NSW, Australia.
Abstract - Study Type - Therapy (case series) Level of
Evidence 4.
OBJECTIVE To critically analyse the learning curve for one
experienced open surgeon converting to robotic surgery for
radical prostatectomy (RP).
PATIENTS AND METHODS - From February 2006 to
December 2008, 502 patients had retropubic RP (RRP) while
concurrently 212 had robot-assisted laparoscopic RP (RALP)
by one urologist. We prospectively compared the baseline
patient and tumour characteristics, variables during and after
RP, histopathological features and early urinary functional
outcomes in the two groups.
RESULTS - The patients in both groups were similar in age,
preoperative prostate-specific antigen level, and prostatic
volume. However, there were more high-stage (T2b and T3,
P= 0.02) and -grade (Gleason 9, P= 0.01) tumours in the
RRP group. The mean (range) operative duration was 147
(75-330) min for RRP and 192 (119-525) min for RALP (P <
0.001); 110 cases were required to achieve '3-h proficiency'.
Major complication rates were 1.8% and 0.8% for RALP and
RRP, respectively. The overall positive surgical margin (PSM)
rate was 21.2% in the RALP and 16.7% in the RRP group
(P= 0.18). PSM rates for pT2 were comparable (11.6% vs
10.1%, P= 0.74). pT3 PSM rates were higher for RALP than
RRP (40.5% vs 28.8%, P= 0.004). The learning curve started
to plateau in the overall PSM rate after 150 cases. For the
pT2 and pT3 PSM rates, the learning curve tended to flatten
after 140 and 170 cases, respectively. The early continence
rates were comparable (P= 0.07) but showed a statistically
significant improvement after 200 cases.
CONCLUSIONS - Our analysis of the learning curve has shown
that certain components of the curve for an experienced
open surgeon transferring skills to the robotic platform take
different times. We suggest that patient selection is guided by
these milestones, to maximize oncological outcomes.
Doumerc N, Yuen C, Savdie R, Rahman MB,
Rasiah KK, Pe Benito R, Delprado W, Matthews J,
Haynes AM, Stricker PD.
British Journal of Urology 2010 (Epub ahead of print).
NEW ABIRATERONE STUDY
Abiraterone Acetate, Prednisone and Leuprolide Acetate or
Goserelin Before and During Radiation Therapy in Treating
Patients With Localised or Locally Advanced Prostate Cancer.
Fred Hutchinson Cancer Research Center, based in Seattle, are
currently recruiting participants for a Phase II trial of Radiation with
androgen deprivation. Participants will receive abiraterone acetate,
prednisone and LHRH agonist prior to and concurrent with radiation
therapy.
The primary objectives of the trial are to evaluate the safety of
abiraterone and prednisone with LHRH agonist given as neoadjuvant
and concurrent therapy with external beam radiation in patients with
localised prostate cancer and to determine whether pharmacologic
suppression of the prostatic androgen axis by inhibition of androgen
production with abiraterone can decrease tissue androgen levels to
below those observed with GnRH agonist suppression of testicular
androgens.
Patients will receive oral abiraterone acetate and oral prednisone
once daily for 24 weeks and also receive leuprolide acetate or
goserelin , given subcutaneously, in weeks 1 and 13. External beam
radiotherapy will start in week 15 and continue for 8.5 weeks. The
treatment will be ongoing for the 24 weeks in the absence of disease
progression or unacceptable toxicity.
After completion of the study treatment patients will be followed up
every 3 months for 5 years.
Secondary objectives of the trial are to determine whether treatment
with abiraterone acetate with LHRH agonist will be more effective
than LHRH agonist with bicalutamide in inducing inhibition of
androgen-regulated gene expression and increased apoptotic cell
death as assessed by immunohistochemistry, cDNA microarray
analysis and RT-PCR and to evaluate time to PSA progression in
patients treated with LHRH agonist with abiraterone acetate.
ClinicalTrials.gov (A service of the U.S. National Institute of
Health).
HIGHER VITAMIN K INTAKE TIED
TO LOWER CANCER RISKS
People with higher intakes of Vitamin K from food may be less likely
to develop or die from cancer, particularly lung and prostate cancers,
than those who eat relatively few Vitamin K containing foods, a new
study suggests. The study, reported in the American Journal of
Clinical Nutrition online 24MAR10, appears to be the first look at
the association between Vitamin K intake and the risk of developing
or dying from cancer in general. A previous report had linked it to
lower prostate cancer risk. The findings do not prove that consuming
more Vitamin K helps lower the risk of certain cancers. But they lay
the foundation for future studies to try and answer that question,
according to Dr Jakob Linseisin and colleagues at the German
Cancer Research Centre in Heidelberg.
