KELOWNA PROSTATE CANCER SUPPORT & AWARENESS GROUP NEWSLETTER

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1 KELOWNA PROSTATE CANCER SUPPORT & AWARENESS GROUP NEWSLETTER OKANAGAN PROSTATE RESOURCE CENTRE SOCIETY Okanagan Prostate Resource Centre To make an Appointment Call CCS Cancer Information Line Publisher/Editor Bren Witt VOLUME 14 - ISSUE 14 - (NUMBER 170) - JANUARY 2012 Happy New Year The Kelowna Prostate Cancer Support & Awareness group held their regular December meeting on December 10th. We had some general discussion followed by a great deal of fellowship. We had a few new fellows this meeting, we were extremely happy to see them out and look forward to seeing these fellows at future meetings. On behalf of my wife Yvonne we would like to wish everyone a Very Happy New Year and extend our Best Wishes to everyone for

2 Kudo's for Clinical Trials - The following is from The Manitoba Prostate Cancer Newsletter and is a reprint from an article in the book "Why Millions Survive Cancer" by Lauren Pecorino T he testing of new drugs must be carried out in stages. Knowledge about the genetics or physiology of a cancer identifies a target and chemicals that can attack the target are identified/produced and tested. The usual route is that a potential drug demonstrates an effect on a cancer cell line (cancer cells grown in the laboratory) or in an animal tumor model before being tested in humans in clinical trials. Phase 1 - Clinical trials examine drug dose and drug safety using a small number (20-80) of healthy volunteers or patients. Phase 2 - Clinical trials test how well the drug works in a larger group ( ) of people. Phase 3 - clinical trials are large scale studies (1,000-3,000) people that further examine drug efficiency, side-effects and effectiveness compared to currently used treatments. Only about 16% of drugs tested are successful in moving from Phase 1 to approval. This process is long and expensive but it strives to ensure safety for the public. The individuals who volunteer to enter clinical trials are heroes because they may be sacrificing their health for the good of future generations. Editor's Note: Both the Sindi Hawkins Cancer Centre in Kelowna and the Southern Interior Medical Research Inc. also located in Kelowna are involved in clinical trials studies. These trial studies are generally phase 3 studies. Prostate Cancer Hormone Therapy (Androgen Deprivation Therapy) - An Overview - The following appeared in The Manitoba Prostate Cancer Newsletter - The source of this article was Cancer Research UK. Editor's Note: I have made some changes in the original article in order to reflect the Drugs used in Canada. What Hormones Are - H ormones are natural substances made by glands in our bodies. The network of glands that make hormones is called the endocrine system. Hormones are carried in our bloodstream and act as messengers between one part of our body and another. They control the growth and activity of certain cells and organs. What hormone Therapy Is - Some cancers use these hormones to grow. Hormone therapy for cancer is the use of drugs to block the effects of hormones. Not all cancers respond to hormone therapy. Doctors use hormone therapy for people with cancers that are hormone sensitive or hormone 2

