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 18 - (NUMBER 174) - JUNE 2012 Our guest presenter for out May Kelowna Prostate Cancer Support Group Meeting was Dr. Joshua Wiesenthal M.D., FRCPC. Dr. Wiesenthal began his urology practice in Kelowna in September of last year. He is originally from Toronto and completed his Urology residency in Ottawa, Ont. and also completed a two year research and clinical fellowship at St. Michael's Hospital in Toronto where he specialized in minimally invasive (keyhole) surgery, kidney transplantation-surgery, and minimally-invasive kidney stone surgery. Dr. Wiesenthal's presentation to our support group was on Androgen Deprivation Therapy (ADT) [hormone therapy]. He went into the history of ADT and mentioned that Prostate Cancer is the most common solid-organ cancer in men. Contemporary 5-year relative survival rate for men with all stages of prostate cancer combined is estimated to be 98.8%. Because of such high rates of cancer-specific survival, the consideration of treatment-related toxicity assumes major significance. 1

2 Dr. Wiesenthal also mentioned that more than 30% of men with prostate cancer die of cardiovascular disease, which constitutes the most common cause of mortality in this patient population. ADT is used increasingly, however, substantial side effects can occur with this treatment. Historical Overview of ADT - In 1947 Dr. Huggins a Canadian Born Physician and Researcher stated - In many cases a malignant prostatic tumour is an overgrowth of adult epithelial cells... All known types of adult prostatic epithelium undergo atrophy when androgen hormones are greatly reduced in amount... Therefore, significant improvements should occur in the clinical condition of patients with far advanced prostate cancer subjected to castration. Dr. Huggins was the first physician/researcher dealing with Urology to receive the Nobel Prize for Medicine. He received this honor in Another prostate cancer researcher Dr. Schally also received the Nobel Prize for Medicine in 1971 for work in the isolation of LHRH (Luteinizing Hormone Releasing Hormone) In 1941 Dr. Huggins together with Dr. Hodges found that 18/21 patients with locally advanced prostate cancer improved with surgical castration. Four forms of ADT - 1) - Ablation of Androgen Sources Scrotal/simple orchiectomy 2) - Inhibition of Androgen Synthesis Aminoglutethimide Ketoconazole 3) - Antiandrogens Cyproterone acetate (Androcur) Flutamide (Eulexin) Biclutamide (Casodex) Nilutamide 4) - Inhibition of LHRH or LH LHRH agonists LHRH antagonists Dr. Bolla in 1997 established the use of androgen deprivation in combination with external beam radiotherapy for high risk prostate cancer. Dr. Messing in 1999 demonstrated improvement in survival with the earlier use of hormone therapy in men with node positive prostate cancer. There has been a dramatic increase in the use of ADT from 1989 to 2001 using the CaPSURE database. primary ADT increased from 4.6% in low risk group to 14.2% - from 8.9% in medium risk group to 19.7% - and from 32.8% to 48.2% in the high risk group. Neoadjuvant ADT increased from 2.9% to 7.8% with Radical Retropubic Prostatectomy - and from 9.8% to 74.6% with External Beam Radiotherapy. Conservative estimates indicate that in 2001 Medicare spent in excess of $1 Billion on ADT. This is the second highest drug expenditure. 2

3 Dr. Wiesenthal then went into many of the side effects associated with ADT - Sexual dysfunction Hot flashes Fatigue Anemia Neurophysiologic effects (reduced mood, cognition) Loss of muscle mass Increased fat mass Increased insulin resistance and incident diabetes Increased cardiovascular risk factors Osteoporosis and bone fractures Cardiac compromise? The most common, immediate side effect that is experienced by about 80% of patients on ADT is Hot Flashes. 27% of patients on ADT reported that Hot Flashes were the most bothersome side effect and they can start within weeks of initiation of ADT and can continue for at least 3 months after cessation of ADT. Some of the triggers for Hot Flashes may include: Overheating, spicy foods, alcohol, and smoking. He mentioned several possible drugs that may help with the Hot Flashes but he felt the best was mg daily. in trial 4weeks 84% of men on depo-provera found their Hot Flashes decreased, and there were no serious drug related side effects over 12 weeks. Dr. Wiesenthal then spent time on Osteoporosis, why it can happen and the treatment for osteoporosis, he then mentioned Anemia and the treatments for Anemia, he then mentioned several other side effects of ADT including Reduced Mood and Cognition, the loss of Muscle Mass and Fat Mass, Sexual Dysfunction, Cardiovascular risk factors and the possibility of Cardiac compromise. Dr. Wiesenthal's presentation was extremely well received by the over 70 people in attendance including several who were attending this meeting for their first time. Dr. Wiesenthal has indicated that he wants to come back in the Fall and give us a presentation on Minimally Invasive Surgery. The Canadian Cancer Society Cancer Statistics A bout a month ago the Canadian Cancer Society (CCS) published their annual Cancer Statistics predictions on their website. This year Prostate Cancer is again going to be not only the number one diagnosed cancer among men but also the number one diagnosed cancer nationwide, except for non-melanoma skin cancers. In their latest statistics it is predicted that this year we will see and estimated 26,500 new cases of prostate cancer diagnosed in Canada, last year it was an estimated 25,500 and in 2010 it was estimated to be 24,600 new cases. The next highest number of estimated Cancer cases nationwide is expected to be Lung Cancer with an estimated 25,600 new cases, however, Lung Cancer affects both genders whereas Prostate Cancer only affects men. 3