(Vitamin K is chiefly found in leafy green vegetables such as spinach,
cabbage, kale, cauliflower, broccoli, brussels sprouts and parsley.
Some fruits such as avocado and kiwi fruit are also good sources –
Wikipedia – Ed).
Reuters Health.
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Short Cuts
Untreated Prostate Cancer No Death Sentence 18JUN10 NEW YORK (Reuters Health) – Even without treatment, only a small minority of men
diagnosed with early-stage prostate cancer die from the disease, Swedish researchers reported. Drawing from a national cancer register, they
estimated that after 10 years prostate cancer would have killed less than three percent of these men. The study was published in the Journal of
the National Cancer Institute online 18JUN10.
Outlawed Insecticide Linked to Prostate Cancer 21JUN10 Exposure to the long-banned organochloride insecticide “chlordecone” may be associated
with a greater chance of developing prostate cancer, a new case-control study showed. The findings were reported online in the Journal of Clinical
Oncology.
On the front foot over cancer The Federal Government has highlighted measures to fight what it calls a “worrying” rise in cancer. The Health
Minister, Nicola Roxon, has released – a day early – health statistics showing that 115,000 Australians are expected to be diagnosed with cancer
this year – a ten percent rise on four years ago. “Although survival rates have improved significantly for many cancers in the past twenty years,
cancer is still placing an intolerable burden on our community,” M/s Roxon said of the figures from the Australian Institute of Health and Welfare,
to be released formally today. Sydney Morning Herald 23JUN10.
Breast, prostate cancer due to same gene 28JUN10 – Hereditary breast and prostate cancer may be two sides of the same coin, new research
suggests. Scientists have discovered that both diseases develop the same way in men and women with a faulty BRACA2 gene. The gene,
which is involved in DNA repair, is known to play a role in breast, ovarian and prostate cancers. Researchers funded by the Cancer Research UK
charity pinpointed cancer-causing DNA defects in male mice genetically engineered to lack BRACA2 in their prostate glands. The research was
reported in the online journal Public Library of Science Genetics.
Depression often overlooked in cancer patients 29JUN10 ABC Online – Many doctors are failing to recognise the effects that breast and
prostate cancer have on a patient’s mental health, according to a recent study. Radiation oncologist David Christie collaborated with the
University of New England and Bond University to research the link between cancer and mental illness in 1,000 patients across South-East
Queensland.
Genomic Analysis of Prostate Cancer Created – In what its creators call a “unique public resource for the cancer research community”, a
genomic analysis of prostate cancer is now available online. The immediate significance of this resource stems from the fact that the disease
has a “high prevalence” and there is a “relative paucity of large comprehensive genomic datasets in prostate cancer”, according to the authors
of a review of the analysis published online 24JUN10 in Cancer Cell.
With bad news, families often don’t trust docs 30JUN10 (Reuters Health) – Families of critically ill patients may often take a more optimistic
view of their loved one’s condition than doctors do, even when they are given a specific estimate of the chances of survival, a new study
suggests. A number of studies have found that doctors and family members frequently have different opinions on critically ill patients’ odds of
survival. This raises the question of whether doctors are effectively communicating their estimates of patients’ prognosis, that is, the course their
disease is likely to take. So for the new study, researchers looked at whether the numeric and qualitative approaches differed in their effects on
families’ views. The findings were reported in the American Journal of Respiratory and Critical Care Medicine.
Rate ratio of death from prostate cancer in men attending screening versus controls was 0.44 01JUL10 (HealthDay News) – A prostatespecific antigen (PSA)-based screening program is associated with a reduction in prostate cancer mortality of nearly half over 14 years, but
with a substantial risk of over-diagnosis, according to research published online in The Lancet Oncology.
Above Information Sourced from Cancer Daily News.
PROSTATE CANCER PATIENTS FACE RATIONING OF “PROVENGE”
In April 2010 the U.S. Food and Drug Administration (FDA) approved the use of Provenge for the treatment of “asymtomatic or minimally
symtomatic metastatic, castrate resistant prostate cancer.” Provenge is a therapeutic vaccine and the first of a new class of drugs known as
autologous cellular immunotherapies.
Due to limited manufacturing capacity for Provenge only about 2,000 patients can be treated in the first year, falling well short of the 100,000
patients with advanced tumours who may be eligible to receive the drug.
Tom Randall – Bloomsberg Businessweek – 28JUN10.
TOMOTHERAPY COMES TO QUEENSLAND
The Royal Brisbane and Women’s Hospital is currently installing Australia’s first Tomotherapy unit. This unit combines integrated CT imaging
with conformal radiation therapy delivered via a linear accelerator. It differs from the usual whole-of-tumour delivery of radiotherapy in that the
radiation is delivered “slice-by-slice”, accurately pinpointing the tumour and sparing surrounding healthy tissue.
