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A Rational Approach to Design of Tee Shear Connections

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PROSTATE MATTERS SOUTH
P
rospect
PROSTATE CANCER SUPPORT GROUP
PCaSO
Somerset
Prostate Support Association
NEDPSA
North & East Devon
Prostate Support Ass.
DORSET
PSA
Prostate Cancer Network
CORNWALL
PROSTATE SUPPORT ASSOCIATION
( CPSA)
A partnership between prostate support groups
in the southern region sharing news, views
and information about prostate issues.
ISSUE 3
NOV 2007
Over 3000 circulation
Contents Page 2
Can Changing Your Life
style help Treat PCa.
Dealing with Side Effects.
Use It or Lose It
Page 3
Know Your Surgeon and
Understand Your Risks.
Higher PSA readings in
Summer may lead to more
Biopsies
Page 4
Prostate Cancer Screening
Page 5
continued from p.4
Page 6
Clinical Trial - Vital 2
Report on PCR UK �ABC’
Page 7
New Pathology Factor may
help Treatment Decisions
New treatment Prostatitis
Page 8
Meetings & Events
around the region
PMS Editor: Roger Bacon
Contact: 0845 479 7625
email: [email protected]
PMS is published 4 times a year February - May - August - November
Help Lines PCaSO - 0845 650 2555
Somerset PSA - 01460 62935
Torbay PSA - 01803 843806
Dorset PSA - 0845 601 0766
NED PSA - 01392 277295
Prospect - 01373 813060
Cornwall PSA - 01872 253143
Macmillan Cancer Trust agree to
sponsor PMS for the next four issues
The Trust formed in 1974, evolved from the fund-raising committee
for the Macmillan Unit at Christchurch, Dorset. This was the first Unit
in the country and a joint venture with the NHS and a Charity.
The aim of the Trust is to support those who are suffering from
cancer and also provide help and support for the whole family.
The Trust act as custodian for funds donated towards care of the
patients and their families and it both initiates and responds to a
wide variety of needs primarily supporting the Macmillan Unit at
Christchurch but also Cancer services at both Bournemouth and
Poole Hospitals and the Dorset Cancer Network.
The patient support groups that make up Prostate Matters South are
delighted that Macmillan Cancer Trust has agreed to sponsor our
joint newsletter and would like members to support the trust in
whatever way they can.
Further information and donations can be made on the website:
www.macmillancancertrust.co.uk or write to: The Macmillan Unit,
Christchurch Hospital, Christchurch, BH23 2JX. Tel: 01202 477628
Macmillan Cancer Trust
sponsors of PMS Newsletter
5 becomes 7
Our southern region partnership has expanded to 7 patient
support groups now receiving and circulating this newsletter.
Cornwall Prostate Support Association and
Prospect Prostate Cancer Support Group from the
Bristol area have both joined, so our coverage has
expanded. More groups are expected to follow soon.
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Can Changing Your
Lifestyle Help Treat
Prostate Cancer?
Up to 73% of men with prostate cancer take
non-prescription supplements, and smaller numbers
use diet, exercise, or both in the hope of improving
their outcome. Most of these men also receive
conventional therapy, but a few depend on lifestyle
alone. The appeal of lifestyle therapy is obvious - but
does it work? Experts don’t know, though research
raises hope that it may have a beneficial impact,
reports the July 2007 issue of Harvard Men’s Health
Watch.
All of the 93 men who signed up for the trial had newly
diagnosed low to moderate-grade cancers that were
localized to the prostate gland. Half were randomly
assigned to a lifestyle program, and half got no advice
on lifestyle changes.
The program that researchers created included four
elements: 1) An ultra-low-fat vegan diet; 2)
Supplements, including soy, fish oil, vitamins E and C,
and selenium; 3) An exercise program of walking 30
minutes six days a week; and 4) Stress reduction that
included yoga-based stretching, breathing, and
meditation for an hour a day. At the end of a year, a
small but significant difference was evident.
The average PSA in the intensive lifestyle group fell,
whereas the average PSA in the untreated men rose.
The participants in the lifestyle group also showed
favourable cancer-fighting changes in their blood.
Much more research is needed before lifestyle therapy can be recommended clinically. But, the Harvard
Men’s Health Watch notes, men with prostate cancer
may choose not to wait until science catches up with
their disease. And since the lifestyle program study is
good for general health, its elements will make a
reasonable addition to any prostate cancer program.
