Santa Cruz County Prostate Cancer Support Group
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Serving all of SANTA CRUZ COUNTY Santa Cruz PROSTATE CANCER SUPPORT GROUP April 2005 NEWSLETTER Howard Waage (688-0423) -----Editor ______________________________________________________ ___________________________________ When: Tuesday evening, April 26th starting at 7:00 p.m. (The April Steering committee meeting begins at 5:30 p.m., before the regular meeting) Where: Our meeting will be downstairs in two-story redwood Education Building behind the Santa Cruz Dominican Hospital. We’ll meet in the Bennett & Suzy Katz Cancer Resource Center on the 1st Floor. Please feel free to contact any of the following steering committee members if you would like to volunteer or if you have any suggestions or questions.
Tony & Beverley Calvo 684-0940 Frank Schmetz 438 4781 Bill McDermott 423-8350 Howard Waage 688-0423 Richard & Tina Koch 761-3577 Ollie Wright 335-3878 Lynn Dreeszen 439-8632 Tim Ryan 476-6550 Our website: http://www.scprostate.org Doug Thornton 724-6446 (Webmaster)
Dear Members.….We continue to grow in our membership and currently have over 200 members in our support group. We’re slowly outgrowing our meeting room at Dominican Hospital, therefore the steering committee is exploring the possibility of changing our monthly meeting to a different location in order to find a larger room.
The steering committee is also considering forming an additional support group for men whose disease has spread outside the prostate and has become systemic. Typically, these are members who are receiving hormone blockade or some other form of advanced treatment or might be on or considering a clinical trial. This group would meet every three months at the Katz Cancer Resource Center.
If you have any suggestions, questions or concerns regarding these changes, please contact any of the steering committee members. We’ll keep you updated in next month’s newsletter.
….PROSTATE CANCER IN THE NEWS..…
Inoperable' advanced prostate cancer may be operable, curable
02 Apr 2005--New findings from Mayo Clinic indicate that cT3 prostate cancer, a disease in which the cancer has spread locally from inside the prostate to immediately outside it, is operable and has 15-year cancer survival rates of almost 80 percent."These patients have a better chance if they undergo surgery and are living longer than if they undergo radiation therapy," says Horst Zincke, M.D., Ph.D., Mayo Clinic urologist and senior study investigator.
Treatment of this type of prostate cancer has been controversial, as it is a stage 3 cancer in which the malignancy has spread. Due to its advanced stage, some physicians have considered it inoperable via radical prostatectomy, according to Dr. Zincke. He explains that many patients come to him for a second opinion after being told their cT3 prostate cancers could not be surgically removed.
"It's considered inoperable by some urologists and referred to radiation oncology," says Dr. Zincke. "They think surgery can't be done because the cancer is outside the prostate. Currently, only 15 percent are referred for surgery."
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The problem with radiation therapy as the first line of treatment for cT3 prostate cancer, according to the Mayo Clinic researchers, is the cancer survival rate, which is 79 percent at only five years. In contrast, with radical prostatectomy, 79 percent of the patients lived at least 15 years. Says Dr. Zincke, "So, obviously surgery does a better job for these patients." Dr. Zincke also explains that when malignant prostate tumors are high grade -- more aggressive -- they are not especially responsive to radiation therapy alone.He believes the current trend away from surgery is a disservice to patients. "Patients are being denied surgical treatment when indeed they could have had surgery," Dr. Zincke says.
The cancer survival rates for cT3 prostate cancer with radical prostatectomy not only approach those of cT2 prostate cancer (cancer confined to the prostate), which is 90 percent at 15 years, but they are even more impressive due to the ages of the patients, says Dr. Zincke. "It's significant because the average patient is only 62 years old," he says. "So, a 15-year survival is a long time."In addition to a favorable survival rate for the cT3 prostate cancer patients studied, the Mayo Clinic researchers also found urinary incontinence rates and complications were akin to those for cT2 prostate cancer.
Some of the patients studied with cT3 prostate cancer had additional, or adjuvant, therapy after surgery, such as hormone therapy or radiotherapy. Dr. Zincke indicates that adjuvant therapy is necessary for patients whose prostate cancer affects the lymph nodes. Surgery alone may be sufficient treatment for those without lymph node involvement. Approximately 50 percent of the cases of cT3 prostate cancer do not involve the lymph nodes. The study also found that 25 percent of the patients were overstaged -- told that they had a cT3 prostate cancer, a more advanced form, rather than what they really had a cT2 prostate cancer in which the malignancy is confined inside the prostate.
