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Serving all of  SANTA CRUZ COUNTY

Santa Cruz  PROSTATE CANCER SUPPORT GROUP

August 2005                                           NEWSLETTER

                                                                                                                                                        Howard Waage  (688-0423) -----Editor

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  When:    Tuesday evening, August 30th starting at 7:00 p.m.

                   (The August 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 Santa Cruz

                    Dominican Hospital. We 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   Julie Batz 724-2701     Lynn Dreeszen 439-8632     Tim Ryan 476-6550

Our website: http://www.scprostate.org Doug Thornton  724-6446 (Webmaster)

A Heads Up for our Upcoming Meetings !!!!

Heidi Faivre, M.P.H., R.D., dietitian from Dominican Hospital staff,has agreed to present a talk to us at our OCTOBER meeting 10/25/05 7:00 p.m.

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        Maren Martin has agreed to to return to speak to our group on JANUARY 31, 2006!

The subject will be "intimacy" especially as it relates to prostate cancer

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.

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SANTA CRUZ COUNTY PROSTATE CANCER SUPPORT GROUP SUB-GROUP FOR MEN WITH ADVANCED PROSTATE CANCER MEETINGS.

This group will be for men that have been diagnosed with prostate cancer which has spread outside the prostate or who have experienced a recurrence after primary treatment. Typically, these men are receiving hormone blockade, are participating in a clinical trial or are receiving some other form of advanced treatment.

The sub-Group will meet every TWO months at the Katz Cancer Resource Center of Dominican Hospital. The sub-group will meet on the SECOND MONDAY OF THE MONTH with the next meeting on August 8th, from 5:00 to 7:00 PM. The following meeting will be on MONDAY, October10th at the same times.

The purpose of this group will be to better address the special problems and issues of men with advanced prostate cancer. In addition, at some meetings, we will invite local medical oncologists to discuss their approach and treatments

Men with advanced prostate cancer will continue to be welcomed at the regular monthly meetings on the last Tuesday of the month. Tony Calvo has agreed to coordinate the sub-group. If you have any suggestions or questions, contact Tony at 684-0940.

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….PROSTATE CANCER IN THE NEWS..…

How To Deal With Prostate Cancer

By: Steve Kichen, 07/27/05 www.forbes.com

First bit of advice: Do not panic. Prostate cancer is a nasty disease, but it is far more treatable and manageable than many other afflictions, and it doesn't spread as aggressively as many other forms of cancer. Regular screening is important: If caught early, the chances of getting cured are high and the risk of recurrence is low.

Many options are available, and there isn't one ideal solution. Every treatment has its pros and cons. Surgery is generally accepted as the best way to eliminate the cancer, but it isn't foolproof. Some doctors won't operate if the disease has spread outside the capsule of the prostate and into lymph glands, bones or other tissues.

Second tip: Do your homework. Speak with several doctors, search the Web and talk with other patients. Weigh all the factors—your age, aggressiveness of the cancer, overall health, your work schedule and what body functions, specifically continence and potency, you are willing to put at risk. You'll know when you've found the course of action that offers the best trade-offs for you.

A support structure is also important. Have your significant other(s) join you on doctor visits and lab tests and help you search for options. If you opt for robotic surgery, you will be quickly back on your feet. But that doesn't mean that you will immediately have the energy or ability to handle all of your daily needs. Short of going through the actual surgery, my wife, Ina, was with me every step of the way. I don't know if I could have done it without her.

Don't be a prisoner to statistics. Every patient is different. For example, if you opt for surgery your doctor may promise you that you will be continent in a few weeks. But it may take more time. Keep in mind that doctors often try to present the brightest scenario. And why not? It is better to believe that you are going to get better in two or three weeks rather than two or three months. Doctors promoting the most promising statistics for their previous patients may have been cherry-picking and treating mostly young, otherwise healthy prostate patients.

If you opt for surgery—particularly robotic—try to find a doctor who is experienced with this procedure. This form of surgery is generating a lot of excitement, but there's a learning curve for doctors. The ideal surgeon has performed at least 50 robotic procedures and has had experience with conventional prostate surgery. In rare cases, complications with the laparoscopic route make it necessary to switch over to conventional surgery. So don't be afraid to interview several doctors.