A Newswise Medical News article
Dealing with Side-Effects
Prostatectomy is delicate surgery and often affects the
nearby urinary sphincter (which controls urine flow
through the urethra) and the nerves that allow men to
have erections. As a result, most men experience
some form of urinary incontinence and impotence
(also known as erectile dysfunction, or ED) after a
prostatectomy.
Fortunately, post-operative incontinence usually isn't
permanent. Most patients regain continence within six
to 12 weeks after surgery, some more gradually than
others. Some will experience long-term stress
incontinence urine leaks when coughing, sneezing or
exercising that require men to wear protective pads.
Less than one percent suffer from severe incontinence
that requires the surgical implanting of an artificial
sphincter or urethral sling to control urine flow,
Dr. Klein said.
Bilateral nerve-sparing prostatectomy, which
preserves the nerve bundles on either side of the
prostate, has improved rates of ED after surgery. In
the best surgical hands, about 75 percent of all
patients who undergo this procedure will regain
potency within 12 to 14 months after surgery,
according to Dr. Klein.
Others may regain sexual function with the help of
drugs such as sildenafil (Viagra), tadalafil (Cialis) and
vardenafil (Levitra). Many urologists recommend
using these medications immediately after surgery to
promote an early return of erections. Other treatments
such as vacuum erection devices and injections of a
substance known as prostaglandin E1 directly into the
penis may be used if the ED drugs fail to work. A final
option is a penile implant, using inflatable devices or
silicone rods.
Several factors may affect your ability to have an
erection after a prostatectomy: your age, medical
condition, ability to get an erection before surgery and
whether the nerve bundles were damaged. Older men
and those with other health problems, such as
cardiovascular disease or diabetes, usually have
more difficulty regaining potency.
"Most patients can expect a return to regular physical
activity within a few weeks, regardless of how the
surgery's done, and good results with continence and
potency," Dr. Klein said.
A Medical News Today article, August 2007
Use It or Lose It
A new theory about preserving erectile function
after prostate surgery
Erectile dysfunction after surgery to remove the prostate
(radical prostatectomy) has traditionally been attributed to
nerve damage that theoretically should heal over time. But it
can take as long as two years for the nerves to recover
enough for a man to have an erection without the aid of
drugs or devices. By that time, other damage may have
occurred, according to an article in the latest issue of
Perspectives on Prostate Disease.
The Harvard Medical School bulletin notes that when the
penis is flaccid for long periods of time, it is deprived of a lot
of oxygen-rich blood. Recent research suggests that this
low oxygen level causes some muscle cells in the penis's
erectile tissue to lose their flexibility. The tissue gradually
becomes more like scar tissue, interfering with the penis's
ability to expand when it's filled with blood.
Therefore, the traditional advice given to men -- to wait for
erectile function to return on its own -- may not be
adequate. Simply put, erections seem to work on a use-itor-lose-it basis. To prevent the secondary damage that may
occur if the penis goes too long without erections,
researchers now think it's better to restore erectile function
soon after prostate removal. Treatment options include
using a vacuum pump device or taking erectile dysfunction
drugs by mouth or by injection into the penis.
According to Dr. Marc Garnick, editor in chief of
Perspectives on Prostate Disease and a Harvard
oncologist, "Although the evidence supporting this 'penile
rehabilitation' isn't perfect, you may want to ask your doctor
about the options. Such early intervention may help
increase the odds that you will regain erectile function."
A Medical News Today article, August 2007,
www.medicalnewstoday.com/articles/79162.php
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Know Your Surgeon and
Understand Your Risks
You've been diagnosed with localized prostate cancer, and
after talking with your urologist, you've decided to undergo
radical prostatectomy, or surgical removal of the prostate.
Now that you've made a treatment choice, more
questions remain: Which surgical technique is the best?
Will it render me incontinent or impotent? What
happens after surgery?
However, one question may be the most important,
according to a new study involving a Cleveland Clinic
researcher: Who will do the surgery?
"There's very clear evidence that shows that the experience
of the surgeon is the most important factor in determining
the likelihood of a cure, the return of continence and the
return of potency," said Eric Klein, M.D., head of the Section
of Urologic Oncology at Cleveland Clinic's Glickman Urological and Kidney Institute and one of the study's authors,
according to the Cleveland Clinic's Men's Health Advisor.
"The most important factor is finding the most experienced
surgeon you can and querying him or her on their results."
When opting for prostatectomy, it's important that you not
only know your surgeon's experience, but also understand
the risks and side effects of surgery and your long-term
outlook.
Prostate surgery: Who over how?
For years, most urologic surgeons have used standard
radical retropubic prostatectomy, an open surgery in which
the surgeon removes the prostate through an incision (about
five to eight inches long) in the lower abdomen.
