Prostate Cancer News In this issue Queensland Guest Editorial,

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Queensland
Prostate Cancer News
The magazine is a publication of the Queensland Chapter, Prostate Cancer Foundation of Australia.
December 2011
In this issue
Guest Editorial,
Do women really care?
Christmas is approaching and usually we take the time
to send our best wishes to family and friends whom
we haven’t caught up with a lot throughout the year.
An act of kindness most of us do because we care.
No doubt for many who have received the diagnosis of
Prostate Cancer in 2011 it will have been momentous
for you as an individual and as a couple. Moving into
2012 may be filled with apprehension, fear and anxiety
for what the future holds for you both. As a woman
you will now be termed a carer if you have a spouse
with Prostate Cancer.
It’s a strange, unwelcome and not very comfortable
title to have. At least that was my experience. But
this role we assume, adopt and run with at the time
because of necessity and the circumstance even
though it’s very unfamiliar territory to us.
Post operatively as a carer our lives seem to take
on a whole new dimension. It is determined by how
we best support, care for and attend to the needs
of our spouse. It then moves into another stage as
he recovers: of follow up care, encouragement and
understanding despite being on our own emotional
roller coaster.
It is no surprise then that men with Prostate Cancer
become more dependent on their partners to act as
their primary communicator and caregiver.
Duty of care is an aspect of the professional and
medical world we hear so much about, though
not something written into our traditional marriage
vows. It’s more along the lines of ‘love, honour and
cherish’. As a couple you don’t sit down together
and work out your own personal duty of care
statements. It becomes an automatic response
in your relationship, motivated by your depth of
feeling and concern for each other, based on each
other’s needs.
When your spouse has Prostate Cancer and he is
in need of care, that’s exactly what you do, to the
very best of your ability. Being a carer is an inbuilt
and unique quality that women have. It emerges
when our loved one is faced with a disease that is
potentially life threatening.
Do women care out of duty or is it our duty to care?
No, neither! It’s something women do because we
genuinely do care, but more importantly because
we love.
But who cares for the carer? Other carers of
course! Those who are in a similar situation to your
own! Women do really care.
Maggie Fincham Angus,
Coordinator of the Gold Coast Prostate
Cancer Partners Support Group.
Phone 0427 359 375 or
email: [email protected]
Calendar of Events 2011/12
Resources: Web Links,
Associated and Affiliated Groups.
3
SPOTLIGHT ON North West Queensland (Mt Isa).
4
New “Wonder Drug”.
Diet & Cancer.
5
Prostate Cancer Update.
9
Gympie Member’s Final Project.
MMRI Research.
10 Convener a Proud Australian.
11 News Roundup.
12 Mummys Get Prostate Cancer.
Vacuum Erection device
aids recovery after surgery.
13Hypofractionated
Radiotherapy Report.
14 Cancer Etiquette.
15 Combination Therapies for High-Risk Disease.
QOL After Brachytherapy.
16 Brisbane Program: Prostate Cancer Foundation of Australia www.prostate.org.au Cancer Council Queensland www.cancerqld.org.au
Dec 01
World AIDS Day www.worldaidsday.org.au
Jan 30
Medicine Wise Week www.nps.org.au
Anytime
C-vivor (free sessions) www.cancerqld.org.au
Anytime
Barbeque for Prostate Cancer www.pcfa.org.au
www.pcfa.org.au
2
T 1800 22 00 99
T 1300 65 65 85
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.
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
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.
HealthInsite
www.healthinsite.gov.au
Your gateway to a range of reliable, up-to-date
information on important health topics.
Lions Australian Prostate Cancer
www.prostatehealth.org.au
The first stop for newly diagnosed men
seeking information on the disease.
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 Foundation
of Australia
www.prostate.org.au
Phone 1800 22 00 99
Assistance with the experience of diagnosis
and treatment for prostate cancer.
Queensland Chapter
www.prostate.org.au
Information, patient support materials, and
contacts for advice on living with prostate
cancer in Queensland.
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
Beenleigh
Peter Keech
0407 070 194
Mackay
John Clinton
07 4942 0132
Brisbane
Peter Dornan
07 3371 9155
Maryborough
Leoll Barron
07 4123 1190
Bundaberg
Rob McCulloch
07 4159 9419
Mount Isa
Tony McGrady
07 4743 2740
Capricorn Coast
(Yeppoon)
Jack Dallachy
07 4933 6466
North Burnett
Russell Tyler
07 4161 1306
Central Qld.
(Rockhampton)
Lloyd Younger
07 4928 6655
Northern Rivers
(Alstonville)
Pat Coughlan
02 6622 1545
02 6684 2201
Jim Hope
07 4039 0335
Northen Rivers
(Lismore)
Warren Rose
Far North Qld.
(Cairns)
07 5446 1318
Geoff Lester
07 4979 2725
Sunshine Coast
(Maroochydore)
Rob Tonge
Gladstone
Gold Coast North
John Caldwell
07 5594 7317
Toowoomba
David Abrahams
07 4613 6974
Gold Coast Partners
Maggie Angus
07 5577 5507
Bob O’Sullivan
0405 274 222
Gold Coast Central
(Evening Group)
Peter Jamieson
07 5570 1903
North Queensland
(Townsville)
Ross Davis
07 5599 7576
Gympie and District
Robert Griffin
07 5482 4659
Twin Towns &
Tweed Coast
Hervey Bay (Pialba)
Ros Male
07 4125 6701
Whitsunday
(Proserpine)
Dave Roberts
07 4945 4886
Ipswich
Terry Carter
07 3281 2894
The news sheet for any group should have the meeting details for
its neighbouring groups.
Associated Support Groups
2
Group
Contact
Phone
Sponsor
Beaudesert
Carmen O’Neill RN
07 5541 9231
Beaudesert Health/Gold Coast
Kingaroy
Robert Horn
07 4162 5552
Toowoomba/Sunshine Coast
SPOTLIGHT on
North West Queensland (Mt Isa)
Our inaugural Convener, George Apps, passed away in June 2010.
George’s passing was a great loss to our Group and indeed to the Mt Isa
community in general as he was involved in many community activities
through Lions, Rotary and other organisations. Writing in “Queensland
Prostate Cancer News” a few months prior to his death 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.”
The North West Queensland Prostate Cancer Support Group has honoured
George’s vision under the stewardship of Yvonne McCoy and Tony McGrady, by
increasing community awareness of the toll this disease wreaks on Australian
men and raising funds for prostate cancer research.
Our region covers some 30,000 square kilometres and, apart from Mt Isa,
encompasses eleven other communities. Whilst the area’s health care is
administered by North West Queensland Primary Health Care, the nearest
treatment centres for prostate cancer are 1,000 kilometres plus away to the
East. The demographics of the region include a high proportion of males and
the remoteness of some of the communities present us with a real challenge
when it comes to spreading the (prostate cancer) word.
We currently have around 60 Support Group members on our mailing list and
this number is constantly increasing. One of our members, Kyle Small, has
sought and obtained sponsorship from a number of local businesses and Kyle
has used their support to set up a “buggy” which has been a drawcard at a
number of local events.
Towards the end of last month the Mt Isa Civic Centre held “Carols by
Candlelight” which concluded with a fireworks display. The event attracted a
large number of men and their families, a good mix for promoting the need for
men to check for prostate cancer as they reach middle age (if they forget to
follow up their partners will be there to remind them!). We set up an awareness
booth which drew plenty of attention and requests for literature. All proceeds
from the night were donated to our Support Group; a very rewarding evening.
We are currently involved in the establishment of a “Men’s Shed” in Mt Isa
which we see as an ideal venue to promote our cause. Our Support Group
have applied to the local Council for a lease over part of the Frank Ashton
Underground Museum to set up the “Shed”. Mt Isa Mayor, Cr John Molony, has
appointed Cr Robbie Katter as his liaison officer with our Group. Cr Katter has
stated that “I fully support the concept of a Men’s Shed and will be doing all
in my power to ensure that this brilliant idea becomes a reality. I have spoken
to a number of Mt Isa families and the support in the community is there in
abundance. This is what community is all about, the people working with their
Council to achieve things. I am right behind this concept and working together
we can make it happen.”