Last tip: Stay in shape and watch your diet. There is evidence that a diet low in animal fats but rich in foods like soy proteins, tomato sauce and antioxidants such as those found in citrus fruits and green tea, can help stem the spread of the disease.  Source: http://www.forbes.com/2005/07/26/surgery-prostate-health-cz_sk_0727surgery2_print

Prostate Cancer: PSA Change May Be Key to Risk

By Daniel J. DeNoon

July 27, 2005 - What's the risk of dying when prostate cancer comes back after treatment? Two new studies point to who's at high risk and who isn't. A crucial difference, the two new studies suggest, is how fast blood levels of prostate-specific antigen (PSA) go up.

Anthony V. D'Amico, MD, PhD, chief of genitourinary radiation oncology at Brigham and Women's Hospital and Dana-Farber Cancer Institute, led a study of 358 men who underwent radiation therapy. His team looked at whether prediagnosis changes in PSA predicted a man's risk of dying from prostate cancer. The findings confirmed the results of an earlier study of men who underwent prostate surgery. "The best use of PSA is not to look at the number but to look at the trend over time," D'Amico tells WebMD.

Stephen J. Freedland, MD, clinical instructor in urology at Johns Hopkins University, led a team that gathered data on 379 men who underwent prostate surgery but had their cancer come back. "These studies show that looking at changes in PSA are more important than a single value," Freedland tells WebMD. "One PSA result is like looking at a snapshot of a horse race and trying to determine who will win. Looking at snapshots over time gives you a better idea."

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Both studies appear in the July 27 issue of The Journal of the American Medical Association.

PSA Velocity….PSA is a chemical marker on the outside of prostate cells. As prostate cancer cells increase in number, blood PSA levels rise. But PSA levels in and of themselves aren't a reliable indicator of cancer. Blood levels of PSA go up for other reasons besides cancer. And very deadly prostate cancers can occur even at low PSA levels.

"There has been controversy over what is the best use of PSA as a screening tool and what is the best use of the test as a tool to guide treatment," D'Amico says.

Instead of simply testing once for PSA and deciding that it is "high" or "normal," D'Amico says it appears to be more useful to test at regular intervals. This gives a reading on PSA change — what doctors call PSA velocity. "Our study shows that men who experience a two-point rise in PSA in the year preceding a diagnosis of prostate cancer — despite a low level of PSA and despite a biopsy showing a supposedly 'favorable' prostate cancer — have more aggressive cancer and need more aggressive treatment to cure it."

Men whose PSA levels rose more than two points in a year had a 12-fold higher risk of dying from prostate cancer than men whose PSA levels rose less quickly. "The median survival for rapid risers is only six years, and that is very short for prostate cancer," D'Amico says. "The bottom line for patients is this: Get a PSA test annually and know the result. Because even if your doctor isn't looking at year-to-year change, at least you can. We recommend getting a baseline PSA test at age 35, especially for men whose dads had prostate cancer."

Zeroing In on Prostate Cancer Death Risk…..Many men elect to have their prostate glands removed when they are diagnosed with prostate cancer. With no prostate, their PSA levels should drop to zero. But within 10 years of surgery, more than a third of these men eventually have PSA appear in their blood.

Where does the PSA come from? Prostate cancer cells that have begun to grow again. But that's not always bad news. These recurrent cancers often grow very slowly.

"The nice thing is that a PSA test can identify cancer recurrence years before we would detect it clinically," Freedland says. "But then, it is hard to figure out who has aggressive cancer and who doesn't." After looking at hundreds of cases, Freedland's team came up with three things that predict which men are likely to have problems: — How quickly the PSA became detectable after surgery. Men whose PSA came back more than three years after surgery did better than those whose PSA came back in three years or less.   Source: http://www.foxnews.com/story/0,2933,163835,00.html

No specific PSA value predicts clinically significant prostate cancer

……Some significant tumors occur at low PSA levels, some higher PSAs arise from non-cancerous conditions or non-lethal tumors.  No specific PSA value has both high sensitivity and high specificity for monitoring healthy men for prostate cancer, according to a new study, but rather there is a continuum of prostate cancer risk at all values of PSA.

July 5, 2005. One of the most common cancer screening activities in the United States is the measurement of prostate-specific antigen (PSA) levels for the early detection of prostate cancer.  In 2001, approximately 75 percent of men in the United States aged 50 years and older reported that they had previously undergone PSA screening and 54 percent have reported regular PSA screening.