Dr. Zincke points to following patients over 15 years post-treatment as a strength of the study. "The highest incidence of prostate cancer death is not reached until 11 years after treatment, so 15-year data is significant," he says. "In contrast, five-year data is less meaningful." Dr. Zincke recommends that patients with cT3 prostate cancer seek a surgeon who performs at least one prostate surgery per week and has completed at least 300 prostate surgeries. He explains that currently only 3 to 4 percent of urologists are doing more than one prostate cancer surgery per week. As they seek an appropriate surgeon, he encourages patients that "if someone tells you your cT3 prostate cancer is inoperable, don't give up."
With more common use of prostate-specific antigen (PSA) testing in the United States, more prostate cancers are now caught earlier, before the cancer spreads. Thus, the frequency of cT3 prostate cancers seen at Mayo Clinic has declined to 3 percent of all prostate cancers. Canada and Europe have much higher rates of cT3 prostate cancer, as PSA testing is not conducted as frequently and more cancers are discovered later than in the United States, allowing the cancers more opportunity to spread outside the prostate.
This study was conducted as a single-institution, retrospective study of 5,652 men who had radical prostatectomy at Mayo Clinic for confirmed prostate cancer. The title of the paper is "Radical Prostatectomy for Clinically Advanced (cT3) Prostate Cancer Since the Advent of Prostate-Specific Antigen Testing: 15-Year Outcome." The first author is a former Mayo Clinic urology fellow, John F. Ward, M.D., Division of Urology, Naval Medical Center, Portsmouth, Va. Other Mayo Clinic authors include Jeffrey Slezak, Eric Bergstralh, and Michael Blute, M.D. Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=22156#
Prostate Radiation Linked to Rectal Cancer By Jennifer Warner
Tuesday, April 05, 2005 - Men who receive radiation treatment for prostate cancer are more likely to develop rectal cancer, a new study suggests. Researchers found that men with prostate cancer who were treated with radiation had a 70 percent higher risk of developing rectal cancer than those who were treated with surgery only.
"Men who have had prostate radiation should be aggressively monitored for rectal cancer starting five years after treatment," says researcher Nancy Baxter, MD, PhD, of the University of Minnesota Cancer Center, in a news release. "This is the first time rectal cancer risk associated with prostate radiation has been quantified, and these findings may also have implications for patients treated with radiation for other pelvic cancers."
Prostate cancer is the most commonly diagnosed cancer in the U.S. with about 230,000 men diagnosed with the disease each year. Although prostate cancer is highly treatable when caught in the early stages, researchers say men who survive prostate cancer may face higher risks of other types of cancer due to the effects of their treatment. (Page 2)
About 17 percent of men with prostate cancer are treated with radiation, usually because they choose radiation over surgery, are older, or have other medical problems.
In the study, which appears in the April issue of Gastroenterology, researchers looked at more than 85,000 men treated for prostate cancer from 1973 to 1994. More than 30,000 of the men received radiation treatment for prostate cancer and about 55,000 had surgery only.
The results showed that radiation treatment was linked to a higher risk of cancer in areas that were irradiated, such as the rectum, but not in the remainder of the colon. The risk of developing rectal cancer among men who received radiation was 70 percent higher than those who underwent surgery alone. Researchers say that increase in risk is roughly equivalent to the colorectal cancer risk associated with having a family history of the disease.
Improvements With Current Technology : However, researchers say current technology allows for more targeted radiation treatment to the affected area than was available up to 1995. Even so, researchers say some portions of the rectum may still receive a high dose of radiation, which raises the risk of rectal cancer.
In an editorial that accompanies the study, William M. Grady of the Fred Hutchinson Cancer Research Center in Seattle and Ken Russell of the University of Washington Medical School say that the results highlight the need to monitor the long-term health of prostate cancer survivors. “In light of the increasing number of men surviving prostate cancer, these findings have substantial implications not only regarding our understanding of radiation-induced cancers but also for our management of men who have undergone prostate irradiation,” write the editorialists.