The Support Group Chairman, Tony McGrady, said that the Mayor had informed
him that there were other venues which could be available if the Frank Ashton
site was not mutually acceptable.
Earlier in the year we had an awareness booth set up at the Mt Isa Mining
Expo. Many national and international companies participated in this exhibition
of mining machinery, techniques, trends and research and attendance was
as diverse as the exhibitors. Our booth got plenty of attention from the mostly
male attendees.
“The Buggy”
– Getting the
Awareness
Message to the
Community.
Last August the “buggy”, with Kyle in the driver’s seat and ably assisted by
his trusty steed Wally in the shafts, undertook an awareness drive from Mt
Isa to Camooweal. At around 20 kilometres per day the trip took ten days
and Kyle and Wally’s arrival in Camooweal coincided with the town’s Drovers’
Festival. Kyle’s family and a number of local men organised a back-up team
for the trip and the group “rattled the tin” and handed out prostate cancer
literature along the way. The “Horse & Buggy Drive” was a great success as
both an awareness event and fundraiser. In the annual street parade, which
forms part of the Festival, Kyle and Wally were awarded first place.
Kyle Small is
Presented With His
Trophy by Yvonne
McCoy for First Place
in the Camooweal
Drovers’ Festival
Street Parade.
Support Group
Member Terry
McCoy at the
Mining Expo
Booth.
It’s too early to know the awareness and fundraising results as yet but one of
Mt Isa’s premier sporting teams from the Euros Rugby Union Football Club put
the spotlight on men’s health when they agreed to participate in MOvember.
Club secretary, Amber Liddle, said “I came up with the idea of the team
donating to a charity each season and at the last meeting we held one of the
players suggested taking part in MOvember. Participating in MOvember this
year will help raise funds and awareness to the two most common health
problems men tend to face, prostate cancer and depression.”
If you’re in Mt Isa, on business, holidays or a grey nomad passing through,
we’d love to see you and have you attend one of our meetings if the timing
is appropriate.
Yvonne McCoy
Tony McGrady
07-4743 2054
0400 798 315
3
THE NEW “WONDER DRUG” FOR CANCER
Professor Sanchia Aranda, director of cancer services and
information at the Cancer Institute NSW talks about the
importance of exercise in improving survival from cancer.
With Australians failing to take on the exercise message, how
much harder is it to sell exercise to someone undergoing treatment
for cancer?
For most of us, the natural instinct when we are sick is to rest,
especially if the sickness is cancer and fatigue its most common
complication. But, evidence suggests that one of the best ways to
prevent or minimise cancer fatigue is to maintain as much normal
activity as possible during and after treatment.
The advice that people with cancer should rest and take it easy is
outdated and health professionals have an obligation to promote
evidence of the clinical benefits of exercise, such as the reduced
risk of infection, deep vein thrombosis and loss of muscle mass
should resonate.
And, yes, that means exercise.
What better opportunity for clinicians to encourage an active
lifestyle than at a time when patients are receptive to new ideas and
motivated to make changes? People with cancer regularly ask what
they can do to keep themselves well, while health professionals
struggle with the response to this question. Clearly, promoting a
healthy diet and increased activity are ideal self-care messages.
MOVE MORE: A new study by British advocacy group Macmillan
Cancer Support, is calling exercise a 'wonder drug', with evidence
that it not only combats fatigue, depression and anxiety, but that twoand-half-hours per week significantly reduces the risk of people with
breast, prostate and bowel cancers dying from their disease.
The group is calling for exercise to be incorporated into standard
cancer care, as part of clinical guidelines and quality standards,
supported by subsidised gym programs and facilities specifically
for people with cancer.
The advice that people with cancer should rest and take it easy is
outdated and health professionals have an obligation to promote
evidence of the clinical benefits of exercise.
How would this work in the Australian setting?
Australians are leading increasingly sedentary lives and obesity
rates are alarming, despite the rapidly growing fitness industry.
It's important patients feel encouraged and supported to talk to their
doctor, nurse or physiotherapist about what exercise is suitable for
them during and after cancer treatment. In general, the person with
cancer is the best guide on the level of exercise that feels right for
them. They should be encouraged to increase their exercise, but not
to the point of exhaustion.
Friends and family members are also an important help and are
often looking for things they can do to help their loved one get well.
Families are in an ideal position to go for a walk with the person
being treated for cancer, to help them maintain independence
and keep active, rather than always rushing to do things for them
that reduce the amount of exercise and activity severely. A family
exercise prescription will have benefits for everyone!
EATING EGGS, DAIRY, RED MEAT AND POULTRY MAY
INCREASE YOUR RISK OF PROSTATE CANCER
How do you like your eggs? Over easy? Scrambled? How about
switching to oatmeal? A new US study found that eating eggs
may increase your risk of developing advanced prostate cancer.
This is on top of the other evidence over recent years that link
dairy and prostate cancer and meat and prostate cancer.
Researchers from the University of California, San Francisco, and
Harvard School of Public Health evaluated data from 27,607 men
who had been followed from 1994 to 2008 and who were prostate
cancer-free at the beginning of the period. They discovered that
healthy men who ate 2.5 eggs or more each per week had an 81%
higher risk of developing advanced prostate cancer compared with
men who ate fewer than 0.5 eggs per week on average.
As an aside, they also noted a “suggestion” that eating poultry and
processed red meat after a diagnosis of localised prostate cancer
was linked to progression to advanced prostate cancer. Previous
research, however, has indicated a more significant association.
4
In a study conducted by the National Cancer Institute of more
than 175,000 men and spanning the years 1995 to 2003, the
investigators found that men who ate the most red meat were
12% more likely to develop prostate cancer and 33% more likely
to develop advanced cancer than men who ate the least amount of
red meat.
It appears eating eggs can do more than raise your cholesterol level.
If you want to improve your chances of avoiding advanced prostate
cancer, skip the steak and eggs and scrambled eggs and bacon.
Sources:
Richman EL et al. Egg, red meat, and poultry intake and risk of lethal
prostate cancer in the prostate specific antigen-era: incidence and
survival. Cancer Prev Res 2011 Sep; DOI: 10.1158/1940-6207
Sinha R et al. Meat and meat-related compounds and risk of prostate
cancer in a large prospective cohort study in the United States. Am J
Epidemiol 2009 Nov 1; 179(9): 1165-77.
PROSTATE CANCER UPDATE
At the Brisbane Group’s annual prostate cancer awareness
evening Urological Surgeon, Dr Roger Watson and Radiation
Oncologist, Dr Tiffany Daly gave a prostate cancer update covering
the scale of the problem, management of the disease and the
current treatment regimes generally used for cure or control.
The value of screening for prostate cancer has been widely debated for
many years. Prostate Cancer Foundation of Australia recommends that
men should be tested from age 50 or earlier if there’s a family history of
the disease. Ideally screening should consist of a PSA (prostate-specific
antigen) blood test plus a DRE (digital rectal examination) followed by a
prostate biopsy if the initial testing shows any irregularities.
The advantage of screening allows men an opportunity to detect early
cancer and successfully treat it, hence reducing the burden of advanced
prostate cancer and/or reducing the death rate from the disease.
Dr Tiffany Daly
Dr Roger Watson
The prostate gland is situated at the base of the bladder in men. At
puberty male hormones secreted by the testes stimulate prostate
growth until it becomes about the size of a walnut. The urethra, the tube
that carries urine from the bladder to the penis, runs through its centre.
Ejaculatory ducts that carry mature sperm also run through the gland
and during ejaculation the prostate secretes a milky alkaline fluid which
then becomes a constituent of sperm.
