The Manitoba Prostate Cancer Support Group Vol. : 166 - April 2005 Thought For Today Men are an ingenious assembly of portable plumbing -Christopher Morley The Manitoba Prostate Cancer Support Group encourages wives, loved ones, and friends to attend all meetings. Feel free to ask basic or personal questions without fear of embarrassment. You need not give out your name or other personal information. The Manitoba Prostate Cancer Support Group does not recommend treatment modalities, medications, or physicians. All information is however freely shared. ___________________________ Want to reach us by email ? ___________________________________ J. Butler M.D. Radiation Oncologist In This Issue Paul Daeninck M.D. Pain Management page 2 Graham Glezerson M.D. Urologist MOST MATERIALS LEAVE OUT DETAILS KEY TO DECISION MAKING Alan Katz M.D. Family Practitioner page 3 Len Leboldus M.D. Urologist FOCAL CRYOTHERAPY FOR PROSTATE CANCER MAY OFFER BENEFITS OVER CURRENT TREATMENTS Ross MacMahon M.D. Urologist page 4 John Milner M.D. Urologist SEX, CANCER AND ALL THAT JAZZ Gary Schroeder M.D. Radiation Oncologist page 5 POWELL URGES MEN TO DETECT PROSTATE CANCER EARLY Thanks! ___________________________ Cancer Information Service page 6 NEW URINE TEST MAY IMPROVE PROSTATE CANCER SCREENING IMPOTENCE FROM PROSTATE RADIATION MAY BE AVOIDABLE page 7 [email protected] Medical Advisors to The Manitoba Prostate Cancer Support Group EXPERTS CALL FOR TEAM APPROACH TO PROSTATE CANCER Call toll free: 1-888-939-3333 or 1-905-387-1153 When you call the toll free number of the Cancer Information Service, your questions will be answered by someone who understands how confusing the subject of cancer can be. All calls are kept confidential NEXT MEETING: TOPIC: Prostate Health & Naturopathic Medicine Drs. Sims and Schrader Naturopathic Physicians April 21, 2005 7-9 P.M. Location: AUDITORIUM of the Seven Oaks General Hospital - Leila & McPhillips Lots of Free Parking on the street. www.manpros.org The Manitoba Prostate Cancer Support Group Newsletter Most materials leave out details key to decision making Ann Arbor - When a man is diagnosed with early-stage prostate cancer, he must decide among four different treatment methods, each of which carries its own set of benefits and risks. The specialists disagree which method is most effective and the research to date is inconclusive. But when men turn to widely available patient education materials, they're likely to find minimal information on the likelihood of side effects and a bias toward active treatment, according to a new study published by University of Michigan Health System researchers in the May issue of Annals of Internal Medicine. Patients should not rely on only one source of information before making a decision about prostate cancer treatment. We found no single health pamphlet or Web site presented all the information needed to make an informed decision. Prostate cancer patients say they want to learn about the side effects of treatment before making their decision, but our study found many educational materials actually avoided talking about these side effects, says lead study author Angela Fagerlin, Ph.D., a research investigator in the Department of Internal Medicine at UMHS. Early-stage prostate cancer is usually treated with watchful waiting, radical prostatectomy, radiation therapy or hormone therapy. No clinical trials have shown a difference in 10- to 15-year mortality among these treatments, so men must weigh the importance of a variety of side effects when deciding what treatment to pursue. The researchers sought out publicly available materials produced by patient advocacy groups, government organizations, pharmaceutical companies, insurance companies, universities and comprehensive cancer centers. Web sites were identified by reviewing national organizations, pharmaceutical companies and an open-ended Web search. Any materials that did not cover the four standard prostate cancer treatments, looked at cancer in general or focused on prostate cancer screenings was excluded. The final list included 44 print materials, Web sites, videos and CDROMs. Publications Agreement #40037332 Return Undeliverable Canadian Addresses to: Manitoba Prostate Cancer Support Group #705 - 776 Corydon Ave Winnipeg, Manitoba R3M 0Y1 April 2005 2 Each item was scored based on whether it contained information on specific topics, from a basic overview of prostate cancer to the side effects of each treatment option. While most materials covered basic information on prostate anatomy and prostate cancer staging, fewer materials addressed negative topics such as potential side effects, emotional discomfort or death. There was a disturbing lack of discussion about the likelihood of experiencing the side effects of these treatments, as well as a lack of discussion about what it would be like to undergo these types of treatments, says Fagerlin, who is also with the Ann Arbor VA Health Services Research and Development Center for Practice Management and Outcomes Research. Specifically, half the materials did not discuss the need for hospitalization after radical prostatectomy and only 53 percent of print materials talked about catheterization. Incontinence and impotence were frequently listed as side effects of treatment, but bowel disorders and the