However, minimally invasive laparoscopic surgery is
becoming more popular. In this more challenging operation,
the surgeon makes five small incisions and uses a tiny
camera and specialized instruments to remove the prostate.
In a newer laparoscopic technique, robot-assisted surgery,
the surgeon removes the prostate with the help of several
robotic arms that mimic his hand movements and allow for
more precision.
The laparoscopic approach affords the surgeon a magnified
view of the prostate. Advantages for the patient include less
blood loss, shorter hospital stays and the potential for a
faster recovery.
However, these advantages may not matter to you as much
a year or more after surgery, Dr. Klein said, and he advises
his patients to look at the long-term picture. "You're going to
care about whether you're cured, whether you're continent
and whether you're potent. When you focus on those, the
primary factor becomes experience of the surgeon and not
the tools that are used to perform the surgery," he said.
According to Dr. Klein, the recent study found that patients
of surgeons who have performed more than 1,000
prostatectomies are about 10 percent more likely to be
cured of their cancer than those whose surgeons have done
250 to 999 of the procedures and 30 percent more likely
than those whose surgeons have done fewer than 50.
He said preliminary data from another multi-center study in
which he participated suggest that men who underwent
open surgery had better potency results than those treated
with laparoscopic or robotic surgery. "The point it makes to
me is there's nothing magical about a laparoscope or a
robot," he said. "It's still the surgeon who decides where to
cut and where not to cut while doing the surgery."
After your surgery
If you're like the majority of prostatectomy patients with low
or intermediate-risk prostate cancer, you'll receive a
favourable pathology report after your surgery and require
no additional treatment. You'll follow up with your urologist
shortly after surgery and return periodically for blood tests to
measure prostate specific antigen (PSA).
However, if the pathology report reveals lingering cells that
may be cancerous, you may need external-beam radiation
therapy or other systemic treatments once you recover from
surgery, usually about three to six months later.
What You Can Do:
• Ask your surgeon about the number of prostatectomies he
or she has performed and the results of those procedures.
• Have your doctor explain the risks and benefits of
prostatectomy and other treatments, such as radioactive
seed implants (brachytherapy) and external-beam
radiation therapy.
• Prostatectomy causes sterility, so if you still hope to father
children, talk to your doctor about banking your sperm
before surgery.
A Medical News Today article, August 2007.
A study in the Journal of the National Cancer Institute
(USA) comparing the experience of prostate cancer
surgeons with their surgical outcome has revealing
findings. The findings, taken over 16 years, compared over
7,700 patients treated with a radical prostatectomy by 72
surgeons. The results showed that the risk of recurrence
after 5 years of patients treated by surgeons who had
performed 10 operations was 17.9%. For those who had
completed 250 operations it was 10.7%. There was no
significant improvement in surgeons who had done more
than 250 prostatectomies. Thus patients treated by
inexperienced surgeons were 70% more likely to have
recurrence than those treated by the more experienced.
It is of concern that, in the UK, the minimum number of
prostatectomies required by surgeons is just 5 per year.
Higher PSA levels in summer
may lead to more biopsies
Men who undertake the prostate specific antigen (PSA) test
in the summer, are more likely to have a subsequent biopsy
than men tested at any other time of the year.
A new study, published in European Urology shows that
concentrations of PSA are higher in the summer, resulting in
a higher likelihood of referral for a biopsy of up to a quarter.
�’We show that being screened during the summer
increased by 23% the likelihood of having a higher PSA
than the cut-off value (for biopsy),’’ the authors write. �’It may
be prudent to confirm any isolated test result before biopsy,
and even more so if this was obtained in summer.’’
They add �’The present observation is troubling as it
suggests that rigid PSA cut-offs are ill-adapted to routine
clinical practice.’’
The authors say that measurement of PSA serum concentrations is central to all programmes for the early detection
of prostate cancer but that the influence of season on PSA
concentrations has been little investigated.
They looked at the relation between meteorological data
and total PSA testing (which measures nanograms of PSA
per millilitre of blood) as well as free PSA testing (which
measures the percentage of PSA that is not bound to
proteins in the blood) in 8644 men aged 55 to 70 in the
French arm of the European randomized study of screening
for prostate cancer (ERSPC). Significantly higher PSA
concentrations (P=0.001) were found in the summer (total
PSA 1.87ng/ml), than in autumn (1.71ng/ml), winter (1.42ng/
ml), or spring (1.38ng/ml).
This report was published in the BMJ August 2007 issue.