The disadvantages include the fact that the cancer may be slowgrowing and not become dangerous (particularly in older men who may
die “with the disease rather than of it”), the test is not 100% accurate
so it may give false positives or false negatives and unnecessary
treatment of slow-growing cancers can produce side effects,
particularly altered sexual function, which can significantly impair
quality of life. Unfortunately there’s currently no way of distinguishing
aggressive cancers from those which are slow growing.
Whilst early prostate cancer is generally symptomless, once the
tumour grows symptoms may arise including bladder plumbing
problems (difficulty and/or pain when voiding and blood in the urine)
and it may spread to the lymph nodes and bones causing the bones to
become brittle and painful. Once this occurs the cancer is advanced or
metastatic and control may be possible but a cure unlikely.
Even when a man exhibits “plumbing problems”, prostate cancer
may not be the culprit. BPH (benign prostatic hyperplasia or benign
enlargement) is common as men age and may cause difficulties when
urinating. Prostatitis can cause the prostate to become inflamed and
swell causing discomfort and pain. Both these conditions are generally
easily treatable, the first with a TURP (trans urethral resection of the
prostate, commonly called a “re-bore”) and the second with a course
of antibiotics.
Whilst lung cancer is still the largest killer of Australian men, prostate
cancer is the most commonly diagnosed cancer excluding nonmelanoma skin cancers. Diagnoses this year are expected to exceed
20,000 and this figure will grow alarmingly over the next decade as
the Australian population ages and the “baby-boomers” and early
“Gen X-ers” reach the 55 – 75 age group, the most common ages for
prostate cancer to be diagnosed.
Because of the possibility of these other prostate problems, symptoms
alone are not a reliable indication for diagnosing prostate cancer. The
PSA test has been improved since its adoption in the late 1980s. Age
related allowances, patterns over time with regular testing and the
total versus free-PSA levels all assist with more accurate diagnostic
predictions. In conjunction with a DRE by which a trained professional
may detect any prostate irregularities, the PSA gives a reasonable
indication of the presence of cancer or otherwise. However if there
are positive indications or if doubts remain the only definitive test is a
prostate biopsy.
This is generally a TRUS (transrectal ultrasound guided needle biopsy
of the prostate although it can be carried out through the perineum
rather than the rectum). It’s an outpatient procedure carried out in a
hospital’s endoscopy unit. The patient is lightly sedated for comfort and
antibiotics are given to prevent infection. There is a low but defined risk
of infection but this rarely requires in-hospital care.
Continued...
5
When the biopsy
is carried out via
the perineum
(a transperineal
ultrasound
guided biopsy)
there is less risk
of infection and
its more likely
to be able to
diagnose anterior
and smaller
tumours however
the procedure
requires a
general anaesthetic in a hospital operating theatre and there’s an
increased chance of increased urinary symptoms and bleeding.
During the biopsy 12 – 20 cores will be taken for analysis by a
pathologist. The subsequent pathology report may rule out cancer, the
prostate problems may be due to BPH or inflammation, or indicate
that cancerous cells are present or that there are PIN (prostatic
intraepithelial neoplasia) and atypia cells present. PIN is a condition
between normal and cancerous, cells that are likely to evolve into
cancer cells, and atypia cells are not cancerous but not typical either.
Once the cancer has spread beyond the prostate into the surrounding
tissue or spread further afield (metastatic), a cure may not be possible
and the treatment options for localised disease may no longer be
suitable. However androgen deprivation therapy may be recommended
to control the tumour growth.
Other factors to be taken into account when deciding on the way
ahead are the age and health of a patient. A 70 year old man who
has been diagnosed with early localised prostate cancer but is
overweight, has diabetes and a history of cardiovascular problems
will most likely die long before the prostate cancer is cause for
concern whereas, if the 70 year old was in good physical condition
with no other health issues, he could have another 20 years of
productive life ahead of him and treatment may be in order. Problems
with anaesthetics may rule out surgery for some and the time taken
to complete a course of radiotherapy versus a short hospital stay for
surgery may sway some men towards surgery where both types of
treatment could be considered.
If you’re not completely happy or confused about the way ahead
following the discussion with your doctor about treatment options, it’s
always worthwhile getting a second opinion.
From the biopsy results the prostate tumour will be assigned a Gleason
score. The cancer cells are numerically graded from 1 to 5 (the lower
the grade the less potential for aggressive cancer) and the Gleason
score is arrived at by adding the two most common grades from the
biopsy giving a figure of between 2 and 10. For example the most
common grade may be 3 and the next may be grade 4 so the Gleason
score will be 7 (3+4). Gleason scores of 4 or less indicate a tumour of
low aggressiveness, 5-6 is moderate, 7 intermediate and 8-10 is high.
Once prostate cancer has been confirmed your doctor will probably
want further tests carried out such as a CT/CT PET (computerised
tomography) scan, MRI (magnetic resonance imaging) scan and
bone scan to check if there’s been any spread of the tumour beyond
the prostate. With the information now available the cancer can be
assigned a “stage”.
Tumours are “staged” from T1 to T4 are there are sub-groups within
these divisions. T1 is where the tumour is small, confined to the
prostate and cannot be felt during a DRE. It will be picked up on biopsy.
With T2 the tumour is confined to the prostate but can be felt. T3
means the tumour has spread from the prostate into areas such as the
seminal vesicles and with T4 the tumour has spread into the pelvis and
pelvic organs (bladder and rectum).
Now armed with PSA test results (better if it’s a number of readings
over several years), Gleason score, stage and scan outcomes, the
patient and his doctor are in a position to look at the way ahead in
terms of treating or managing the disease.
Assuming the cancer is still confined to the prostate (localised disease)
the treatment options include surgery (radical prostatectomy), external
beam radiotherapy, brachytherapy (either low-dose [seeds] or highdose), androgen deprivation (hormone) therapy, active surveillance
(watchful waiting) or a combination of some of these. Other options less
often used are cryotherapy and HIFU (high-intensity focused ultrasound).
6
The PSA test has led to prostate cancers being detected earlier,
meaning more are being diagnosed before the cancer has spread
outside the prostatic capsule. For this reason more men who decide to
have treatment are opting for surgery to remove the prostate (radical
prostatectomy) and, hopefully, the tumour along with it. Traditionally
open surgery has been used but laparoscopic and robot-assisted
laparoscopic are becoming more common. Regardless of which method
is used the surgeon will try to preserve the nerve bundles running
alongside the prostate (nerve sparing radical prostatectomy) which
affect continence and erectile functions however if there is significant
tumour volume existing near or on the outer parts of the gland this may
not be possible and some or all of the nerves may have to be sacrificed.
The surgeon’s first priority will be preservation of life, then preservation
of continence and then preservation of erectile function.
Long-term, the outcomes from open versus robotic surgery are about
the same. The overall cure rate for open surgery is around 80-85% at
15 years and it’s unlikely that this will be improved upon by the robotic
assisted procedure. Compared to open, robotic surgery causes less
blood loss, has a shorter hospital stay (often just overnight), a quicker
return to general activities and shorter catheterisation and urinary
recovery. However urinary function following either open or robotic
surgery can be assisted by following a pelvic floor exercise regime
(and losing weight if applicable) before and following the prostatectomy.
Continued...
Regardless of which method is used, the skill and experience of the
surgeon is an important consideration.
Recovery of erections may depend on a man’s age, general health
and sexual function prior to surgery but can be helped along with
the use of pharmaceuticals or other devices. If erectile dysfunction
persists following surgery it’s best not to let too much time pass
before seeking medical advice about the problem if this is causing
relationship difficulties.