risk of death were seldom acknowledged. In addition to content, the materials were evaluated for accuracy, balance and readability. The information was found to be accurate for the most part and only one item showed significant imbalance in describing treatment options. In general, though, the materials were biased toward active treatment over watchful waiting and the impact of side effects was minimized. The researchers also found the average reading level for the materials was above the ninth-grade level typical for health information but above the average reading ability of American adults. Materials were also written in passive, third-person, clinical language and contained dense pages full of text with no graphics, photos or other visual elements to engage readers. The study authors recommend that organizations producing patient education materials offer complete information on how the treatment is provided, including its risks and benefits. The material should speak from a patient's point of view and should use a clear and engaging writing style and presentation. To help patients obtain thorough, balanced information on treatment options, the study authors developed a set of patient education materials, available in booklet form, on CD and audiotape, and on the Internet at www.prostatecancerdecision.org. www.manpros.org (Continued on page 3) The Manitoba Prostate Cancer Support Group Newsletter (Continued from page 2) In addition, Fagerlin suggests patients seek out educational materials from organizations that have established credibility, such as the National Institutes of Health, the Centers for Disease Control and Prevention, the National Cancer Institute or the American Cancer Society. Funding for the study came from the Michigan Department of Community Health and the Michigan Public Health Institute. In addition to Fagerlin, study authors are John Wei, M.D., from the UMHS Department of Urology; David Rovner, M.D., Christophir Jentoft, and Margaret HolmesRovner, Ph.D., from Michigan State University; and Sue Stableford from the Maine Area Health Education Center Health Literacy Center at the University of New England. Soucre: University of Michigan Comprehensive Cancer Center ... Videos, We Have Videos! More than 100 video tapes are available for loan or purchase. We have вЂњvideographedвЂќ almost every speaker for the last six years, and there are others from outside sources on particular topics. A detailed listing with indexes is available on our website www.manpros.org Contact Eleanor or Lorne Strick (204) 667 9367 if you are interested. April 2005 3 Focal cryotherapy for prostate cancer may offer benefits over current treatments NewsRx.com - July 29, 2004 Physicians are adopting a new cryosurgical procedure for prostate cancer using focal, freezing technologies, which early evidence suggests causes fewer side effects than the current surgical treatments for the disease. Clinical results of this new focal procedure called the "male lumpectomy" were presented by Gary Onik at the recent annual meeting of the Society of Uroradiology. Onik's study examined 21 patients aged 58 to 70 with prostate cancer who underwent focal cryosurgery, and 20 had no evidence of cancer in follow-up examinations between 2 and 8 years later. Onik said, "Essentially 95% of the patients had stable prostate specific antigens (PSA) at an average of 4 years. This demonstrates that patients are responding to the procedure." Impotency and incontinence are the two most common complications associated with any prostate surgery, but Onik and colleagues found about 80% of men receiving focal cryosurgery remained potent and none became incontinent. Endocare Inc., the manufacturer of the Cryocare system used for the procedure estimates that the number of focal procedures has doubled each year in recent years. A recent survey cited in Physicians Weekly said approximately 60% of the 150 centers that perform cryosurgery in the U.S. now offer some form of focal cryotherapy. Additionally, targeted cryosurgery is the most effective treatment for men with recurrent prostate cancer (after failed radiation treatment) whose PSA levels again rise. Aaron Katz of Columbia Presbyterian presented compelling 6-year clinical data at the national AUA conference where he showed 71% of failed patients still had undetectable PSA values 5 years after undergoing targeted cryosurgery. This article was prepared by Biotech Law Weekly editors from staff and other reports. Copyright 2004, Biotech Law Weekly via LawRx.com ... www.manpros.org BRIAN RICHARDSON BILL BACKMAN TUSIA KOZUB CHRIS SIGURDSON SOFIA COSTANTINI PETE SZEKELY The Manitoba Prostate Cancer Support Group Newsletter April 2005 5 Powell Urges Men to Detect Prostate Cancer Early The Milwaukee Journal Sentinel - July 8, 2004 Thursday, July 8, 2004 Sex, Cancer and All That Jazz, was conceived by our member, Norm Oman, who collected stories told by cancer survivors: some funny, others not funny, but all are perplexing. The musical has been written, performed and produced by a group of talented artists, many of whose lives have been touched by cancer. Help throw some light on the issues of sexuality confronting cancer patients by treating yourself to an hour of entertainment! Friday, Aprill 22 7:00 PM School For The Deaf 285 Pembina Hwy Washington -- Looking fit after traveling some 2,900 miles on diplomatic business in four countries over eight days, Secretary of State Colin Powell still looks back on his successful prostate cancer surgery as carrying an important message for all men. "Detect prostate cancer early," Powell says. Otherwise, if you don't, "it will kill you." And the younger you are, the more aggressively the cancer will grow, Powell said this week in an interview on PBS' Tavis Smiley show. African-Americans have to be more careful, and have more examinations on a regular basis to detect the disease as early as possible, Powell said. "That's just a fact of life." "We are at a higher risk to prostate cancer than our white brothers," Powell said. "It's well-known. It's documented." Forrest Nickerson Theatre But, he said, all men are at risk. ... Powell's experience bears out how elusive prostate cancer can be. Referring to a test given routinely to men at about 50 and usually to African-Americans a few years earlier, Powell said that a test about six years ago showed that his PSA (Prostate Specific Antigen) level was high. He had two biopsies in the late 1990s that did not detect cancer, he said. Last August, with the PSA level still elevated, he had a "very intrusive biopsy" at Walter Reed Army Medical Center and the tumor was found. Out of 13 samples, only one had shown the cancer. Powell elected surgery over radiation and other options. "Nobody likes to have surgery," he said. "And, believe it or not, even though I am 67 years old, until that operation last December I had never spent one day or night in a hospital. I've been in remarkably good health." Suddenly, to hear you have cancer and it's got to be removed "is a little unnerving," Powell said. "But you have got to face it." (C) 2004 The Milwaukee Journal Sentinel. via ProQuest Information and Learning Company; All Rights Reserved Stitches February 1998 www.manpros.org ... The Manitoba Prostate Cancer Support Group Newsletter New Urine Test May Improve Prostate Cancer Screening The following information was obtained from the Cancerfacts.com website. Researchers have developed a simple urine test for a protein reduced exclusively by prostate cancer cells that may improve the accuracy of screening. A research team led by Dr. Bruce Zetter, from Children's Hospital Boston, discovered a protein, called thymosin beta-15, unlike prostate specific antigen (PSA), is produced almost exclusively by cancer cells and is detectable in urine. The protein stimulates cell migration and promotes the spread, or metastasis of prostate cancer. The study results first appeared in the January 21st, 2005 issue of the online edition of the journal The Prostate. The authors reported, "thymosin beta-15 (T beta-15) is a urinary biomarker for prostate cancer, and suggested that T beta- 1 5, in combination with PSA, can be used to improve both sensitivity and specificity of prostate cancer diagnosis.вЂќ In the study, Zetter and colleagues compared thymosin beta-15 levels in urine samples from 121 men with prostate cancer, 15 men with kidney or bladder cancer, 81 men with non-malignant prostate disease such as prostatitis, 73 men with other non- malignant urologic diseases such as urinary tract infections, and 52 healthy men without prostate cancer who served as a comparison, or control group. T beta- 1 5 were elevated in men with aggressive or untreated prostate cancer but near normal in healthy men and other genitourinary diseases. Men with aggressive prostate cancer were 12 times more likely than the healthy controls to have elevated thymosin beta- 1 5. Men with aggressive prostate cancer were 12 times more likely than the men that were used as the control subjects to have elevated thymosin beta- 15. T beta-15 levels were found to be normal or near normal in healthy men as well as those men with other genitourinary diseases. Notably, nearly half of cancer patients whose PSA levels were considered normal tested positive for thymosin beta- 1 5. Conversely, many men with other genitourinary diseases had elevated PSA'S, but normal thymosin beta-15 values. When PSA and thymosin beta15 were combined, the combination detected prostate cancer more often than PSA testing alone, with far fewer false- positives. April 2005 6 Impotence from Prostate Radiation May be Avoidable The following information was obtainedfrom the Google Alerts website - and came from ASCO (American Society of Clinical Oncology) Radiation therapy is effective for prostate cancer, but up to 90 percent of men will develop impotence after the treatment. New research indicates that this frustrating side effect may be avoided if MRI and CT, rather "than just CT, are used to plan exactly how and where radiation will be delivered. Previous reports have suggested that prostate radiation causes impotence by damaging the structures that control blood supply in the penis. Therefore, radiotherapy that avoids these structures could potentially preserve sexual function. This is where treatment planning comes on. Dr. Patrick W McLaughlin, from the University- of Michigan in Ann Arbor, said that with standard CT planning, it is often assumed that the distance between the prostate and these key structures is 1.5cm, however, Dr. McLaughlin and colleagues found that when they used combination of MR[ and CT