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.

Joe Ferrara 426-7724
Frank and Janet Schmetz 438 4781
Bill McDermott 423-8350
Howard Waage 688-0423 Michael & Julie Batz 724-2701
Tim Ryan 476-6550

...PROSTATE CANCER IN THE NEWS...

Men and their partners speak out on prostate cancer treatments
Summarized by Susan Aldridge, PhD, medical journalist - April 25, 2008

Summary: In a multi-center study, researchers looked at factors that impact health-related quality of life after treatment for prostate cancer for both men and their partners. These included urinary, bowel and sexual problems and issues, such as 'vitality', which have previously been neglected. These factors profoundly influence patient and partner satisfaction with treatment.

Introduction: Prostate cancer can be treated by surgery, brachytherapy (placement of 'seeds' to delivery radiotherapy), external radiotherapy, hormone therapy or 'watchful waiting'. Each approach has an impact on quality of life. For instance, surgery can cause bowel, urinary and sexual problems. But 'watchful waiting' can cause stress and anxiety because nothing 'active' is being done about the cancer. While the physical side effects of surgery for prostate cancer are well established, less is known of how newer treatments, such as brachytherapy, impact health-related quality of life and, therefore, satisfaction with the outcome Nor is much known about the views and feelings of partners and spouses of those surviving prostate cancer. In a new wide-ranging study, researchers from nine hospitals across the United States, led by a team at Beth Israel Deaconess Medical Center, surveyed various issues related to prostate cancer treatments to see how they affected satisfaction with the outcome.

What was done: A group of 1201 patients and 625 partners or spouses were assessed before and after radical prostatectomy, brachytherapy or external-beam radiotherapy. Some patients also had adjuvant hormonal therapy. They were questioned about various health-related quality of life issues, including sexual function, urinary incontinence, urinary function, bowel function, vitality, fatigue, depression and weight change.

What was found: Different treatment choices were linked to specific problems with health-related quality of life. For instance, nerve-sparing procedures in prostatectomy led to a better recovery of sexual quality of life compared to standard surgery. Radiotherapy with hormonal therapy was linked to poorer recovery of sexual function than radiotherapy alone. Older age, larger prostate and higher pre-treatment prostate specific antigen (PSA) score were all linked to worse sexual function after treatment. Partners also reported distress when the patient had a sexual problem after treatment. --- Urinary incontinence was worse with older age, black race and high PSA, but prostatectomy could also improve urinary obstruction or irritation. Brachytherapy produced some urinary problems, especially when the prostate was large. Both brachytherapy and radiotherapy also reduced quality of life through impairing bowel function, while prostatectomy did not, on the whole. Hormonal therapy worsened the patient's vitality through leading to hot flashes and depression and these symptoms sometimes persisted after cessation of treatment.

Despite the inconvenience and distress caused by such symptoms, a patient and his partner could still feel the treatment had been worthwhile, if his life had been saved. Accordingly, the researchers asked how these quality of life changes affected satisfaction with overall treatment outcome. They learned that, in descending order, symptoms linked to sexual function, vitality, and urinary function were directly linked to patient satisfaction, or lack thereof. Diminished sexual function was linked to lack of satisfaction on the side of the partner. Black men were significantly less satisfied with their treatment outcome compared to men from other racial backgrounds.

What this means: The researchers note that each kind of treatment for prostate cancer has its own pattern of side effects which affects health-related quality of life. Hormonal therapy leads to long-lasting symptoms and its use in low or intermediate risk cases should perhaps be questioned. Nerve-sparing techniques appear to offer benefit in terms of preserving sexual function, with corresponding improvement in satisfaction with treatment for both patient and partner. It is not clear why the black patients were less satisfied with their treatment, because their care settings were not dissimilar to those of the other patients. Further study is needed to see if there were differences in expectation or some undetected difference in quality of care. The findings should help guide doctors and patients in selecting the treatment options for their cancer, preparing them for what to expect in terms of quality of life outcomes.

Source: Quality of life and satisfaction with outcome among prostate cancer survivors. MG. Sanda, RL. Dunn, et al, New England Journal of Medicine, March 20, 2008, vol. 358, pp. 1250-61 http://www.healthandage.com

What You Need to Know About the Risk Factors for Prostate Cancer

In this excerpt from a recent issue of The Johns Hopkins Prostate Bulletin, Dr. Jacek Mostwin discusses what you need to know about five of the important risk factors for prostate cancer.

Ferndale, WA (PRWEB) April 30, 2008 -- As with all cancers, there are many theories as to what might cause prostate cancer. Based on the research thus far, we can be fairly certain that age, race, and family history are important risk factors for prostate cancer. Diet and lifestyle factors may also influence whether a man develops the disease.

Thus far, no clear association has been found between the development of prostate cancer and smoking; vasectomy; the presence of benign prostatic hyperplasia (BPH); or regular alcohol intake (although binge drinking may increase the risk). Increasing evidence suggests that fat intake, physical inactivity, or being overweight may influence the development or progression of prostate cancer.