3 dependent. Cancers that can be hormone sensitive include breast cancer, prostate cancer, womb cancer and kidney cancer. How Hormone Therapy Works - Cancers that are hormone sensitive or hormone dependent need hormones to grow. So stopping the hormone reaching the cancer cells may either slow down or stop the growth of the cancer. hormone therapies can work by either Stopping hormones being made Preventing the hormone from reaching the cancer cell Prostate Cancer Hormone Therapy - Prostate cancer depends on the male hormone testosterone for its growth. Hormone therapy aims to reduce or stop the body making testosterone and slowing down or stop the growth of the cancer. There are different types of hormone therapy, including luteinizing hormone releasing hormone (LHRH) Analogs or blockers and anti androgens. Luteinizing Hormone Releasing Hormone (LHRH) Analogs - A gland in the brain, called the pituitary gland, controls the amount of testosterone made by the testicles. LHRH analogs are drugs that act on the pituitary gland and prevent the testicles making testosterone. You may also hear these drugs being referred to as Gonadotrophin Releasing Hormone (GnRH) blockers. GnRH is another name for LHRH. LHRH Analogs for prostate cancer include Goserelin L.A. (Zoladex), Leuprolide Depot (Lupron) and Leuprolide Acetate (Eligard). LHRH analogues cause a temporary increase in testosterone production Testosterone Flare) and therefore may cause a temporary increase in tumor size that can last for one to two weeks before testosterone levels fall to very low levels. Very often men are prescribed an anti androgen drug to help combat this flare in testosterone. Anti Androgen - Prostate cancer cells have areas called receptors. Testosterone attaches to these receptors and that can encourage the cells to divide so that the cancer grows. Anti Androgen drugs work by attaching themselves to these receptors so that they stop testosterone from reaching prostate cancer cells. There are a few different Anti Androgens used in Canada they include Bicalutamide (Casodex), Flutamide, Megestrol (Megace) and Nilutamide (Nilandron). General Side Effects of Hormone Therapy for Men - Tiredness Erectile Dysfunction Loss of Libido (or decreased or absent sexual desire) Hot flushes and Sweating Breast Tenderness Pain from Tumor flare Weight Gain Memory Problems Mood Swings and Depression Changes in Bone Density Risk of Earlier heart Attack Other General Side Effects Tiredness - You may feel more tired when you are taking hormonal therapy. 3

4 Erectile Dysfunction (Problems in getting an Erection) & Loss of Libido (Decreased or Absent Sexual Desire) Difficulty getting an erection (Erectile Dysfunction used to be called impotence is a common side effect of hormone therapy for prostate cancer. This is because the drugs stop you producing testosterone. It may be possible for you to have an erection again once the treatments stop. This can take 3 months to a year, or even longer. For some men, erection problems are permanent. It depends on the drug you are on and how long you have been taking it. Another problem associated with Hormone therapy is also the Loss of Libido which is the decreased or absence of sexual desire. You physicians will be able to offer you more advice. Hot Flashes and Sweating - Hot flashes and sweating can be troublesome. They are the same as the hot flushes women friends and relatives may have had when going through menopause. The flushes are caused by your testosterone levels dropping. They may gradually get better as you get used to the treatment. Hot flushes are most likely to happen when men are on the LHRH analogue drugs because these drugs cut off testosterone production altogether. Getting overheated, drinking tea or coffee, and smoking can all make flushes worse. Unfortunately, in some men the flushes keep on happening as long as you take the drug. if you are having problems coping with the sweating, please discuss this with you physician as there may be some drugs that may help. Breast Tenderness - Breast tenderness is a particular problem with high dose bicalutamide (Casodex). The breast tissue can become painful and swollen. Taking the drug tamoxifen can help to reduce breast tenderness in about 6 out of 10 men taking Casodex. Or sometimes it can help to have a small dose of radiotherapy to the breasts before your hormone treatment starts. Editor's Note: The above recommendations are from the UK please check with your local physicians for their recommendations. Pain from Tumor Flare - Pain caused by a secondary prostate cancer can temporarily worsen when you start hormone treatment and this is called tumor flare. Your doctor should always prescribe another hormone therapy when you start on Lupron or Zoladex injections to help prevent tumor flare causing bone pain. If the pain carries on, your doctor can prescribe drugs called bisphosphonates to treat it. Weight Gain - You may put on weight. You should be able to control this with diet and exercise, but it is often a struggle to keep your weight down when you are having hormone therapy. Memory problems - Some men feel that their memory gets worse after they have been on hormone treatment for a while. Your memory may not improve while you are taking the hormone treatment, but there are ways to make life easier, such as making lists so you don't forget things. It is 4