“As more men are successfully treated for their prostate cancer, the prevention of long-term complications from prostate cancer treatment can be predicted to become a major medical issue.”
SOURCES: Baxter, N. Gastroenterology, April 2005; vol 128: pp 819-824. News release, American Gastroenterological Association Source: http://www.foxnews.com/story/0,2933,152521,00.html
Prostate Cancer Research and Advocacy Lag By Marilynn Marchione
ORLANDO, Fla. Mar. 31, 2005 (AP) - It's the most common major cancer in America, even though it affects only one sex. Lifetime odds of getting it are 1 in 6. Testing for it is controversial, and treating it robs many of a body part that's important to their sexuality. This isn't breast cancer, a disease tattooed into the American psyche. It is its male counterpart, prostate cancer, which has made a much fainter mark.
Prostate cancer gets a fraction of what is spent on breast cancer research, and virtually nothing is known about what causes it. It is the only cancer that doctors debate not just how to treat but whether they should at all. Nine out of 10 men don't need treatment but the rest will die, and there's no good way to tell them apart. It also kills at a higher rate than breast cancer. Nearly 32 men out of 100,000 will die of prostate cancer; 27 women out of 100,000 die of breast cancer. Advocacy has been weak. Men don't like to wear little blue ribbons, and the field has suffered from lack of support. Consider Dr. Ernie Bodai's situation. The California surgeon got a special postage stamp that has raised a whopping $50 million to fight breast cancer, a disease he cuts out of dozens of women's bodies each year. But he's been unable to win a similar stamp for his own cancer. "The prostate cancer community is 10 years behind the breast groups in terms of being acknowledged and coming forward," he lamented.
Now, many are trying to catch up. More than a thousand specialists, from surgeons to radiologists to dietitians, met in Orlando recently for a first-of-its-kind conference similar to the breast cancer symposium that's been held in Texas for 27 years. "As San Antonio is to breast cancer, we want this to be for prostate cancer," said Dr. Eric Small of the University of California in San Francisco, who organized the meeting with several big cancer organizations.
What emerged from the three-day conference was a clearer picture of this murky disease and new insights into preventing, detecting and treating it. Among them:
_The immune system might be more effectively harnessed to fight this cancer than many other types. Doctors reported the first success using this approach.
_Smoking has less of an effect on prostate cancer risk than other cancers. (Page 3) _Obesity affects the odds of dying from the disease more than the odds of getting it.
_Diet may play a key role. More is known about how specific nutrients affect the risk of prostate cancer than any other cancer type. Diet might even help explain why blacks have double the rate of the disease than whites.
_Treatments are improving. New techniques are minimizing surgery's side effects, and newer ways of giving radiation are allowing higher doses and better control of the disease.
_Use of the PSA blood test is being refined. Studies are evaluating whether a rising score means more than the score itself, and other ways to fine-tune interpretation. Other potentially better biomarkers for prostate cancer also are being studied.
_Doctors are starting to prescribe finasteride for some men at high risk of the disease after a big study found the drug could prevent prostate cancer, much as tamoxifen prevents breast cancer. The study was notable not just for its outcome, but also because 18,000 men took part, after years of studies begging for participants.
"This was a real question in the 1990s: If you gave a party, would the men show up?" said Dr. Howard Parnes, director of cancer prevention at the National Cancer Institute, which funded the study.
"Only one patient with prostate cancer is entered into a clinical trial for every four patients with breast cancer. That's our biggest challenge," Dr. Eric Small said.
More than 232,000 American men are expected to be diagnosed this year with cancer of the prostate, a walnut-shaped gland beneath the base of the penis that makes seminal fluid. About 30,000 will die of it. Worldwide, 680,000 cases and 221,000 deaths are projected _ figures that seem low primarily because in many poor countries men don't live long enough to develop it.
Cases climbed dramatically in the United States in 1988 and 1989 with the advent of the PSA blood test, which measures a protein the prostate makes when it's inflamed. The test is controversial because PSA can be high for many reasons, and there's no proof that screening saves lives.