AGE: As a man ages, his risk of developing prostate cancer increases dramatically. This age-related increase is greater for prostate cancer than for any other type of cancer. The average age at the time of diagnosis is between 65 and 70, and the average age of death is between 77 and 80.

RACE: The incidence of prostate cancer in the United States varies by race. The rate for white men is 101 per 100,000 each year. Black men are at higher risk (137 per 100,000), and Asian Americans are at the lowest risk (20 to 47 per 100,000).

FAMILY HISTORY: Studies of identical and fraternal twins show that prostate cancer has a stronger hereditary component than many other cancers, including breast and colon cancer. Having one first-degree relative (a brother or father) with prostate cancer doubles the risk of developing the disease; having a second-degree relative (an uncle or grandfather) with prostate cancer confers only a small increase in risk. A number of genetic mutations are linked to prostate cancer. The best studied of these mutations are in a region of chromosome 1 known as HPC1. HPC1 may be involved in protecting against prostate inflammation. Some analyses have suggested that mutations in HPC1 increase the risk of prostate cancer, but other studies have failed to find an association. Other genes involved in how the body handles male hormones (androgens), its reaction to inflammation or infection, and its ability to process certain types of fat may also be important. Although genes can influence a man's risk of developing prostate cancer, other factors are also at work. The likelihood that identical twins (who share all genetic information) will both develop prostate cancer is 19% to 27%. This suggests that lifestyle choices can modify the effects of the genetic cards that a person is dealt at birth.

ENVIRONMENTAL FACTORS: Much effort has been devoted to searching for environmental factors that might serve as promoters for prostate cancer. The incidence of microscopic prostate cancer (cancers too small to be seen except under a microscope) is similar among men in the United States and in all other countries that have been examined. However, the mortality rates from prostate cancer differ widely from one country to another and even within different regions of the United States. These differences suggest that environmental factors (such as diet, lifestyle, or exposure to certain substances or forces) can influence prostate cancer's progression from microscopic tumors to clinically significant ones.

DIETARY FAT: Most studies examining the relationship between dietary fat and prostate cancer have found that a higher fat intake (especially animal fat) is associated with an increased incidence of prostate cancer. Fat makes up 30% to 40% of the calories in the American diet, compared with 15% in Japan. This difference in fat consumption may help explain the much lower death rate from prostate cancer in Japan, as well as the great variability in prostate cancer mortality rates around the world. It is also possible that people who consume large amounts of high-fat foods are less likely to eat healthful foods that may protect against cancer.

While one can't control age, race and family history, men who fall into the high-risk categories might want to consider making PSA testing a regular part of their usual health check-ups. And for those who fall into the high-risk bracket, they may wish to consider limiting their dietary fat and looking at their overall lifestyle to help prevent prostate cancer. The Johns Hopkins Prostate Bulletin is a quarterly publication bringing the latest news on prostate health direct to readers via Priority Mail. It covers prostate cancer, BPH (enlarged prostate), prostatitis, overactive bladder, erectile dysfunction, and other prostate health issues. For more information, please see The Johns Hopkins Prostate Bulletin The Johns Hopkins White Paper: Prostate Disorders 2008 is our annual review of the latest research and findings on prostate cancer, BPH (enlarged prostate), prostatitis, and erectile dysfunction which can be found at: Source: http://www.johnshopkinshealthalerts.com/alerts_index/prostate_disorders/25-1.html

05 June 2008, BERKELEY, CA (UroToday.com) - Dr. Allen and a large group of European investigators report their data evaluating intake of protein and the risk of developing prostate cancer (CaP). In the online version of the British Journal of Cancer, they cite other studies that implicate a possible link. Their study used the European Prospective Investigation into Cancer and Nutrition database to study the relationship between diet, lifestyle, environmental factors and cancer. Dietary intake data was obtained by questionnaire and cancer data from cancer registries. Cox regression was used for analysis and separate analyses were conducted for localized and advanced disease, and also for low-grade and high-grade cancer.

A total of 2,722 men were diagnosed with CaP from a total of 142,520 participants at an average of 8.7 years of follow-up. The median age at diagnosis was 66 years. Protein intake was derived from meat in 32%, cereals in 18%, cheese in 9%, and milk in 7%. Dietary calcium was largely from dairy products (53%). There was a strong correlation between dairy protein and dairy calcium intake. There was no association between meat, fish or eggs and risk of CaP. Dairy products and yoghurt had an increased risk (HR1.17 for the highest vs. lowest fifth of intake). A similar risk was found for total dietary calcium intake and calcium intake from dairy foods. Calcium from non-dairy foods was not associated with CaP risk. An increment of 35g/day of dairy protein was associated with an HR of 1.32. No statistical difference was found for localized vs. advanced disease but there was an association for high-grade CaP (HR1.76).