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Prostate Cancer Screening (part 1) by Dr Louis Denis
This article first appeared in the newsletter of the European Oncology Nursing Society and Louis Denis
has kindly given permission for it to be published in PMS. The second part will appear in PMS4.
Louis Denis is Director of Oncology at the Oncology Centre Antwerp (OCA), Antwerp, Belgium.
He is also secretary of Europa Uomo the European Prostate Cancer Coalition of patient support groups
One ounce of prevention is worth a pound of treatment
remains a popular idea in many cultures. It is certainly
true that this statement applies to a number of public
health threats such as speed control and seat belts to
prevent car accidents, smoking cessation programs,
and information on lessening the risk of sexually
transmitted diseases such as HIV disease. However,
prevention of cancer remains controversial and
prevention of prostate cancer even more so.
Prostate cancer was somewhat neglected in the
previous century for three reasons: it was usually
incurable after diagnosis, it was a disease of the
elderly, and hormonal treatment brought relief in the
great majority of cases. This situation changed
drastically with the introduction of Prostate Specific
Antigen (PSA), a simple blood test that indicates the
risk for having prostate cancer. Simultaneously we
saw the development of the biopsy gun, allowing
multiple painless biopsies of the prostate gland, and
trans-rectal ultrasound (TRUS) offering accurate
positioning of the biopsy needle in the different regions
of the prostate. A star technique was born resulting in
thousands of publications extolling the virtues of this
diagnostic procedure.
Cancer Screening
The enthusiasm for the hypothesis overcame caution
and most people forgot that the U.S. Food and Drug
administration took one year to approve the use of
PSA in diagnosing progressive disease but needed
five years to approve PSA as a diagnostic marker for
prostate cancer. No heed was taken to the complex
reality that screening results in over detection,
increases false positive and false negative results, and
can lead to over treatment. A classic case is the
neuroblastoma screening in 1996 in Japan with a
five-fold increase in incidence, surgery and identical
mortality (1). We all know the difficult course in judging
the advantages of breast cancer screening in women
over 50 and the debate in screening from the age of
40.
TRANSBIG, the international translational research
network linked to the Breast International Group (BIG),
makes it clear that it aims to develop individualized
breast cancer treatment and reduce over treatment in
breast cancer estimated to range from 10 to 20% of
cases (2). Recent results of a failed lung cancer
screening test received media interest. In this case, a
CT scan detected lung cancer 144 times in 3.246
people. More than 300% of the expected cases and a
1000% increase in surgery resulted from this trial
ending up with the same mortality rate achieved
without screening (3).
Table 1: Principles of screening for cancer
♦ The disease should be an important health problem
♦ The disease should have a detectable preclinical phase
♦ The natural history of the lesions identified by screening
should be known
♦ There should be an effective treatment for such lesions
♦ The screening test should be acceptable and safe
(Adapted from AB Miller, 1996)
The public health experts and epidemiologists
recognised the danger of simplistic thinking and
described the principles of screening which were
condensed to five points by Anthony Miller in 1996
(see Table 1).
The use of correct definitions is important: screening is
the systematic examination of asymptomatic men to
detect and hope to cure localised disease in a given
population. Screening is not intended to fit the need of
the individual patient. Here it is more appropriate to
use case finding, cancer testing or early diagnosis. To
be blunt you don’t need to be Einstein to use a test
that finds more cancer and if you treat all cancers you
will save lives. The question is how many lives are
saved and at what price of human suffering and health
costs? Currently, one needs to operate on 17 to 22
men to save one life leaving half of those treated
impotent and a fourth of those patients incontinent (4)
which leaves the benefit of such procedures in doubt.
Europa Uomo, the European coalition against prostate
cancer, believes that quality of life is of utmost
importance and that the indication for curative
treatment which is aggressive should be limited to
younger patients with potentially fatal disease – in
reality, only a fraction of the total number of men
diagnosed with prostate cancer.
The Miller Principles applied to Prostate Cancer
An important health problem
Prostate cancer is the leading cancer in males
(20.3%) in Europe. This figure may be influenced by
the frequency of use of the PSA test which had a
similar effect as mammograms did in breast cancer.
Still the number of deaths has risen 16% since 1995
due to the rapid increase in the number of men
reaching older age. The figures for incidence (new
cases/year) of 237,800, mortality rates of 85,200, and
the prevalence of cancer of 2 million men in the EU
makes prostate cancer management a priority in
public health (5).