The prefix “tomo” is the Greek for “slice”.
Once installed the unit will be able to treat around 20 patients per day.
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DOGS SNIFF OUT PROSTATE CANCER - Approach Associated
With Few False Positives in Early Testing
Dogs may be able to sniff out the smell of chemicals
released into urine by prostate tumours, setting the stage
for a new means of early prostate cancer detection.
In early tests, the approach produced fewer false positives
than would be expected with the commonly used PSA test,
French researchers report.
The concept isn’t new. Other researchers have reported
varying degrees of success using dogs to detect cancers of
the skin, lung and bladder, says researcher Pierre Bigot MD of
Tenon Hospital in Paris.
The theory is that many tumours release chemicals with
distinct odours that can be picked up by dogs, whose sense
of smell is much more sensitive than that of humans, he tells
WebMD.
Better Prostate Cancer Tests Needed
More accurate prostate cancer tests are sorely needed, says
Anthony Y. Smith MD, chief of urology at the University of New
Mexico in Albuquerque.
While the widely used PSA test picks up a lot of cancers, it
also has a high false-positive rate, he tells WebMD.
“If all the men with high PSA scores go on to have biopsies,
fewer than one-third will actually have cancer,” Smith says.
“Plus, many men with early prostate cancer are unnecessarily
treated because existing tests can’t distinguish between lifethreatening and slow growing tumours,” he says.
In the United States, one man in six will receive a diagnosis
of prostate cancer during his lifetime, but a much smaller
proportion – one in thirty-five – will die from the disease,
according to the American Cancer Society.
Smith moderated a news briefing on the findings at the
American Urological Association annual meeting.
Dogs Sniff Out 63 of 66 Prostate Cancer Samples
For the new study, researchers led by Jean-Nicolas Comu MD,
also of Tenon Hospital, trained a Belgian Malinois – a shepherd
breed used for detecting bombs and drugs – to identify urine
from patients with confirmed prostate cancer and then to
discriminate those samples from urine of healthy men.
After about a year of training, the dog was put to the test.
During 11 runs, the dog faced six urine samples, only one of
which came from a man with prostate cancer. Its mission: To
sit in front of the urine it considers cancer.
In 66 tests, the dog was correct 63 times. There were three
false positives, in which the dog mistakenly identified samples
from healthy men as being cancerous. And there were no false
negatives.
And one of the three false positives might not have been
that false; when the man who provided the urine sample had
another biopsy, he turned out to have prostate cancer, Bigot
says. Other dogs are now being trained.
‘Electronic Nose’ for Prostate Cancer Detection.
The low false-positive rate “is pretty spectacular,” Smith says.
“But this is a very small study and it remains to be seen if the
findings will hold up in other studies. Sceptics are concerned
that the animals may be picking up on subconscious signals
from researchers among other things. The next step is to
figure out what chemicals or combination of chemicals the
dog is sensing.”
If the approach does pan out, don’t look for dogs running
around hospitals, sniffing urine samples. That would be
impractical and prohibitively expensive, Bigot says. But if
researchers can identify which chemical the dog is reacting to,
they hope to develop an “electronic nose” for more accurate
prostate cancer detection.
Charlene Laino – WebMD.com – 02JUN10.
SPONGE COULD HOLD PROSTATE THERAPY
British Columbia scientists have developed an experimental new drug to shrink prostate cancer tumours, based on molecules
extracted from a marine sponge collected in New Guinea.
Their study, published today in the journal Cancer Cell, shows the experimental drug, “EPI-001”, not only shrunk tumours, but did
so without toxic effects on the cancer-afflicted laboratory mice that got injections of the drug.
“The day I saw the way tumours were actually shrinking, I ran all around the building showing everyone the pictures,” said
Marianne Sadar, a scientist with the British Columbia Cancer Agency. Sadar has spent years looking for new drugs to help men who
suffer from relapses when their cancer becomes resistant to androgen ablation therapy: surgical or drug treatment meant to stop
production of male hormones (testosterone) that fuel tumour growth.
Continued...
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In such men, prostate cancer begins to grow again and standard therapies may increase survival by only about two months,
according to the new study.
Several years ago, Sadar teamed with Raymond Andersen, a natural compounds chemist and University of British Columbia
professor, who has spent much of his career combing the seas for natural compounds to be used as anti-cancer medicines.
Sadar said there have been a number of chemotherapy drugs developed from sponges. And a survey by the U.S. National
Cancer Institute showed that natural products or synthetic versions of natural products make up about 64 percent of anti-cancer
compounds currently in pre-clinical studies or clinical trials.