PubMed Abstract PMID: 18382426 Source: UroToday.com Prostate Cancer Section

Hormone Therapy in Prostate Cancer and Metabolic Risk for Atherosclerosis

Department of Internal Medicine (S.S.), Harbor Hospital of Baltimore, Baltimore, Maryland 21225; Consultant Endocrinologist (M.B.-B.), Baltimore, Maryland 21209; and Division of Endocrinology and Metabolism and Oncology (S.B.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21224

Context: Prostate cancer (PCa) is the most common cancer in men. Androgen-deprivation therapy (ADT) (hormone therapy) is generally employed in the treatment of locally advanced and metastatic PCa. Although its use as an adjuvant therapy has resulted in improved survival in some patients, ADT has negative consequences. Complications like osteoporosis, sexual dysfunction, gynecomastia, and adverse body composition are well known. Recently, metabolic complications like insulin resistance, diabetes, dyslipidemia, and metabolic syndrome have emerged, which may be responsible for the increased cardiovascular mortality in this population.

Evidence Acquisition: A MEDLINE search was conducted for articles published over the last 20 yr based on the key words androgen deprivation therapy AND insulin resistance, hyperglycemia, diabetes, dyslipidemia, metabolic syndrome, and cardiovascular disease. Relevant studies in non-PCa populations evaluating the association between testosterone and metabolism were also reviewed and briefly mentioned where relevant.

Evidence Synthesis: Prospective studies evaluating early (3Ð6 months) metabolic changes of ADT show development of hyperinsulinemia; however, glucose levels remain normal. Cross-sectional studies of men undergoing long-term (³12 months) ADT reveal higher prevalence of diabetes and metabolic syndrome compared with controls. Furthermore, men undergoing ADT also experience higher cardiovascular mortality.

Conclusion: Long-term prospective studies of ADT are needed to determine the timing of onset of these metabolic complications and to investigate the mechanism behind them. In the meantime, we recommend baseline and serial screening for fasting glucose, lipids, and other cardiovascular risk factors in men receiving ADT. Glucose tolerance tests and cardiac evaluation may be required in selected cases.

SOURCE: http://jcem.endojournals.org/cgi/content/abstract/93/6/2042

Silent Risk Of Osteoporosis In Men With Prostate Cancer

ScienceDaily- Men being treated for prostate cancer using hormone therapy maybe under-recognized for their risk of developing osteoporosis, according to a new study. Researchers writing in a peer-reviewed journal of the American Cancer Society, say few patients get tested for osteoporosis during treatment. Moreover, even men with other risk factors for osteoporosis, such as smoking or receiving the hormone treatment for a long time, are still unlikely to receive prevention or treatment. It is caused by dysregulation of the hormone-regulated bone remodeling system that leads to a loss of bone mineral density. Risk factors for male osteoporosis include age-associated hormone changes, alcoholism, smoking, some medications, including those used in the treatment of prostate cancer.

Osteoporosis can be prevented and even treated using a wide range of therapies. Common prevention measures include calcium and vitamin D supplements, regular exercise. Screening test such as the dual-energy X-ray absorptiometry (DXA) scan is also available. Treatment strategies include bisphosphonates, which have been shown to prevent further bone loss, but it is inconvenient, sometimes expensive, and may cause serious side effects. To find out how clinicians were managing osteoporosis risk in the U.S. in year 2003 and identify factors that might predict who gets treated, Tawee Tanvetyanon, M.D. from Loyola University Chicago Stritch School of Medicine reviewed the sampled records of 184 prostate cancer patients who received androgen deprivation therapy (ADT), which is known to raise the risk of osteoporosis.

Dr. Tanvetyanon found that "the majority of patients undergoing ADT did not receive osteoporosis prevention or treatment," even when they reported other risk factors, as well. Only about one in seven (14.7 percent) eligible patients received any sort of osteoporosis management. Fewer than one in ten (8.7 percent) received at least one DXA scan within three years, and only one in twenty (4.9 percent) was prescribed a bisphosphonate. The only factor that predicted clinical management of osteoporosis risk and disease was the presence of bony metastases (prostate cancers that had spread to the bones). Analysis also showed that primary care physicians were the most aggressive at managing osteoporosis while cancer specialists were the least.

Source: http://www.sciencedaily.com/releases/2004/12/041220023615.htm

We have started the Silicon Valley Advanced Prostate Cancer Support Group. We currently have 9 members and have been meeting monthly since March. We meet the 1st Thursday of each month (except July and January due to holidays) from 5:30 to 6:45 PM, in Meeting Room D/E of the Cafeteria Conference Center of El Camino Hospital, 2500 Grant Road, Mountain View, CA 94040. Call or email me if you'd like more information. Please let members of the Santa Cruz Prostate Cancer Support Group know. You can contace Walt at: 650-961-4875 or whda@aol.com

Fair Use Notice: This newsletter may contain copyrighted material whose use has not been specifically authorized by the copyright owners. We believe that this not-for-profit, educational use constitutes a fair use of the copyrighted material (as provided for in section 107 of the US Copyright Law). If you wish to use any copyrighted material for purposes of your own that go beyond fair use, you must obtain permission from the copyright owner.

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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 250 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.