In most men, prostate cancer grows so slowly that it will never threaten their lives. Treatment often leads to problems having sex or controlling the bladder, so finding a way to distinguish which tumors can safely be left alone is the field's top priority. "We need to know who those people are so they can be spared unnecessary treatment," said Dr. Philip Kantoff, a prostate specialist at the Dana-Farber Cancer Institute in Boston.
It would help to know what causes the disease. It regresses when men are given drugs to block testosterone, yet the incidence of the disease rises as men age, when levels of the male hormone diminish. "We still don't understand it to the degree we do any other cancer," said Dr. Durado Brooks, who heads prostate cancer research for the American Cancer Society.
Two genes have been implicated, and both are linked to inflammation, said Dr. William Nelson of Johns Hopkins University. Chronic inflammation or infection may set the stage, and a carcinogen, like smoking, may finish the job.
Scientists have done elaborate studies on carcinogens, like those generated by cooking meat at high heat. One even examined whether flipping burgers once or multiple times made a difference. The bottom line: Charring meat isn't good.
Diet is emerging as a possible way to prevent the disease. June Chan, a dietitian at the University of California in San Francisco, summarized studies on risk. Bad: diets high in fat, red meat, dairy products and calcium. Good: fish, soy, vegetables like broccoli and Brussels sprouts, and cooked tomato products rich in lycopene. Diet may be especially important in later life; a Harvard study found that most of the benefit of lycopene was in men 70 and older.
Can diet prevent prostate cancer? "The short answer to that is 'probably yes,'" said Dr. Meir Stampfer, chief of epidemiology at Harvard Medical School, where the possible benefit of selenium was first seen in studies in the 1980s. "It's taken 25 years to get a randomized trial off the ground," he complained.
Michael Milken wants to help change the situation. The former Wall Street junk bond king founded the Prostate Cancer Foundation after his diagnosis in 1993. (Page 4)
"There was very little support for prostate cancer research," with the National Cancer Institute spending a mere $37 million, Milken said at the Orlando meeting, which his foundation helped sponsor. A decade later, federal spending had risen to $390 million, but trailed breast cancer's $699 million. The pattern is the same at the American Cancer Society, which made 175 grants totaling $98 million this year for breast cancer, and 63 worth $36 million for prostate.
Milken's foundation says it has raised more than $230 million in roughly a decade and provided funding to more than 1,200 researchers around the world. It's also trying to bring celebrity power to the disease. Bob Dole, Rudy Giuliani, Colin Powell and John Kerry have talked about having prostate cancer, but more voices are needed, said Leslie Michelson, the foundation's CEO.
The National Basketball Association recently started airing "Act Like a Man" commercials to foster awareness. Fortune magazine is donating $750,000 and has made prostate cancer its charity of the year. New York and California have started income tax checkoffs for donations to research.
A more subtle sign is the box that recently landed on Thomas Kirk's desk in Chicago. Inside were hundreds of pale blue wristbands like the yellow Lance Armstrong ones that have become must-haves of fund-raisers and fashion. Kirk said the prostate cancer support group he heads, Us TOO, has learned a lot from Y-ME, the breast cancer group led by his wife, Margaret Kirk. Advocacy "is part of our mission. It's not one of the ones we're strongest in," he admitted.
The prostate foundation also is working on a lapel pin it hopes men will be willing to wear, shaped like a blue necktie instead of a ribbon. "We're starting to beat the drums, to get a voice for this important cause," Michelson said. Source: http://www.wtopnews.com/index.php?nid=106&sid=12020
Recruiting For the New Prostate Cancer Study
The Geminal Study: Can We Affect Prostate Cancer Gene Expression? Dr. Peter Carroll, Chair of Urology at UCSF and Dr. Dean Ornish, president of the non-profit Preventive Medicine Research Institute and Clinical Professor of Medicine at UCSF, recently completed a study demonstrating that diet and lifestyle changes may beneficially affect the progression of prostate cancer. Now, they are beginning two new studies to better understand some of the mechanisms by which this may occur, including if nutritional supplementation or comprehensive lifestyle changes may affect prostate cancer gene expression. In particular, they are studying whether diet and lifestyle changes can “turn on” protective genes and “turn off” harmful ones.