The other mainstream treatment for prostate cancer is radiotherapy
(radiation therapy). Radiotherapy uses various types of ionising
radiation to treat the cancer. The ionising radiation damages a cell’s
DNA causing irreversible damage which leads to cell death. The
treatment aims to achieve maximum tumour cell kill with minimal
damage to normal tissue. As normal tissue is better at repairing
radiation damage than cancerous tissue, if the treatment doses
are small enough the cancer cells can be eliminated. Consequently
external beam radiotherapy, the most common form of radiotherapy
for treating localised prostate cancer, is given in small doses (fractions),
daily Monday to Friday, over a period of 7-8 weeks.
Radiotherapy can be given externally (external beam radiotherapy or
EBRT) or internally (brachytherapy).
Whilst the aim of this treatment is to eliminate the prostate cancer,
radiotherapy can also be used for palliative purposes in cases where
the cancer has metastasised. External beam radiotherapy is delivered
via a machine called a linear accelerator, a typical example of which is
shown in the slide below.
Unfortunately the
radiation beams
don’t just stop at
the prostate. Other
organs, the bladder,
urethra and bowel,
can be affected
leading to both
immediate and longterm side effects.
The early side effects
could include altered bowel and bladder function (urgency, diarrhoea,
incontinence, frequency, pain and bleeding) but these mostly settle
down once treatment is finished. However, in a few men, side effects
remain with scar tissue (strictures) from radiation damage forming
in the bowel, bladder and/or urethra and adding to the problems. In
severe cases the bleeding problems (proctitis) could be treated with
formalin (bowel) or hyperbaric oxygen therapy (bowel and bladder) or
surgery to remove the strictures.
In the past decade these side effects have been greatly reduced
with the advent of image guided radiotherapy (IGRT) and intensity
modulated radiotherapy (IMRT).
Unfortunately the prostate is continuously on the move depending on the
fullness or otherwise of the bladder, the amount of wind or solid matter
in the bowel and pressure from other organs. IGRT is the placement of
small markers (gold seeds or fiducial markers), normally three, within
the prostate to ensure its location can be accurately assessed and the
radiation beam appropriately aimed to avoid other organs.
The three markers can
be seen in the above
slide. They are inserted
in a procedure similar
to a prostate biopsy.
IMRT allows the
intensity of the
radiation beam to
be altered. When the
angle of the beam
is such that it may affect organs other than the prostate the beam’s
intensity is modulated so that the dose to normal tissue is reduced
whilst the dose to the tumour can be increased when the beam is
appropriately positioned.
Results of long-term trials in Australia and overseas have shown
that up to six months of hormone blockade (androgen deprivation or
hormone therapy) used in conjunction with EBRT and beginning five
months prior to EBRT greatly assists disease control and survival.
Brachytherapy is a form of radiotherapy where the radiation is delivered
to the prostate from an internal source. It can take two forms. Low
dose (LDR) brachytherapy where radioactive “seeds” are permanently
implanted in the prostate to kill the cancer cells and high dose (HDR)
brachytherapy where hollow needles or catheters are temporarily
placed into the prostate and a radioactive source is introduced through
the needles. Once treatment is complete the catheters are removed.
Advantages of brachytherapy are the ability to deliver a high dose of
radiation directly to the tumour with minimal exposure to surrounding
tissue and organs and, because of this, the dose of radiation can be
higher than may be safe using EBRT.
The procedures for inserting the “seeds” or the catheters are similar for
both LDR and HDR.
Diagram
showing the
position of
the implant
X-ray
showing the
position of
the seeds in
the prostate
after the
implant
LDR is normally used for patients who have been diagnosed with
prostate cancer in the low to moderate range or, for various reasons,
may not be suitable for other treatments. Up to 80-100 radioactive
“seeds”, each about the size of a small grain of rice, are implanted
in the prostate through hollow needles which are inserted through
the perineum and guided to their destination with ultrasound and
other guidance systems. The operation is carried out under a general
anaesthetic in a hospital operating theatre.
Continued...
7
PROSTATE CANCER UPDATE Continued...
Radiation emitted from the “seeds” decreases rapidly within a couple
of millimetres from each “seed” and the positioning of the “seeds”
can be planned prior to insertion to give most benefit in terms of killing
tumour cells and not causing damage to other organs. The following
slide shows a CT scan slice showing the implanted “seeds”.
The procedure
normally
requires an
overnight stay
in hospital
after which the
patient returns
home and the
“seeds” get on
with the job of
eliminating the
cancer cells. The
patient is not
radioactive (although bouncing grandchildren on your lap is not advised
for a couple of months!) and the implants will gradually lose their
radioactive potency over time with most gone in the first 10-13 weeks.
Early side effects may include some tenderness and urinary symptoms
such as pain on urinating, or urination difficulties if the prostate has
swollen. Ejaculate may be discoloured from blood in the seminal fluid.
Rectal complications are rare. These side effects will generally settle
down. Erectile function will depend on a patient’s situation prior to the
implantation but compares well to other procedures. Urethral strictures
could be a problem in a small number of patients but these can be
surgically corrected if the problem is severe.
HDR may be used as a monotherapy but it’s mostly used in conjunction
with EBRT to increase the dose of radiation without affecting surrounding
organs. Normally about one-third of the radiation dose is delivered via
HDR and the balance by EBRT. Because higher radiation doses (dose
escalation) can be delivered it is often used for higher-risk cancers.
The catheters are positioned in the prostate in a similar operation to
the LDR procedure and are left in place for around 36 hours. During
this time the catheters will be connected to an “afterloader” and a
radioactive source will be briefly introduced into each one. The amount
of radioactivity delivered to the prostate can be controlled by the time
the radioactive source remains in the catheter. This process is repeated
3 times (3 is the norm but it could be less) at intervals over the next day
and a half at which time the needles are removed and the patient can
be discharged from the hospital.
Side effects are similar to those of LDR although the chance of urethral
strictures is slightly greater.
Active surveillance or watchful waiting is a system for monitoring the
tumour whilst not using any interventionist treatments. It’s a serious
option for men with early, low-grade cancers, taking into account
their expected life-span, co-morbidities and general health or who,
for various reasons, may not want or be able to undergo a surgical
procedure or radiotherapy.
8
Many prostate cancers are slow growing or even indolent and if
they’re not causing any problems it may be a better option to leave
them well alone rather than attempt to treat them and possibly suffer
ongoing side effects. The cancer can be regularly monitored for change
with PSA testing and a DRE and/or biopsy if it appears the tumour is
growing and the man should be aware of the possible prostate cancer
symptoms mentioned earlier.
This won’t be for everyone. On discovering they have prostate cancer
many men will seek the soonest possible curative treatment to rid
themselves of the disease and give themselves peace-of-mind. For
these men watchful waiting would be akin to what Dr Prem Rashid
calls in his book “Your Guide to Prostate Cancer”, watchful worrying.
As mentioned above, hormone therapy or androgen deprivation
therapy (ADT) has proven to improve the results of radiotherapy when
used prior to and during the start of the radiotherapy. Androgens are
the male sex hormones, including the hormone testosterone. Prostate
cancer “feeds” on testosterone and the cancer will shrink or even die
in its absence.
If a man is diagnosed with advanced or metastatic prostate cancer (it’s
spread beyond the prostatic capsule into surrounding tissue, organs
and bones), surgery is not going to be able to remove the tumour and
radiotherapy, unless the tumour cells remain in the tissue immediately
around and close to the prostate, will be similarly ineffective. Or if a
man has had surgery or radiotherapy but has a rising PSA, it may
indicate that some cancer cells may still be present.
In these cases ADT can be used to weaken and shrink the cancer cells
by reducing or eliminating a man’s testosterone production. This can
be achieved via pharmaceuticals (taken orally or injected) known as
chemical castration or by surgical castration (orchidectomy or removal
of the testicles). The drugs can be used alone or in combination or
used intermittently.