A Detectable Preclinical Phase
Prostate Cancer is characterized by a long (10 to 20
years) sub-clinical stage. Considered as one of the
strong arguments for screening, the long sub-clinical
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stage is also an argument to avoid diagnosing
prostate cancer without symptoms in men with a life
expectancy limited to 10 years. Indeed after the first
diagnosis it takes another 10 to 15 years to die of the
disease. With a mean life expectancy of + 77 years in
the EU it would seem reasonable from a screening
point of view to not screen men over age 70.
Table 2: Prostate specific problems among Dutch
prostate cancer survivors and an age matched norm
population in percentages
The establishment of PSA > 4 ng/ml as the cut-off risk
factor (now considered outdated) prompted a tsunami
of biopsies resulting in increased incidence. The
detection of smaller tumours including indolent
cancers, led to a significant shift in the stage of
cancer detected and a lower mean age of patients at
the time of diagnosis (6). In simple words, PSA
directed biopsies anticipate the clinical diagnosis by
10 years and the majority of patients in the PSA era
present with earlier stages and few with metastatic
disease.
(Adapted from TF Mols, 2007)
However, 50% of patients do not need immediate
treatment, 30% will probably never need treatment
and 25% of those that we treat have locally advanced
disease (7).
The natural history of identified cancers
The facts look easy to understand. Prostate cancer
starts at age 30 and half of all men have some type of
precancerous lesion (prostate intraepithelial neoplasia
- PIN) or microscopic cancer that can only be
identified by a meticulous histologic examination on
autopsy or surgical specimen by the age of 50. The
percentage of these minicancers increases with age.
At age 80, a man has an 80% chance of having a
microscopic cancer. These histologic cancers are
called latent since they don’t seem to act like cancer.
However some of these cancers controlled by our
body defences do grow very slowly and given enough
time can be detected usually at a size of 0,5 cc in up
to 30% of men by age 60 in the western world.
Only one third of these (10% of men in the western
world) develop prostate cancer with symptoms. After
a long disease course, metastasis is detected after 7
to 10 years and 2% to 4% of patients die of their cancers after 10 to 15 years.
The detectable number of cancer by biopsy is variable
in different parts of the world: there is much less
cancer in Asiatic countries and much more in AfricanAmericans which raises the question of genetic
determination and/or lifestyle as a possible
contributing factor of cancer.
These figures show that most small cancers remain
latent and that screening must lead to over detection
and possibly over treatment. There is no guarantee
that these mini cancers will never become aggressive
over the remaining years of a lifetime. Generally
speaking, a relaxed policy is indicated over the age of
65 but extra caution advised in the age range of 50 to
65. It is understandable that this point of uncertainty
can be used pro or against screening practice and lies
at the base of a continuing controversy between
public health experts and clinicians.
♦ Incontinence urine
♦ Incontinence bowel
♦ Erectile dysfunction
Treated
Norm
23 - 48%
4%
5 - 14%
2%
40 - 74%
18%
There should be an effective treatment
There is no doubt that surgery, radiation (external or
internal) and other forms of treatment by cold
(cryosurgery) or by heat (high focused ultrasound) can
destroy the prostate and all cancer limited to the
gland.
The preferred treatment policy of the last century was
seek and destroy. Based on our increased knowledge
and experience we now aim treatment to focus and
control. Approximately 50% of screen-detected
cancers do not need treatment meaning patients could
be saved from the side-effects of obliterating the
prostate. Treatment side effects are decreasing
through improvements in technique both in surgery
and radiation therapy but they remain substantial if
one observes the reported side effects in a study of
964 patients alive 5 to 10 years after primary
treatment based on UCLA-EPIC and SAC questionnaires (Table 2) (8).
The screening test should be acceptable and safe
There is no dispute that the serum PSA test, used to
indicate the risk of having prostate cancer, is acceptable to the patient and safe to perform. It was readily
accepted by the medical profession and is now a
widespread test used routinely in aging men. However, the PSA is not specific for prostate cancer but for
prostate diseases which then produces increasing
numbers of false positive and false negative test
results causing anxiety for the patients or a false
sense of security. The development of a number of
derivatives to increase the positive predictive value
(PPV) shows that PSA testing is not very reliable (in
the clinical accepted ranges from 4 to 10 ng/ml). Free
screening with PSA is unreliable as laboratory blood
analysis must be performed within 2 to 3 hours of
drawing blood samples. More reliable are repeated
tests over time to evaluate the kinetics of PSA.
References
(1) Welch HG (2004): Should I be tested for Cancer? Maybe not and here's why.
(2) Straehle C et al: Transbig - Tailored Treatment for Breast Cancer, Poster 4th
UICC world Cancer Conference for Cancer Organisations, Dublin – Ireland,
November 17-19, 2004.