If you are a man who has diagnosed prostate cancer and decided not to undergo conventional treatment with surgery or radiation please contact Dr. Dean Ornish at (800) 775-7674 or Dr Peter Carroll at (415) 885-3673 for more information. In the GEMINAL study, eligible participants will be asked to follow a comprehensive diet and lifestyle change program for 3 months and in the MENS trial eligible participants will use a nutritional supplement for 3 months. In both studies, participants will undergo testing at UCSF. Participation in the study is free. Your willingness to participate in this study may help the scientific community answer this question and make a meaningful difference in the search for a cure for prostate cancer.
Participants in the study must meet the following criteria: * Biopsy-proven prostate cancer, a PSA less than 10, and a Gleason Score of 6 * No history of conventional treatment such as surgery or radiation * Willingness to follow a healthy lifestyle program for 3 months * Live in the greater Bay Area We will be recruiting for this study between December 2004 – July 2005. If you are interested, please contact us at 1 (800) 775-7674, extension 290
Hormonal treatment improves survival in high-risk prostate cancer patients
01 Apr 2005 - Administering hormonal treatment in addition to radiation therapy in patients with high-risk prostate cancer can improve survival rate, according to a new study published in the April 1, 2005, issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of ASTRO, the American Society for Therapeutic Radiology and Oncology.
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The study, conducted between1987 and 1992, separated 977 patients into two groups: the adjuvant arm and the observation arm. Those in the adjuvant arm received radiation therapy and goserelin acetatc, a type of hormonal agent. The patients in the observation arm received radiation therapy only. Goserelin acetatc was administered only if they experienced a relapse.
As of July 2003, the median follow-up for all patients was 7.6 years and for surviving patients, 11 years. At ten years, the overall survival rate was significantly higher for the adjuvant arm than the observation arm - 49 percent to 39 percent, respectively. The local failure rate at ten years for the adjuvant arm was 23 percent and 38 percent for the observation arm and the ten year rates for cancer metastasizing to other parts of the body were 24 percent for the adjuvant patients versus 399 percent for the observation patients. Finally, the prostate cancer-related death rate was 16 percent for adjuvant and 22 percent for the observation arm.
"The results of the study firmly establish the role of adjuvant hormonal management in high-risk carcinoma of the prostate treated with definitive radiotherapy," said Miljenko V. Pilepich, M.D., a radiation oncologist at the University of California, Los Angeles and lead author of the study.
For more information on radiation therapy for prostate cancer, please visit astro.org/patient/treatment_information for a free brochure.
For a copy of the study "Androgen Suppression Adjuvant to Definitive Radiotherapy in Prostate Carcinoma - Long-term Results of Phase III RTOG 85-31," please contact Nick Lashinsky at nickl@astro.org or 1-800-962-7876.
ASTRO is the largest radiation oncology society in the world, with more than 8,000 members who specialize in treating patients with radiation therapies. As a leading organization in radiation oncology, biology and physics, the Society is dedicated to the advancement of the practice of radiation oncology by promoting excellence in patient care, providing opportunities for educational and professional development, promoting research and disseminating research results and representing radiation oncology in a rapidly evolving socioeconomic healthcare environment. Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=22094#
DO YOU HAVE A NEWS ITEM TO CONTRIBUTE?
We want to hear from you! Members of the support group are welcome to contribute any items of interest to the group at large. Updates on your status, news about prostate cancer treatments, or anything you feel would be of interest to the group are all welcome. Contact Howard Waage, 688-0423 with your story.
Heads Up For Our Special Event Speaker for The May 31st Meeting:
Topic: “Getting Back to Intimacy After Prostate Cancer Treatment", and it's specifically about sexual intimacy.
Our Speaker: Maren Martin is a Licensed Clinical Social Worker with a psychotherapy practice in Pacific Grove as well as a Certified Sex Therapist and specializes in sex and couple therapy. She has a special interest in helping cancer survivors have emotional intimacy and fulfilling sexual relationships.
Location: Katz Cancer Resource Center at Dominican Hospital. Date and Time: May 31st – 7:00 P.M.
The Santa Cruz County Prostate Cancer Support Group does not endorse any provider, organization, product or individual. All medical decisions should be made with the advice and consultation of medical professionals.
Many THANKS to the American Cancer Society for assisting with the printing and mailing of this newsletter and the Katz Cancer Resource Center for allowing us to use their facility. (page 6)
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