5 natural to feel cheated and upset if you have this particular side effect. Talk to your doctor if you feel this is having a significant effect on your life. Mood Swings and Depression - Hormone therapy can affect your mood. Some men say they have mood swings and even depression while having treatment such as Zoladex. Talking with someone close to you may help. If you don't feel comfortable sharing your feelings with people you know, seeing a counselor may help. Bone Changes - Men taking hormone therapy for prostate cancer are at risk of bone thinning (Osteoporosis). There is evidence that the risk of problems, such as bone fractures, is slightly higher for men having long term treatment to block testosterone. Your doctor may suggest taking vitamin D or calcium to help lower your risk of problems from osteoporosis. Other advice is to stop smoking, reduce the amount of alcohol you drink and take regular weight bearing exercise, such as walking. Risk of Earlier Heart Attack - There is some evidence that if you are over 65, and at risk of dying from a heart attack, this is more likely to happen sooner if you have been taking hormone therapy for 6 months. This may be because some of the side effects of hormone therapy, such as weight gain, can make heart disease worse. Editor's Note: The above information is for information purposes only. Please always consult with you Doctor about all your concerns and questions related to your personal health. WIT'S WIT (ON THE LIGHTER SIDE) - Black Testicles A male patient was lying in bed in the hospital, wearing and oxygen mask over his mouth and nose, still heavily sedated from a difficult four hour surgical procedure. A young student nurse appears to give him a partial sponge bath. 'Nurse', he mumbles, from behind the mask, 'Are my testicles black?' Embarrassed, the young nurse replies, 'I don't know, sir. I'm only here to wash your upper body.' He struggles again, 'Nurse are my testicles black?' Concerned that he may elevate his vitals from worrying about his testicles, she overcomes her embarrassment and sheepishly pulls back the covers. She raises his gown, holds his penis in one hand and his testicles in the other, lifting and moving them around and around gently. Then, she takes a close look and says, 'No sir, they aren't and I assure you there's nothing wrong with them, sir!!' 5

6 The man pulls off his oxygen mask, smiles at her and says very slowly, 'Thank you very much. That was wonderful, but listen very, very closely... Are-my-test-results-back?' B.C. MLA Seeks to Establish Prostate Screening Program - The following is an excerpt of an article that was published in the Georgia Straight on Dec. 20, A ndrew Gordon was 59 years old when he had surgery for prostate cancer. Now 65, he says that he's living a very normal life. Part of that is helping other men through a support group of the nonprofit Prostate Centre. Gordon can't imagine what would have happened if he didn't have a PSA test when he was 50. From then on, his condition was monitored until surgical treatment became necessary. "I only know that I had a cancer detected." Unlike in most of the other provinces, PSA screening isn't free in B.C. It is only covered when it is considered diagnostic, meaning when one has symptoms of prostate cancer and the doctor call for this blood test. Because It's not covered by the Medical Services Plan, many men don't consider it important to have the test, according to Gordon. It costs around $25. "It sends a message that it is a less valued screening tool than the other kinds of screening tools that are available for free," Gordon said. Women don't pay for the Pap. smear for cervical cancer. MSP also covers mammograms to detect breast cancer for women between the ages of 40 and 79. For Surrey-Green Timbers MLA Sue Hammell, having a free PSA - screening program is smart policy because deaths can be prevented through early detection. Her private member's bill seeks to establish a prostate cancer screening program for men between the ages of 40 and 70 The BC NDP's deputy health critic has a deep personal connection to prostate cancer. Her 69-year-old husband, John is a survivor. Her 48-year-old stepson, James Pollard, is fighting an aggressive form of this cancer. "My bill is saying there is a test, and because we charge for it, many men don't take advantage of it," Hammell told the Straight in a phone interview. "And although there is a digital rectal exam, it is not a hundred percent effective and neither is the PSA test. But when you combine things and you have active surveillance, if there's any sign of prostate cancer, it's more likely that we'll be on top of it if we use effectively these two tools. Hammell first filed her bill in 2010 to no avail. She did so again in It was given first reading in the legislature on November 23. 6

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