(3) International Herald Tribune: CT scan for lung cancer is called risky, March 4,
2007
(4) Schröder F, Albertsen P: The Motion: There is Evidence That Prostate Cancer
Screening Does More Good than Harm, European Urology 50: 377-380, 2006.
(5) Boyle P et al: Estimates of the cancer incidence and mortality in Europe in
2006, Ann Oncol 18: 581-592, 2007.
(6) Aus G et al: Prostate Cancer Screening Decreases the Absolute Risk of Being
Diagnosed with Advanced Prostate Cancer - Results from a Prospective, Population-Based Randomized Controlled Trial, European Urology 51: 659-664, 2007.
(7) Roehl KA et al: Cancer progression and survival rates following anatomical
radical retropubic prostatectomy in 3.478 consecutive patients: long-term results,
J Urol 172: 910-914, 2004.
(8) Mols TF: Psychical and psychological well-being among long-term cancer
survivors, Universiteit Tilburg, 2007.
The 2nd part of this article on Prostate Cancer Screening will be in Feb 08 issue
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Clinical Trial
VITAL 2
Phase III Randomised Study to
compare Docetaxel in
combination with GVAX verses
Docetaxel and Prednisone
Vaccine Development
Cell Genesys’ GVAX vaccine for prostate cancer
is designed to stimulate a systemic anti-tumour
immune response against the patient’s prostate
cancer.
It has two components, PC-3 and LNCaP cells,
which are administered at the same time. Each
has a prostate carcinoma cell line that has been
genetically modified to secrete GM-CSF, a
hormone that activates the immune system to
recognise, target and destroy the prostate cancer
cells that persist or recur following hormone
therapy. The vaccine is injected into the skin.
Eligibility Criteria
Males greater than 18 years of age who:
♦ Have a confirmed diagnosis of or clinical history
consistent with adenocarcinoma of the prostate.
♦ Have metastatic prostate cancer deemed to be
unresponsive or refractory to hormone therapy (after
discontinuation of anti-androgen therapy).
♦ Are taking any level 3 pain medication or level 2 pain
medications for cancer-related pain.
♦ Have NOT had taxane chemotherapy
Aiming to recruit 600 patients
Study Arms
Patients will be treated for approximately 27 weeks.
Arm 1: this group receives docetaxel + GVAX
vaccine every 21 days for up to 10 study
vaccinations.
Arm 2: this group receives docetaxel and
prednisone every 21 days for up to 10 treatments.
In both arms docetaxel is administered
intravenously on first day of each 21-day cycle.
Locations / Contacts
Royal Marsden, Sutton - Ruth Woode-Amissah
0208 661 3070
Mt Vernon, Middlesex - Jessica Milner
01923 844534
Royal Surrey, Guildford - Hardev Pandha
0208 725 0811
Also - Cambridge > Leeds > Scunthorpe > Preston
Nottingham > London
www.clinicaltrials.gov/ct/show/NCT00133224?order=17
Prostate Research Campaign UK
“ABC of Prostate Diseases”
Masterclass held at Southampton
Rose Bowl on 5th October 2007
Prostate Research Campaign UK have run successful
“ABCs” elsewhere in the country over the past two
years, and this was the seventh “specialist
master-class” aimed primarily at Practice Nurses and
GPs, the aim being to focus on the first point of call
for patients, and to provide excellent up-to-date
information on Prostate Diseases. A GP may typically
have 4 or 5 prostate patients, and some GPs may
have had their training some time ago, so a
“refresher” is very useful. Over 100 attended from
Hampshire, Sussex, Dorset, Isle of Wight, Wiltshire,
Somerset, and Surrey. There was roughly a 50% split
between GPs and Nurses.
PCaSO was a major sponsor for the event, providing
50% of the cost. As a patient led awareness group,
this provided excellent publicity. Each delegate pack
included PCaSO and PMS newsletters, information
booklets, awareness leaflets, and a PCaSO pen,
along with various leaflets from Prostate Research
Campaign. Along with PRC, Astra-Zeneca and
sonofi-aventis Oncology, PCaSO also had an
impressive display stand.
The conference opened with a joint introduction by
Brig. John Anderson, Chief Executive of PRC UK
and Sandy Tyndale-Biscoe, chairman of PCaSO.
The quality of the speakers at the event was first
class. Bill Dunsmuir, consultant urologist at Ashford
and St. Peters Hospital, Chertsey, gave an excellent
detailed presentation on how the prostate and PSA
inter-relate, and gave a summary of the three main
diseases and their symptoms.