Whilst men will react differently to these drugs they can extend life
for many years. Unfortunately the withdrawal of testosterone does
have an almost immediate downside. Tiredness, reduced libido, mood
swings and hot flushes are some of the early side effects. Longer-term
users may suffer from loss of mental function, erectile dysfunction,
muscle weakening, osteoporosis and breast tenderness and possible
enlargement. Some of these problems can be countered with exercise
(physical and mental) and with other drugs and some men will
experience other problems so it’s very much horses-for-courses.
Regardless of diagnosis or treatment recommendations, make your
own enquiries (a good place to start is with the sources listed on Page
2 of this magazine), get second or other opinions, talk to others who
have been there (Prostate Cancer Support Groups can assist here) and
don’t rush, prostate cancers are generally slow growing and a couple
of months won’t alter your situation.
RAY GIVES HIS LAST WEEKS TO OTHERS
Story: Arthur Gorrie – GYMPIE TIMES 06AUG11
Photo: Renee Pilcher
Ray Cheasley is the exception to many rules, giving an
impression of effortless courage in the face of the end
he knows is coming, probably before Christmas. He has
dedicated his last months on earth to an unusual project to
help others see the way forward when they are diagnosed
with a terminal illness. He also wants to leave behind a real
life story “for the grandkids,” and to help publicise the good
work of Gympie’s Little Haven Palliative Care service.
The video movie he will star in will show the positives of the
inevitable end that waits for us all and he hopes it will help others
deal with it when it happens to them. Friend Luke Mancell is
making the movie, which will be entered in Gympie’s famous Heart
of Gold Film Festival. There will also be a “director’s cut” version
which will be his biography, something to leave behind “for the,
grandkids”.
He is determined not to spend his last months “moping around” and
has agreed to be the “star” in a movie where he will have no trouble
“acting naturally”. He hopes the final scene, in which he will die, will
be videoed in his own bed.
“I want to show the way for others,” he said yesterday. “I don’t
know what’s ahead of me, because no-one talks about it. You’ve got
no idea. Even now I know where I’ve been, but I don’t know where
I’m going”
Luke is open in his admiration for a man who wants to help
others as he dies. “Ray will be a mentor for people following in his
footsteps,” he said.
Helping others is a focus that probably helps Ray cope as he deals
with the prostate cancer which has got into his bones and blood.
Radiation treatment, a torment in itself, has dealt with the outbreaks
which occur from time to time.
“Luke and I filmed the treatment and the doctor let us behind the
scenes.”
Ray was convenor and president of the Gympie and District Prostate
Cancer Support Group. He even got to interview his doctor for the
film. Now he is equally dedicated to helping people like Klara, the
spouses of people facing inevitable death.
“Little Haven does that too. They look after the patients but also help
the family for as long as it takes”
FOR THE RECORD:
Luke Mancell filming Ray Cheasley, as he prepares for
the inevitable and tries to help others.
“I’ve got terminal cancer he said yesterday “They don’t know how
long. They forecast November originally, but they don’t really know.
“When someone tells you you’re, terminally ill it takes some sinking
in. But at the end of the day I’m okay with it,” he said at the home
he still lives in with the help of his wife Klara and the support of the
Little Haven service.
“It’s a long and lonely road for spouses too,” Klara said.
“Then the penny dropped ,” Ray said, “and I realised how the
partners suffer, so we started up a group for the partners of people
with cancer. People suffer in different ways.”
(Ray has been part of the Gympie & District Prostate Cancer Support
Group since its inception in 2006. He was Treasurer for four years and
Convener for one year prior to resigning because of ill health - Ed).
PROSTATE CANCER RESEARCH AT THE MATER
MEDICAL RESEARCH INSTITUTE
During October Support Group members from Brisbane and the
Gold Coast were given the opportunity to visit the Mater Medical
Research Institute (MMRI) at South Brisbane to hear about and
discuss their research work being carried out in relation to prostate
cancer followed by a tour of their research laboratories.
The visit was hosted by Assoc. Professor John Hooper from
MMRI’s Cancer Cell Biology Laboratory. John Hooper, along with
researchers from other laboratories within the complex, gave a
brief overview of the work being carried out by the Institute within
the various laboratories.
Continued...
9
PROSTATE CANCER UPDATE Continued...
Nutritionist, Dr Olivia Wright from the MMRI Nutrition Laboratory
and who also lectures on nutrition and dietetics at the University of
Queensland, spoke about adjunctive nutritional therapy in prostate
cancer, its role during cancer treatment and the assistance it can
offer with quality of life issues post-treatment or during ongoing
treatment for those with advanced cancer.
FOR THE RECORD: “Researchers & Support Group Members at
MMRI, Dr Hooper is Sixth from the Right”.
In Assoc. Professor Hooper’s Cancer Cell Biology Lab they are
looking to understand the molecular drivers of aggressive prostate
cancer, whether DNA changes drive aggressive tumours, why do
these tumours spread to bones and how does prostate cancer
survive in bone.
Dr David Munster from the Therapeutic Antibodies Laboratory
spoke about MMRI’s research into producing and testing improved
therapeutic antibody drugs for prostate cancer. The antibodies
would bind tumour antigens to the prostate cancer cells, causing
the death of the cancer cells.
The Cancer Immunotherapy Laboratory is researching cell-based
dendritic cell immunotherapy and Dr Kristen Radford detailed
the problems in producing a “one-size-fits-all” immunotherapy
vaccine for prostate and other cancers. To do this it is necessary
to better understand human dendritic cell biology. The laboratory’s
goal is to make immunotherapy more efficacious, cost effective
and adaptable to treat a wide range of cancer patients and a
variety of malignancies.
Following on from this, Assoc, Professor Nigel Waterhouse from the
Apoptosis & Cytotoxicity Laboratory continued the immune theme
by detailing work being carried out to understand how immune cells
kill prostate cancer cells.
Much of MMRI’s work relies on assistance from individual and
corporate sponsorship, details of which can be found on the website
listed on Page 2. Some of the research equipment in the MMRI
laboratories has been purchased from grants given by Prostate
Cancer Foundation of Australia.
PRIDE OF AUSTRALIA
The annual Pride of Australia awards, now in their seventh
year, recognise the contribution of Australians who have
gone beyond usual limits to support the community and
other Australians. The awards are spread over ten categories;
Courage, Care & Compassion, Fair Go, Young Leader,
Inspiration, Child of Courage, Community Spirit, Outstanding
Bravery, Heroism and Environment.
The Community Spirit award recognises an individual or a group
whose selfless, tireless and largely unacknowledged actions have
enriched the lives of those around them in their community.
The Convener of the Maryborough Prostate Cancer Support
Group, Leoll Barron, was one of three Queensland finalists in the
“Community Spirit” division of the 2011 awards.
committees at the local golf club, junior cricket and touch football.
After retiring as the well-respected principal of Maryborough
High School in 2005, he has continued to share his expertise with
associate teachers at the University of Southern Queensland.
“After fighting off prostate cancer, he has initiated and organised
Relay For Life events, raising more than $100,000 and has started
a local support group for other prostate cancer sufferers. And he
does all this while maintaining a cheery nature and an unwavering
attitude to live life to the fullest.”
Queensland Prostate Cancer News, and I’m sure all of our readers,
congratulate Leoll on this wonderful achievement.
The citation accompanying this honour reads;
Leoll Barron
“Leoll Barron is an unsung hero whose selfless community work
has enriched the lives of many in the Maryborough region. He
volunteers with countless sporting clubs, coaching roles and
10
NEWS ROUND UP
Roche bone drug eases pain in prostate cancer trial (Reuters) – Roche’s bone strengthening drug “Boniva” is as good for pain relief as single
dose radiotherapy in patients whose prostate cancer has spread to their bones, according to data from a late-stage trial. Trial investigators said
the level of side effects of “Boniva”, known generically as ibandronate (IB), were also comparable with radiotherapy suggesting it could offer
an alternative option for advanced cancer patients suffering pain. Bone metastases, or secondary tumours in the bone, are common in many
advanced cancers and “are a serious problem for men with prostate cancer” said Peter Hoskin, a professor of clinical oncology at University
College, London, who presented the data at the European Multidisciplinary Cancer Congress (EMCC) in Stockholm on 25SEP11.