More than 70 percent of the Earth’s surface is covered by oceans and it’s been estimated there are more than 100,000 species of
invertebrates in the oceans. Sponges are considered ideal for providing raw materials for the development of new drugs.
But in a surprising turn of events, scientists discovered that the compounds in the marine sponge had a chemical composition
resembling a compound called BADGE (Bisphenol A Diglycidic Ether), which indicated the sponge was harvested from contaminated
water possibly polluted by ship traffic.
Sadar said sponge material was collected from a shipping route and it would appear the sponge “bioaccumulated the metabolites
or byproducts of Bisphenol A,” a ubiquitous compound used in the plastics industry.
Bisphenol A (BPA) is the subject of concern, as research has shown it can be an endocrine system disrupter and may be especially
harmful to infants and children.
Sadar said her team isolated and extracted only the sponge’s desired compound, EPI-001, into a purified form and then synthesised
it.
The drug does not contain BPA and, indeed, in the study, mice getting high doses of EPI-001 suffered no ill effects on their internal
organs as shown by pathologic examination.
Future studies must satisfy Food and Drug Administration guidelines before being used in humans in clinical trials.
Pamela Fayerman – The Montreal Gazette – 21JUN10.
NEW NEOADJUVANT MAY RENDER ADVANCED PROSTATE
CANCER OPERABLE
Ipilimumab (also known as MDX-010 or MDX-101) is a human monoclonal antibody being developed by Bristol-Myers Squibb and
Medarex. It is intended to be used as a drug to activate the immune system. Ipilmumab binds to CTLA-4 (cytotoxic T lymphocyteassociated antigen 4), a molecule on T-cells that is believed to play a critical role in regulating natural immune responses. The
absence or presence of CTLA-4 can augment or suppress the immune system’s T-cell response in fighting disease. Ipilimumab is
designed to block the activity of CTLA-4, thereby sustaining an active immune response in its attack on cancer cells.
As neoadjuvant therapy, ipilimumab appears to boost T-cell responses in patients with advanced prostate cancer receiving
androgen ablation therapy. In a randomised phase II study at the Mayo Clinic and Memorial Sloan-Kettering Cancer Center, more
patients on ipilimumab showed a decline in PSA to undetectable levels. Some had a significant clinical response with disease
downstaging. A further study of 12 patients who opted for radical prostatectomy showed a “profound” local response among those
in the ipilimumab arm: disaggregation of solid tumours into isolated organ-confined foci potentially amenable to resection.
This combined therapy “may have significant implications for improving prostate cancer treatment,” the researchers say.
Wikipedia/SearchMedica/ASCO 2010 Genitourinary Cancer Symposium.
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PROSTATE SCREEN QUEENSLAND - PROSTATE CANCER FIRST
The first prostate screening clinic in Australia will be opened in Brisbane this week by prostate cancer specialist and urologist Dr Peter
Swindle.
As the most common cancer and the second leading cause of cancer death in Australian men, prostate cancer is an
important issue. Until now, there has not been a dedicated service focused solely on delivering information regarding the
pros and cons of prostate cancer testing. The screening service offers easily accessible and simplified testing for prostate
cancer by highly trained medical practitioners in a specialised primary care framework.
“The sole focus of the consultation at Prostate Screen Queensland is discussion and education regarding prostate cancer
testing and early diagnosis. Informed decision making is vital,” Dr Swindle, developer of Prostate Screen Queensland, said.
Prostate Screen Queensland will be situated at the Mater Private Clinic, South Brisbane.
Dr Peter
Swindle.
Sunday Mail 13JUN10.
Prostate Screen Queensland can be contacted by ‘phone on 07-3010 3333 or by going to www.prostatescreenqld.com.
Brisbane PCSG - 2010 meeting program
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley.
Evenings at 7pm (even months).
Mornings at 9.30am (odd months).
August 4
September 8
“Researching New Therapies for Late Stage Prostate
Cancer” - Professor Pamela Russell, QUT Faculty of
Life Sciences”.
TBA”.
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 Vicki Mol on 07-3634 5264.
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: 1/145 Melbourne Street, (P.O. Box 3420) South
Brisbane Qld 4101 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 th e 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.
LAST
WORD
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 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).
Patricia and I were sitting at the breakfast table last Sunday reading the papers when an article about a young
widow remarrying caught my eye. “If I was to die suddenly I want you to immediately dispose of all my stuff,
either sell it or give it to Vinnies,” I said.
“Now why would you want me to do that?” she said.
“Because I guess you’d remarry and I don’t want some silly old bugger using my things.”
She gave me a quizzical look and said “What makes you think I’d marry another silly old bugger?”
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