Prof. Roger Kirby, Professor of Urology and Director
of Postgraduate Education at St. Georges Hospital,
London. has personally undertaken more than 1000
radical prostatectomies, including 50 with the da Vinci
robot. Having talked about the advantages of the new
PCA3 test, his main presentation showed in live
close-up detail, the process of a robotically assisted
prostatectomy, with the use of the 3D camera.
Heather Payne, consultant in Clinical Oncology at the
Middlesex Hospital, gave a presentation on the treatment of both locally advanced and advanced prostate
cancer, outlining the methods of radiotherapy, and
discussing hormone and chemotherapy treatments.
Dr Brian Wells, a consultant psychiatrist and himself
a prostate cancer sufferer, spoke of the problems and
support needed for patients and their families when
faced with a diagnosis. Ted Clucas, a prostate
patient and also a trustee of PRC UK, outlined his
“journey” as a patient, speaking frankly about his
experiences of diagnosis and treatment.
Prostate Research Campaign UK are planning four
�ABCs’ next year, including two in the west at
Plymouth and Cardiff. Support groups in that area
would be well advised to get involved.
6
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New Pathology Factor may help Treatment Decisions
Deciding on the appropriate treatment decision is a
very difficult time for men newly diagnosed with
prostate cancer. They are worried that if they make
the wrong decision that the cancer will progress.
Analysis of a new factor as part of the Gleason score
may help men and their doctors decide if they need
more aggressive treatment.
US News& World Report has an article that discusses
a new report in the Journal of the American Medical
Association. (JAMA). They say:
“The less it looks like normal tissue, the more
aggressive [the cancer] is,” Patel explained. They
then add up the two numbers to arrive at a Gleason
score. A score of 7 calls for treatment such as
radiation therapy, Patel said, while higher scores
indicate an even more dangerous tumour.
In the new study, the Brigham and Women’s team
looked for a third pattern of disorder from another part
of the samples. Such disorderly patterns are found in
about 5 percent of cases but usually are ignored.
disorderly third pattern. In fact, the failure time for men
with a Gleason score of 7 and the third pattern of
disorderly cells was the same as for men whose
cancers had a Gleason score of 8 or greater.
Design, Setting, and Patients From 1989 to 2005,
2370 men with clinical tumour category 1c to 3b,
node-negative, and non-metastatic prostate cancer
underwent definitive therapy with surgery or radiation
therapy with or without hormonal therapy. A
pathologist with expertise in genitourinary cancers
assigned Gleason scores to the prostate needle
biopsy specimens. Cox regression was used to
assess whether a significant association existed
between the presence of tertiary grade 5 in men with
Gleason score 7 disease and time to recurrence
compared with men with Gleason score 7 without
tertiary grade 5, Gleason score 5 to 6, or 8 to 10
disease, adjusting for known prognostic factors and
treatment.
The results and conclusions from the JAMA abstract are:
GRADING OF PROSTATE CANCER
When a biopsy confirms the presence of cancer, the
next step, called grading, is to determine how
aggressive the cancer is. The most common cancer
grading scale runs from 1 to 5, with 1 being the least
aggressive form (tissue cells look normal). Known as
the Gleason scores, these numbers (which refer to
the appearance and activity of cancer cells) may be
helpful in determining which treatment option is best.
The Gleason score adds the grades of the two most
prevalent patterns of cells. Therefore, scores may
range from 2 (non-aggressive cancer) to 10 (very
aggressive cancer). The eventual spread of the
tumour is dependent on the aggressive nature of the
prostate cancer cells.
The time to what physicians call “PSA failure”
averaged five years in these men, compared to 6.7
years in men with a Gleason score of 7 but no
Results. Men with Gleason score 7 and tertiary grade
5 disease had a significantly shorter time to PSA
failure than men with 7 without tertiary grade 5
(median time, 5.0 vs 6.7 years, respectivel) or score
of 6 or less (median time, 15.4 years).
However, a significant difference was not observed
when these men were compared with men with
Gleason score 8 to 10 disease (median time, 5.1
years).
Conclusion. In this study population, men with
prostate cancer having biopsy Gleason score 7 and
tertiary grade 5 had a higher risk of PSA-failure when
compared with men with Gleason score 7 without
tertiary grade 5 and had a comparable risk with men
with Gleason score 8 to 10.
Ref: PSA Failure Following Definitive Treatment of Prostate
Cancer Having Biopsy Gleason Score 7 With Tertiary Grade 5
Abhijit A. Patel, MD, PhD; Ming-Hui Chen, PhD; Andrew A.