Distinct Prognosis for Gleason Scores 4 + 3 and 3 + 4 (HealthDay News) – A Gleason Score of 4 + 3 = 7 is correlated with pathological
stage and increased risk of biochemical recurrence after radical prostatectomy (RP). Ali Amin from the Johns Hopkins Institutions in Baltimore and
colleagues investigated whether the breakdown of Gleason Score 7 into 3 + 4 versus 4 + 3 has prognostic significance in predicting the pathological
stage and biochemical progression. A total of 1,791 cases with Gleason Score 7 on prostatic biopsy identified between 2004 and 2010 were
analysed. The study was published in the October 2011 issue of The Journal of Urology.
Link Between High Blood Pressure and an Increased Risk of Developing or Dying from Cancer – Raised blood pressure is linked to a higher
risk of developing cancer or dying from the disease according to the findings of the largest study to date to investigate the association between
the two conditions. Dr Mieke Van Hemelrijck told the European Multidisciplinary Cancer Congress in Stockholm on 27SEP11 that there had been
contradictory results from previous smaller studies investigating the link between cancer and blood pressure. However her study, which included
289,454 men and 288,345 women, showed that higher than normal blood pressure was statistically significantly associated with a 10-20%
higher risk of developing cancer in men and a higher risk of dying from the disease in both men and women.
ASTRO: Fewer Side Effects With IMRT for Prostate Cancer (HealthDay News) – Treatment of localised prostate cancer using intensity
modulated radiation therapy (IMRT) is associated with a considerable reduction in late bowel and rectal side effects and significantly decreased rectal
and bladder toxicity compared to three-dimensional conformal radiation therapy (3D-CRT), according to a study presented to the annual meeting of
the American Society for Radiation Oncology held at Miami Beach 02-06OCT11.
Vitamin E May Hike Risk of Prostate Cancer – Men receiving vitamin E supplements in a large randomised trial showed a slight but statistically
significant increase in prostate cancer diagnoses, researchers said. After being followed up to 10 years after randomisation, the hazard ratio for
prostate cancer in SELECT trial participants assigned to vitamin E supplements was 1.17 (95% CI 1.004 to 1.36) relative to the study’s placebo
group, reported Eric A. Klein MD of the Cleveland Clinic, and colleagues. The four-arm trial also included selenium supplements, given alone
or in combination with vitamin E. Participants in those groups showed a smaller increase in prostate cancer risk that failed to reach statistical
significance, Klein and colleagues indicated in the 12OCT11 issue of the Journal of the American Medical Association.
Married People More Likely to Survive Cancer 14OCT11 – Some people think that unattached blokes have it made. But being a lifelong bachelor
may not be all it’s cracked up to be, at least when it comes to a man’s odds of surviving cancer. A man without a mate is 35% more likely to die from
cancer as a man who wears a wedding ring, a new study reveals. Researchers tracked the number of cancer deaths for thirteen common cancers,
including breast, prostate, malignant melanoma, colon and lung in more than 440,000 Norwegian men and women over a 40-year period from
1970 to 2007. Overall, single men and single women fared the worst in their cancer outcomes. Never-married men and women were found to have a
greater risk of losing their life to the disease compared to those who had tied the knot, divorced, or were widowed. The study was published online in
the journal BMC Public Health.
Age a Big Factor in Prostate Cancer Deaths, Study Finds 19OCT11 (ScienceDaily) – Contrary to common belief, men aged 75 and older are
diagnosed with late-stage and more aggressive prostate cancer and thus die from the disease more often than younger men, according to a
University of Rochester analysis published online in the journal Cancer. The study is particularly relevant in light of the recent controversy about
prostate cancer screening. Earlier this month a government health panel said that healthy men aged 50 and older should no longer be routinely
tested for prostate cancer because the screening test in its current form does not save lives and sometimes leads to needless suffering and
over-treatment.
Measuring Quality of Life Important in Cancer Survival Research – Cancer survival studies should treat questions about how well people are
surviving with the same importance as how long; putting quality of life on an equal footing with survival years, say researchers writing in a scientific
journal this month. Effective and reliable quality of life measures offer increasingly valuable information for cancer patients and their doctors when
they discuss treatment options, their potential consequences and the likely rehabilitation needs, write Drs Paul B. Jacobsen and Heather S. Jim, of
the Department of Health Outcomes and Behavior at the Moffitt Cancer Center in Tampa, Florida, in the OCT11 issue of Cancer Epidemiology,
Biomarkers and Prevention.
Above Information Sourced from Cancer Daily News
11
PROSTATE CANCER FOUND IN 2,000 YEAR
OLD EGYPTIAN MUMMY
By Simon Tomlinson – 03NOV11
www.dailymail.co.uk
were several post-mortem fractures, possibly produced when the
mummy was transported to Europe.
Scientists believe they have discovered the oldest case of
prostate cancer in Egypt after scans on a 2,250-year-old
mummy showed the man died a slow and painful death
from the disease.
But they also found a variety of tumors, measuring between
0.03inches and 0.59inches, interspersed along M1’s pelvis and
lumbar spine.
The unnamed Ptolemaic mummy, which is kept at the National
Archaeology Museum of Lisbon, had a pattern of round and dense
tumours between its pelvis and lumbar spine - giveaway signs of
man’s modern-day killer.
The mummy was that of a 5ft 5ins adult male who lived between
285 and 230 BC and was between 51 and 60 years old when he
died, researchers said.
‘The bone lesions were considered very suggestive of metastatic
prostate cancer,’ wrote the researchers in the International Journal
of Paleopathology.
They subjected the mummy, known as M1, to powerful Multi
Detector Computerized Tomography (MDCT) scans, which produced
‘really unusual high quality images’, Carlos Prates, a radiologist at
Imagens Médicas Integradas in Lisbon, told Discovery News.
Digital X-rays showed that M1 had been buried with crossed arms
- a common pose in Ptolemaic mummies, although in the New
Kingdom it was often associated with royals.
He was adorned with a cartonnage mask and bib, and boasted an
elaborately painted shroud.
Prostatic carcinoma begins in the walnut-sized prostate gland and
typically spreads to the pelvic region, the lumbar spine, the upper
arm and leg bones, and the ribs, ultimately reaching most of the
skeleton.
Dr Prates and colleagues considered other diseases as alternatives.
But M1’s sex, age, the distribution pattern of the lesions, their shape
and density, strongly argued for prostate cancer.
‘It is the oldest known case of prostate cancer in ancient Egypt and
the second oldest case in history,’ Dr Prates said.
The earliest diagnosis of metastasising prostate carcinoma came in
2007 when researchers investigated the skeleton of a 2,700-yearold Scythian king who died, aged 40 to 50, in the steppe of
Southern Siberia, Russia.
‘This study shows that cancer did exist in antiquity, for sure in
ancient Egypt. The main reason for the scarcity of examples found
today might be the lower prevalence of carcinogens and the shorter
life expectancy,’ Paula Veiga, a researcher in Egyptology, told
Discovery News.
Moreover, high-resolution CT scanners, able to detect tiny tumors
became available only in 2005, which suggests earlier researchers
may have missed them.
The images showed he suffered from lumbosacral osteoarthritis,
which was probably related to a lower lumbar scoliosis and there
VACUUM ERECTION DEVICE AIDS RECOVERY AFTER SURGERY
This study aimed to examine the effect of the early use of the vacuum
erection device (VED) on erectile dysfunction (ED) and penile shortening
after radical retropubic prostatectomy (RP) for prostate cancer. These
devices fit over the penis and create a vacuum (by hand pumping) to
encourage blood flow into the penis. A constriction ring prevents it from
flowing out.