In general, prostate biopsy has not been recommended unless PSA levels exceed a threshold value, generally 4.0 ng/mL, with slightly lower values recommended recently by some researchers. Prostate cancer screening with PSA has been controversial, as no studies have proven that this strategy reduces death from prostate cancer.

Now, according to a study in the July 6 issue of JAMA. evidence suggests that there is no specific PSA value that has both high sensitivity and high specificity for monitoring healthy men for prostate cancer, but rather there is a continuum of prostate cancer risk at all values of PSA.

Ian M. Thompson, M.D., of the University of Texas Health Science Center at San Antonio, and colleagues conducted a study to determine the effectiveness of PSA testing by estimating the receiver operating characteristic (ROC) curve (a

measure of diagnostic accuracy) for PSA. The researchers analyzed data from 18,882 healthy men aged 55 years or older without prostate cancer and with PSA levels less than or equal to 3.0 ng/mL and normal digital rectal

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examination results, followed up for 7 years with annual PSA measurement and digital rectal examination. These data

came from the Prostate Cancer Prevention Trial, a randomized, prospective study conducted from 1993 to 2003 at 221 U.S. centers. If PSA level exceeded 4.0 ng/mL or rectal examination result was abnormal, a prostate biopsy was recommended. After 7 years of study participation, an end-of-study prostate biopsy was recommended in all cancer-free men.

For this analysis, the authors included 8,575 men in the placebo group of the trial who had at least 1 PSA measurement and digital rectal exam in the same year. Of these men, 5,587 (65.2 percent) had at least 1 biopsy, and of these, 1,225 (21.9 percent) were diagnosed with prostate cancer.

The researchers found that for detecting any prostate cancer, PSA cutoff values of 1.1, 2.1, 3.1, and 4.1 ng/mL yielded sensitivities of 83.4 percent, 52.6 percent, 32.2 percent, and 20.5 percent, and specificities of 38.9 percent, 72.5 percent, 86.7 percent, and 93.8 percent, respectively. "A clear-cut decision rule for prostate biopsy based on PSA values would be challenging to derive from these data," the study teams says.

"On one hand, the commonly used cutoff value of 4.1 ng/mL would have a 6.2 percent false-positive rate (1-specificity) but would detect only 20.5 percent of cancer cases (sensitivity). To improve cancer detection, the cutoff could be lowered to 1.1 ng/mL, thus detecting 83.4 percent of cancer cases, but would subject 61.1 percent of men without cancer to prostate biopsy. The recently recommended cutoff of 2.6 ng/mL would detect only 40.5 percent of cancer cases. … there is no single cutoff that would simultaneously yield both high sensitivity and high specificity,” the authors write.

“The delay in diagnosis of high-grade tumors until PSA levels exceed current threshold '‘normal' values could also explain why there is a 35 percent risk of subsequent treatment after radical prostatectomy, presumably due to disease recurrence. However, lowering the threshold would have 2 consequences: increased biopsy rates and the possibility of increased detection and treatment of biologically inconsequential cancers. Currently, men in the United States have a 17.3 percent lifetime risk of prostate cancer diagnosis, while the lifetime risk of prostate cancer death is 3 percent," the researchers write.

"The implications of this analysis are substantial. Prior to clinical use of biomarkers or other tests for cancer screening, properly designed validation studies are essential. A multi-step process for validation is currently used by the Early Detection Research Network of the National Cancer Institute. While prostate cancer is not unique, it has a variable natural history, ranging from markedly aggressive to indolent. Consideration should be given to the development of biomarkers that incorporate disease prognosis. Finally, it will be a challenge to the medical community to change the long-held notion that there is a '‘normal' PSA level. Patients and health care professionals must be re-educated that there is a continuum of risk and no clearly defined PSA cutpoint at which to recommend biopsy. It will be the patient, in concert with his health care professional, who will ultimately have to weigh the sensitivity-specificity tradeoffs in combination with the uncertain natural history of the disease to determine whether further evaluation with a prostate biopsy is appropriate," the authors conclude. (JAMA. 2005;294:66-70 http://www.jamamedia.org)

This study was supported in part by Public Health Service grants from the National Cancer Institute.

Source: http://www.psa-rising.com/med/psa/psa_accuracy.html

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.

Our newsletter serves over 200 members. 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.

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