Renshaw, MD; Anthony V. D’Amico, MD, PhD
New Treatment for Prostatitis
Prostatitis is a condition most men rarely discuss because of its embarrassing symptoms. Sufferers often
have urinary frequency, genital pain and cannot sit without increasing their pain. Sexual activity usually makes
the pain worse. Prostatitis is the only one of the big three prostate diseases – prostate cancer and BPH are
the others – that strikes men at their sexual peak. It is poorly understood and often unsuccessfully treated.
A new treatment for prostatitis has been developed at Stanford University Urology Department. Rather than
treating it as a disease of the prostate gland, the Stanford treatment focuses on relaxing chronic tension and
releasing spasm in the pelvic muscles.
The Stanford treatment pioneers a self-administered physical therapy done inside and outside the pelvic floor.
It identifies over 60 trigger points inside and outside the pelvis that can refer pelvic pain and symptoms. The
protocol simultaneously trains patients in a specific method to relax the pelvic floor and to modify the tendency
to tighten the pelvis under stress. The researchers report a high level of symptom relief, when the muscles of
the pelvis become soft and relaxed through a self-administered physical therapy. More details can be found
at: www.pelvicpainhelp.com
This article was taken with permission, from the Newsletter of the Prostate Research Campaign UK, Issue No.30
7
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PROSTATE MATTERS SOUTH Southern Region Meetings & Events
2007
19th Nov - Cornwall PSA meeting at Knowledge Spa, Room G01,
Royal Cornwall Hospital, Treliske, Truro, 7pm.
www.tpsa.org.uk
24th Nov - Somerset PSA meeting & AGM at the Albemarle Centre,
Taunton, 10.30 to 12.30pm. Two or three men will share their
personal stories & a urology nurse will accept questions
NEDPSA
North & East Devon
Prostate Support Ass.
27th Nov - PCaSO Basingstoke group meeting, ARK Centre,
North Hants Hospital, 6.30pm
28th Nov - Dorset PSA meeting, Merley Community Hall, Harrier Drive,
www.nedpsa.org.uk
Somerset
Prostate Support Association
Merley, Wimborne, 7.30pm
4th Dec - Torbay PSA Christmas Lunch, Dainton Golf Club, 12 noon
12th Dec - PCaSO Southampton group meeting, Taunton’s College,
Southampton, 6.30pm. Speaker - Dr Christian Ottensmeier will talk
on �Update on Prostate Cancer Research’
www.somersetprostatecancer.org.uk
DORSET
PSA
www.prostatecancersupport.info
2008
10th Jan - PCaSO Regional meeting, Ferneham Hall, Fareham, 2pm.
Three or four men will share their personal stories and talk about
their experiences.
16th Jan - Prospect meeting, BAWA Centre, Southmead Road, Bristol
7.30pm Speaker is Paula Bond, Macmillan Cancer Support
Development Co-ordinator for South West
PCaSO
Prostate Cancer Network
21st Jan - Cornwall PSA meeting at Knowledge Spa, Room G01,
Royal Cornwall Hospital, Treliske, Truro, 7pm.
23rd Jan - Dorset PSA meeting, Merley Community Hall, Harrier Drive,
Merley, Wimborne, 7.30pm
www.pcaso.com
24th Jan - NEDPSA meeting, ISCA Centre, Summer Lane, Whipton,
Exeter, 10 to 12.30pm.
CORNWALL
PROSTATE SUPPORT ASSOCIATION
(CPSA)
29th Jan - PCaSO Basingstoke group meeting, ARK Centre,
North Hants Hospital, 6.30pm
24th or 31st Jan - Torbay PSA meeting at Livermead House Hotel,
Torbay Sea Front, 10am. Speaker will be a leading Consultant
Urologist from Torbay Hospital.
P
rospect
PROSTATE CANCER SUPPORT GROUP
6th Feb - PCaSO Southampton group meeting, Taunton’s College,
Southampton, 6.30pm.
18th Feb - Cornwall PSA - meeting at Knowledge Spa, Room G01,
www.prostatecancer-help.org.uk
Royal Cornwall Hospital, Treliske, Truro, 7pm.
26th Feb - PCaSO Basingstoke group meeting, ARK Centre,
North Hants Hospital, 6.30pm
General Disclaimer This newsletter is providing news, information, personal memoir and opinion about prostate cancer. It
also reports, quotes and cites published medical views and research findings about prostate problems. Anyone who wishes to
embark on any dietary, drug, exercise or other lifestyle change intended to prevent or treat a specific disease or condition,
should first consult with and seek clearance from a qualified health care professional.
8
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