28 men who had nerves controlling erections spared during their surgery
took part in the early (1 month after RP) group. Patients followed a
daily rehabilitation program of 10 minutes/day using the VED with no
constriction ring for 5 months. The control group used it starting 6 months
after surgery. Both groups were evaluated for erectile function and length
and girth of their penises after 9 months.
12
Erectile function scores were higher in the group with early use of the VED
compared with the control group during the recovery period. Stretched
penile length was significantly decreased in the control group at 3 and 6
months by approximately 2cm. By contrast, stretched penile length was
preserved in the early intervention group at all sample times.
The study authors conclude the use of a VED program 1 month after RP
promotes return of sexual function and helps to preserve penile length.
http://www.phoenix5.org/glossary/vacuum_erection_device.html
5 YEAR DATA: HYPOFRACTIONATED RADIATION FOR
PROSTATE CANCER BLADDER TOXICITY A PROBLEM
Nick Mulcahy
September 26, 2011 — Hypofractionated radiation reduces the
treatment time of prostate cancer by 2.5 weeks, compared with
conventional radiation, but does not sacrifice efficacy, according
to new 5-year data that will be presented at the upcoming annual
meeting of the American Society for Radiation Oncology (ASTRO).
However, persistent grade 2 or greater urinary adverse effects were
significantly more common in patients treated with hypofractionated
therapy at 5 years, according to the lead author Alan Pollack, MD,
chair of radiation oncology at the University of Miami Miller School of
Medicine in Florida. He spoke at press briefing held in advance of
the meeting.
When asked by Medscape Medical News if saving 2.5 weeks of
treatment time was worth the potential risk of years of urinary
problems for some men, Dr. Pollack replied that “there may be a
trade-off with this particular regimen.”
The rate of persistent urinary problems seen at 5 years in
hypofractionation patients was “less than 10%,” compared with
“less than 5%” for those treated with conventional radiation in the
study, he said.
The rate of late urinary problems was “still rather low” and “extremely
favourable” in both study groups, compared with results from other
radiotherapy studies, Dr. Pollack emphasized.
The multicentre phase 3 trial of 303 men with intermediate- and highrisk prostate cancer compared a 5-week course of hypofractionated
intensity-modulated radiotherapy (HIMRT) with a 7.5-week course of
conventional intensity-modulated radiotherapy (CIMRT).
The study hypothesis was that HIMRT would improve efficacy — the
rate of prostate cancer biochemical failure — and not increase toxicities,
compared with CIMRT. On both counts, the trial was not a success.
The 5-year cumulative incidence rates of biochemical failure were
similar — 14.4% for CIMRT (95% confidence interval [CI], 8.8% to
21.5%) and 13.9% for HIMRT (95% CI, 8.4% to 20.9%).
Biochemical failure was defined as an increase in prostate-specific
antigen (PSA) score using the nadir + 2 ng/mL definition.
On the bright side, Dr. Pollock said that the long-term rates of bowel/
rectal adverse effects and erectile dysfunction were identical for the 2
radiation approaches.
HIMRT is a work in progress, said Michael Steinberg, MD, ASTRO
president elect, who moderated the press briefing. “We are learning
more about how to do this and who this is best for,” explained Dr.
Steinberg, who is from the University of California at Los Angeles
Health System.
HIMRT is likely to make its way into the treatment of prostate cancer.
“We will see more places do this,” he said about hypofractionation,
especially as these study results “get out there.”
HIMRT represents a “change in how we were classically taught,” added
Dr. Steinberg.
The 5-year data are an update of results previously reported by
Medscape Medical News, when the median follow-up was 39 months.
Notably, there was no statistically significant difference in persistent
urinary problems early in the study, said Dr. Pollack; the difference
emerged only at the planned 5-year analysis.
More Data
The trial compared 76 Gy in conventional 2.0 Gy fractions (CIMRT)
with 70.2 Gy in 2.7 Gy fractions (HIMRT), which was estimated to be
equivalent to 84.4 Gy in 2.0 Gy fractions, said Dr. Pollack. The men
received treatment from 2002 to 2006.
No significant differences were seen between the treatment groups
in terms of the distribution of patients by T-category, Gleason score,
pretreatment initial PSA, use of androgen-deprivation therapy (ADT),
or length of ADT, report Dr. Pollack and colleagues.
There were 41 biochemical failures at 5 years — 20 in the CIMRT
group and 21 in the HIMRT group. Six biochemical failures occurred
within 6.5 months of either local-regional failure or distant metastasis.
Rates for local-regional failure or distant metastasis were 1.0% for
CIMRT and 1.3% for HIMRT at 5 years.
The 5-year cumulative incidence rates for any failure, including 4
deaths, were 15.4% for CIMRT (95% CI, 9.5% to 22.7%) and 15.3%
for HIMRT (95% CI, 9.5% to 22.4%).
“The anticipated failure rate of 15% in the HIMRT arm was accurate, but
fewer failures were seen in the CIMRT arm at the time of this planned
analysis,” write Dr. Pollack and colleagues in the study abstract.
Overall, there were no statistically significant differences in late toxicity
between the groups, note the authors in the abstract. The grade 2
or higher toxicities for the CIMRT and HIMRT groups were 8.9% and
13.8% (P = .2), respectively, for the genitourinary tract, and 4.1% and
5.9% (P = .5), respectively, for the gastrointestinal tract. However, the
genitourinary rates were for any event, including 1-time occurrences,
said Dr. Pollack. The rates of persistent urinary problems were, as noted
above, appreciably different for the 2 groups.
American Society for Radiation Oncology (ASTRO) 53rd Annual Meeting:
Abstract 1. Presented 03OCT11.
13
CANCER ETIQUETTE 79
Cancer Sucks...
Cancer invaded my life many years ago. I’m not a personal victim
of cancer but I feel I’ve been victimized witnessing the agony
my loved ones have endured. I personally witnessed events and
statements in their lives while they were fighting the beast. I feel
compelled to share some common sense knowledge I’ve learned
over the years. Possibly by me sharing this hub another cancer
survivor or fighter won’t have to hear or deal with uncomfortable
moments or questions. There are many people who never had to
deal with cancer, to them it’s something that happens to others
which is understandable. Those people might not know what to
say or do when they hear someone is struggling to save their life.
I hope this helps you learn what to say and what not to say when your
encountered with an awkward situation. This is my opinion and the
responses I’ve heard from victims over the last 11 years.
Don’t ever, ever tell someone “You have the good cancer!” There is
no such thing as a good cancer, cancer is cancer and all cancers
are deadly but treatable if caught early. Early detection is of upmost
importance but sometimes there are no symptoms. Either way there
are NO GOOD CANCERS.
Don’t be afraid to ask a cancer victim or their family member how
they are feeling. How their treatments are going. Some people think
they shouldn’t approach the subject because they don’t know if it’s
the right time, there is no such thing as the right time...just ask...if they
don’t want to discuss it they will tell you that. On the other hand, they
might need to vent so ask only if you truly care and want to hear their
response no matter how lengthy it might be.
Don’t assume cancer is contagious and by discussing it you might catch
it. That’s impossible but that question has been asked, oddly enough.
Don’t say “You don’t look like you have cancer”! How is someone with
cancer supposed to look? The monster is internally gnawing away at
their organs, their hearts are heavy with sadness...that’s not always
possible to see. Not all cancer patients are bed-ridden waiting to die.
Medical technology has come a long way in treating cancer and victims
can now live a lot longer and have more productive lives.
Don’t say “I’ll pray for you” unless you truly intend to pray for them.
Granted there are some people who keep a list of ones to pray for but
I believe that most people say that because they feel it’s customary. If
you intend to actually pray for that person then say it, if not something
such as “I’ll be thinking of you”, “You’ll be in my thoughts” or “break a
leg” will suffice.