4 Looking at this information the CCS is estimating that 3,700 of these new cases of prostate cancer this year will be in men from B.C., this is up from an estimated 3,400 last year. The Canadian Cancer Society also predicts that approximately 4,000 men will die from their disease this year. The death rate from prostate cancer seems to be remaining fairly stable and possibly even decreasing slightly, however, the incidence rate of Prostate Cancer continues to climb significantly every year. WITT'S WIT (ON THE LIGHTER SIDE) - The Shoebox A man and a woman had been married for more than 60 years. They had shared everything. They had talked about everything. They had kept no secrets from each other except that the little old woman had a shoe box in the top of her closet that she had cautioned her husband never to open or ask her about. For all these years, he had never thought about the box, but one day the little old woman got very sick and the doctor said she would not recover. In trying to sort out their affairs, the little old man took down the shoe box and took it to his wife's bedside. She agreed that it was time that he should know what was in the box. When he opened it, he found two crocheted dolls and a stack of money totally $95,000. He asked her about the contents. 'When we were married,' she said, 'my grandmother told me a secret to happy marriage was never to argue. She told me that if I ever got angry with you I should keep quiet and crochet a doll.' The little old man was moved; he had to fight back tears. Only two precious dolls were in the box.. She had only been angry with him two times in all those years of living and loving... He almost burst with happiness. 'Honey,' he said, 'that explains the two dolls but what about all of this money? where did it come from?' 'Oh,' she said, 'that's the money I made from selling the dolls.' 4

5 U.S. Preventative Services Task Force (USPSTF) Recommendations Re: PSA - The following is an article written by Thomas Kirk President & CEO of Us TOO International in response to the recent recommendations put out by the USPSTF. R ecently this group of physicians came out against the use of PSA testing in the early detection of prostate cancer. As suspected this group gave PSA testing a "D" grade. In other words, they recommended against the service and that there is moderate or high certainty the service has no net benefit or that the harms outweigh the benefits. Like many people and organizations, Us TOO international is deeply disappointed with this recommendation and has joined with the Prostate Cancer Roundtable to express our concern in a joint press release. I believe a "D" grade from the USPSTF will discourage men and their doctors from even beginning a conversation about individual risk of prostate cancer or whether PSA screening may be right for them. We know that certain categories of men are at increased risk of developing prostate cancer - including African American men, men with a family history, veterans exposed to Agent Orange and men with and above-average baseline PSA in their 40's - and the USPSTF does not address the benefits of PSA screening for men in these groups. It's also important to remember that prostate cancer just doesn't affect men - the disease can have a serious impact on their partners, families and even on society. Research from the National Cancer institute has shown that as much as 70 percent of the drop in prostate cancer deaths since 1975 can be attributed to PSA screening. And research based on data from Sweden and Denmark, published in the Journal of Clinical Oncology and elsewhere, shows that even a single PSA test given between the ages of 44 to 50 can help predict the future diagnosis of prostate cancer. It is about education, informed decision making, and selfempowerment. While the PSA test is not perfect, it is the best we have at our disposal right now. Now more than ever, in this period of confusing messages as the media reports surface, we along with the other member organizations of the Prostate Cancer Roundtable encourage men to continue to have educated discussions with their healthcare providers about whether PSA testing is right for them. What can you do? Take action to educated yourself and speak up to educate others. Use your passion on this issue in a constructive manner to reach out to help others determine what step is best for them. I, like many, believe that every individual has a right to know if he has cancer and to make and informed decision about what is best for him. I also believe no one wants to be overtreated or undertreated. We are here to help others work through such decisions - that is what Us Too is all about. we say, "Someone to talk to who understands..." 5

6 Some Info. from Johns Hopkins The following is some information recently received from Johns Hopkins Medicine - D id you know that having sex within 72 hours of your PSA test can produce a false reading. Did you know that more than 50 percent of men over the age of 50 and 80 percent of those over 80 will experience some benign prostatic hyperplasia (BPH) [the enlargement of the prostate gland] related symptoms. The early detection of prostate cancer is a KEY factor in treating the disease successfully. A Simple Test - True or False? - Prostate cancer has a stronger hereditary component than breast or colon cancer. True or False? - Lifestyle choices may be able to modify the effects of the genetic cards you are dealt a birth. True or False? - Deaths from prostate cancer can vary from region to region in the U.S. True or False? - The most reliable way to detect prostate cancer in its early stages is to combine digital rectal exams with PSA testing. True or False? - Doctors believe that the overall PSA level may be less important than the rate at which the PSA level rises. I hope all those reading this newsletter are well informed - the correct answer to each of the above questions is True. Each of these questions is taken from the 2012 Johns Hopkins Prostate Disorders White Paper. Please NOTE there will be no Newsletter published for July and August the next issue will be published in September. Also Please NOTE there will be NO Support Group Meetings in July and August next meeting Sept. 8th. Yvonne and I hope everyone has a great summer. See you in September. The Kelowna Prostate Cancer Support & Awareness Group does not recommend treatment modalities or physicians: However, all information is fully shared and kept confidential. The information contained in this newsletter is not intended to replace the services of your health professionals. You are advised to consult with your health professionals regarding matters of your personal health. The Kelowna Prostate Cancer Support & Awareness Group would like to thank Janssen - manufacturer of Zytiga (Abiraterone) for their support in producing this newsletter. 6

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