scans in 25 men who had prostate cancer in order to determine the exact distance from the prostate to the blood-containing structures it was found that the average distance - 1.45 cm - was close to that used with CT-based planning, however, the actual values varied from 0.7 to 2.1 cm. The exact determination of the distance allowed the team to target radiotherapy more precisely, and dramatically reduce the dose to the critical erection structures. The new findings were published in the International Journal of Radiation Oncology Biology Physics. The authors of this study reported that further studies would be needed in order to determine if MRI plus CT planning of the radiation therapy actually prevents impotence. ... www.manpros.org ... The Manitoba Prostate Cancer Support Group Newsletter Experts Call for Team Approach to Prostate Cancer 22 September 2004 WASHINGTON (Reuters) - Doctors need to develop a more organized team approach to prostate cancer, with a clear outline of how to screen for and treat the disease, a panel of cancer experts said on Wednesday. Doctors still do not agree on the best way to screen for prostate cancer, let alone how to treat it, the panel of 24 doctors and researchers said. April 2005 7 Because prostate cancer is often a slow-growing disease, doctors and patients alike often do not take it seriously until it has spread, said Dr. Anthony D'Amico of Brigham and Women's Hospital and Harvard Medical School in Boston. About a third of all cases of prostate cancer are dangerously aggressive, D'Amico, a member of the panel, said in a telephone interview. "A three-month delay in the management of this type of prostate cancer may actually lead to lower control rates," he added -- meaning these patients will be more likely to relapse and perhaps even to die of their disease. "This is a third of all the guys coming in, out of 230,000 prostate cancer cases a year. It is not a small number." "The coordination of care among urologists, radiation oncologists and medical oncologists is crucial to the wellbeing of patients and to the proper management of prostate cancer, but many patients are not made aware of a multidisciplinary team approach until their cancer has progressed to a late stage," the report from the philanthropic Prostate Cancer Foundation reads. In June doctors reported that prostate cancer patients can also be helped by Taxotere, a breast cancer drug made by Aventis SA. Standard advice currently is for men to choose their preferred treatment, in consultation with their urologist, who may or may not be a cancer specialist. The usual choices are surgical removal of the prostate, radiation treatment or a hormone-based treatment. D'Amico has also pressed for new ways to analyze the standard screening test for prostate cancer, a measurement of PSA or prostate specific androgen. In contrast, when a woman is diagnosed with breast cancer, she usually meets immediately with a surgeon, a radiation specialist, and a medical oncologist who can talk to her about chemotherapy. His team has found that how quickly PSA levels rise, rather than the absolute numbers, are the best indication of how dangerous a patient's prostate cancer is. The panel said this theory needs to be validated with more tests and put into practice. Men should have clearer choices, and their doctors should have clearer guidelines on what to recommend, said the report. "This opens the door now to the testing of chemotherapy in earlier stages of prostate cancer," D'Amico said. http://www.prostate-cancer.org.uk/news/fullStory.asp?id=1440 "The need for innovation is more urgent than ever, as the baby-boomer men reach the target age for prostate cancer beginning at age 50," said Leslie Michelson, chief executive officer of the Santa Monica, California-based group. "The number of new prostate cancer cases in the United States is anticipated to increase by 50 percent to more than 300,000 new cases per year by 2012." Prostate cancer now kills 29,000 Americans a year. The report calls for better research and efforts to get men with prostate cancer to take part in trials that can help answer questions. www.manpros.org ... Manitoba Prostate Cancer Support Group # 705 - 776 Corydon Ave., Winnipeg R3M OY1 Publications Agreement # 40037332 FUTURE MEETINGS: M.P.C.S.G. 2005 Manitoba April 21, 2005 7-9 P.M. Topic Prostate Health & Naturopathic Medicine Dr. Sims / Dr. Schrader May 19, 2005 7-9 P.M. Topic Dealing With Incontinence After Prostate Cancer Treatment Fran Rosenberg RN Nurse Advisor Continence Control Executive Committee: (204) Marv Brodsky, Secretary Jack M. Chapman, Honorary Lawyer Ted Chivers, Special Projects Joseph Courchaine, Treasurer Michael Doob, Newsletter Editor Herold Driedger, Political Action Michael Iwasienko, Phone Committee Jim Jannetta, Prostate Cancer Awareness Dan Joss, Volunteer Coordinator Ken Kirk, New Member Chairman Larry Lakey, Member at large Sol Masarsky, Hospital Visitation Norm Oman, Chairman, Events Coordinator Lorne Strick, Videographer Pete Szekely, Newsletter Layout / Webmaster Arthur Wortzman, Speaker Chairman Our Answering Machine 452-5717 487-0647 257-2602 488-0804 254-4110 582-9057 275-1044 895-9061 261-7767 632-6210 334-3508 487-4418 667-9367 224-9905 287-8621 989-3433 CAN YOU HELP? 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