Don’t offer to chauffer a patient to an appointment or hold someone’s
hand during a procedure unless you intend to. Many people out of the
goodness of the hearts offer assistance and don’t come through when
needed so please don’t offer and get their hopes up unless you are
able to be there.
Do call them. A phone call to say hello and share some memories or to
simply talk about the weather are appreciated. Conversations don’t have
to revolve around cancer. Trust me, patients want to forget they have the
beast sometimes and escape into your world if even for a little while.
14
Don’t ignore them and assume by doing so there isn’t an issue. Cancer
isn’t that easy to get rid of. Your loved one is ill and now is the time they
need interaction from you. Your support is an important part of healthy
healing. Without support a cancer victim might not have a purpose to
fight as hard as they should.
Do suggest to stop by for a visit, bring along a delicious cake and
savour the moment. Your heart will be enlightened by your meaningful
visit. Your loved one will cherish the time you spent together. Even if no
words are spoken your presence alone could make their day.
Do offer to cook a meal, mow the lawn, babysit the children etc...
these deeds might seem small to you but will be huge in the mind of
your loved one.
Don’t preach to them...if they drink, smoke, eat a pizza...don’t tell them
it’s unhealthy, don’t you think they already know that. It’s their bodies to
do with what they please. We all make choices in life, show them the
respect by allowing them to make theirs.
Don’t suggest alternative forms of treatment, healthier lifestyles,
vitamins or supplements...trust me they have been there and heard
it and possibly tried it. That’s what their physician and Google are
intended for.
Do remember silence is deadly and so is cancer. One we have control
over and one we don’t. Be the best you can be and show your support
without being overly sympathetic which can actually make your loved
one feel worse.
Don’t forget humour is the best medicine. Laugh with them until you
both can’t laugh anymore (and then laugh even more).
Don’t ask “Are you cancer free now”? Ugh! There is no such thing as
cancer free! We were all born with cancer cells in our bodies. These
cells are inactive until they become active. So you get cancer when
there are more factors that promote cancer growth than factors that
inhibit cancer growth. It’s that simple.
Added bonus: Do be your own advocate for your health. Doctors
are human and they make mistakes. No one knows your body like
you. Without thoroughly explaining all of your symptoms, no matter
how trivial you think they might be, your physician won’t be able to
effectively diagnose you. Keep in mind you made the choice to “hire”
your physician for his abilities. So, unless you feel comfortable with
his performance, you are free to speak your mind until you receive the
answers that you are comfortable with.
Disclaimer: I’m not judging anyone. I understand how it might be
uncomfortable and you might be at a loss for words. I’m not a medical
professional. I’m an advocate for victims of cancer. My terminology
might offend someone and for that I apologize but my personal journey
has brought me to this point. I lost my mother to a six-year battle with
Colon Cancer. I’ve been by my husband’s side during his three-year
battle with Prostate Cancer and the emotional roller coaster takes it’s
toll at times. My heart goes out to all cancer fighters and their families.
Be well, Anon.
COMBINED ADJUVANT THERAPIES IMPROVE
OUTCOME OF HIGH-RISK PROSTATE CANCER
NEW YORK (Reuters Health) 12SEP11 - After radical
prostatectomy for cancer involving the seminal vesicle, men
fare best with adjuvant radiotherapy plus androgen deprivation
therapy, a French study shows.
Seminal vesicle invasion is associated with decreased survival, and
radical prostatectomy alone is “probably insufficient” in this setting,
note Dr. Cyrille Bastide, at Hopital Nord in Marseille, and colleagues
in their report.
Working with radical prostatectomy records on 4,090 patients
from nine hospitals, they identified 310 with seminal vesicle
involvement. After excluding men with lymph node metastases,
detectable prostate specific antigen (PSA) after surgery, or less
than 18 months’ follow-up, the research team had a study group
of 199 patients.
group, 48.4% in the ADT-only group, and 82.8% with combination
therapy, according to a report in BJU International online August 18th.
Estimated seven-year biochemical-failure-free survival rates in the
four groups were 25.9%, 28.6%, 32.3% and 62.1%, respectively.
Only the combination of radiotherapy and androgen deprivation
was an independent prognostic factor, the team found. “The
hazard ratio associated with adjuvant radiotherapy combined
with hormonal therapy was 0.15 (p<0.001) for biochemical
progression,” they calculated.
Dr. Bastide and colleagues conclude, “The findings reported in
the present study suggest that adjuvant ADT combined with
radiotherapy after radical prostatectomy for patients with seminal
vesicle invasion confers a substantial benefit.”
Eighty-two men were monitored without further treatment, 41
received adjuvant radiotherapy alone, 26 received only androgen
deprivation therapy (ADT), and 50 received ADT combined with
radiotherapy.
An editorial adds, “Continued investigation is needed to identify the
accurate cohort of high risk prostate cancer patients at highest risk
for cancer progression and therefore most likely to benefit from a
multimodal treatment approach.”
The estimated five-year survival rate free from biochemical failure
was 32.6% in the monitored group, 44.4% in the radiotherapy-only
British Journal of Urology International 2011.
SURVEY FINDS GOOD LONG-TERM QOL AFTER PROSTATE
CANCER BRACHYTHERAPY
NEW YORK (Reuters Health) 08SEP11 - Long-term toxicity is
low and quality of life (QOL) good or acceptable after low-dose
rate brachytherapy for prostate cancer, UK researchers say.
20.7% had received hormones, brachytherapy, and external beam
radiotherapy; and the remaining 2.3% received brachytherapy and
external beam radiotherapy.
Lead investigator Dr. Amr M. Emara from Royal Surrey County
Hospital and colleagues sent questionnaires to 226 men whose
cancer was successfully treated with low-dose brachytherapy
(alone or with external beam radiotherapy and/or hormonal
treatment) at least five years previously.
Most of those who presented with mild or moderate urinary
symptoms still had them at follow-up. Just under a third of men
who started out with mild symptoms (31.2%) developed moderate
symptoms, and 10.9% of men with moderate symptoms at baseline
transitioned to severe symptoms.
They received responses from 174 men (77%), according to a
report August 19th in BJU International.
More than a quarter (28.1%) of men with moderate baseline
symptoms had only mild symptoms at follow-up, however.
Just over a quarter (27.6%) had received brachytherapy alone;
49.4% had been treated with hormones and brachytherapy;
Quality of life related to urinary symptoms was rated as good
by 77%, acceptable by 21%, and poor by 2% of the survey
respondents.
Continued...
15
SURVEY FINDS GOOD LONG-TERM QOL AFTER PROSTATE CANCER
BRACHYTHERAPY Continued...
Of the 62 men who were potent before brachytherapy, 62.9% were
still potent at follow-up, although the mean IIEF-5 score (a measure
of erectile function) had worsened from 13.08 at baseline to 8.04.
“The interpretation of data of bowel symptoms at follow-up is
limited by the fact that we did not have baseline data available with
which to make any comparison,” the investigators say.
“The finding is more favourable than the potency outcomes
reported in other studies,” the researchers note. They attribute the
improvement to lower doses of brachytherapy to the penile bulb.
“Overall, the results obtained in the present study confirm that
brachytherapy has a favourable side effect profile over the longterm with regard to potency, urinary, and bowel toxicity,” the authors
conclude.
“Improvements in brachytherapy techniques should allow even
better outcomes for patients treated with brachytherapy in the
future,” they add.
At follow-up, 51.7% of patients reported normal bowel function and
45.4% reported mild bowel symptoms. Only 2.9% had moderate
symptoms, and none reported severe symptoms.
British Journal of Urology 2011.
Brisbane PCSG - 2011/12 meeting program
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley.
Evenings at 7.00am (Even months).
Mornings at 9.30am (odd months)
December 14 “Men’s Sheds - Graham Curnow, National
President Men’s Sheds: Dermot Dorgon, Survivor:
Christmas Function”
January 11
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 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: (P.O. 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 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.
16
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).

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