PROSTATE MATTERS SOUTH P rospect PROSTATE CANCER SUPPORT GROUP PCaSO Somerset Prostate Support Association NEDPSA North & East Devon Prostate Support Ass. DORSET PSA Prostate Cancer Network CORNWALL PROSTATE SUPPORT ASSOCIATION ( CPSA) A partnership between prostate support groups in the southern region sharing news, views and information about prostate issues. ISSUE 3 NOV 2007 Over 3000 circulation Contents Page 2 Can Changing Your Life style help Treat PCa. Dealing with Side Effects. Use It or Lose It Page 3 Know Your Surgeon and Understand Your Risks. Higher PSA readings in Summer may lead to more Biopsies Page 4 Prostate Cancer Screening Page 5 continued from p.4 Page 6 Clinical Trial - Vital 2 Report on PCR UK вЂ�ABCвЂ™ Page 7 New Pathology Factor may help Treatment Decisions New treatment Prostatitis Page 8 Meetings & Events around the region PMS Editor: Roger Bacon Contact: 0845 479 7625 email: editor@prostatematters-uk.org PMS is published 4 times a year February - May - August - November Help Lines PCaSO - 0845 650 2555 Somerset PSA - 01460 62935 Torbay PSA - 01803 843806 Dorset PSA - 0845 601 0766 NED PSA - 01392 277295 Prospect - 01373 813060 Cornwall PSA - 01872 253143 Macmillan Cancer Trust agree to sponsor PMS for the next four issues The Trust formed in 1974, evolved from the fund-raising committee for the Macmillan Unit at Christchurch, Dorset. This was the first Unit in the country and a joint venture with the NHS and a Charity. The aim of the Trust is to support those who are suffering from cancer and also provide help and support for the whole family. The Trust act as custodian for funds donated towards care of the patients and their families and it both initiates and responds to a wide variety of needs primarily supporting the Macmillan Unit at Christchurch but also Cancer services at both Bournemouth and Poole Hospitals and the Dorset Cancer Network. The patient support groups that make up Prostate Matters South are delighted that Macmillan Cancer Trust has agreed to sponsor our joint newsletter and would like members to support the trust in whatever way they can. Further information and donations can be made on the website: www.macmillancancertrust.co.uk or write to: The Macmillan Unit, Christchurch Hospital, Christchurch, BH23 2JX. Tel: 01202 477628 Macmillan Cancer Trust sponsors of PMS Newsletter 5 becomes 7 Our southern region partnership has expanded to 7 patient support groups now receiving and circulating this newsletter. Cornwall Prostate Support Association and Prospect Prostate Cancer Support Group from the Bristol area have both joined, so our coverage has expanded. More groups are expected to follow soon. PDF created with pdfFactory Pro trial version www.pdffactory.com Can Changing Your Lifestyle Help Treat Prostate Cancer? Up to 73% of men with prostate cancer take non-prescription supplements, and smaller numbers use diet, exercise, or both in the hope of improving their outcome. Most of these men also receive conventional therapy, but a few depend on lifestyle alone. The appeal of lifestyle therapy is obvious - but does it work? Experts donвЂ™t know, though research raises hope that it may have a beneficial impact, reports the July 2007 issue of Harvard MenвЂ™s Health Watch. All of the 93 men who signed up for the trial had newly diagnosed low to moderate-grade cancers that were localized to the prostate gland. Half were randomly assigned to a lifestyle program, and half got no advice on lifestyle changes. The program that researchers created included four elements: 1) An ultra-low-fat vegan diet; 2) Supplements, including soy, fish oil, vitamins E and C, and selenium; 3) An exercise program of walking 30 minutes six days a week; and 4) Stress reduction that included yoga-based stretching, breathing, and meditation for an hour a day. At the end of a year, a small but significant difference was evident. The average PSA in the intensive lifestyle group fell, whereas the average PSA in the untreated men rose. The participants in the lifestyle group also showed favourable cancer-fighting changes in their blood. Much more research is needed before lifestyle therapy can be recommended clinically. But, the Harvard MenвЂ™s Health Watch notes, men with prostate cancer may choose not to wait until science catches up with their disease. And since the lifestyle program study is good for general health, its elements will make a reasonable addition to any prostate cancer program. A Newswise Medical News article Dealing with Side-Effects Prostatectomy is delicate surgery and often affects the nearby urinary sphincter (which controls urine flow through the urethra) and the nerves that allow men to have erections. As a result, most men experience some form of urinary incontinence and impotence (also known as erectile dysfunction, or ED) after a prostatectomy. Fortunately, post-operative incontinence usually isn't permanent. Most patients regain continence within six to 12 weeks after surgery, some more gradually than others. Some will experience long-term stress incontinence urine leaks when coughing, sneezing or exercising that require men to wear protective pads. Less than one percent suffer from severe incontinence that requires the surgical implanting of an artificial sphincter or urethral sling to control urine flow, Dr. Klein said. Bilateral nerve-sparing prostatectomy, which preserves the nerve bundles on either side of the prostate, has improved rates of ED after surgery. In the best surgical hands, about 75 percent of all patients who undergo this procedure will regain potency within 12 to 14 months after surgery, according to Dr. Klein. Others may regain sexual function with the help of drugs such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). Many urologists recommend using these medications immediately after surgery to promote an early return of erections. Other treatments such as vacuum erection devices and injections of a substance known as prostaglandin E1 directly into the penis may be used if the ED drugs fail to work. A final option is a penile implant, using inflatable devices or silicone rods. Several factors may affect your ability to have an erection after a prostatectomy: your age, medical condition, ability to get an erection before surgery and whether the nerve bundles were damaged. Older men and those with other health problems, such as cardiovascular disease or diabetes, usually have more difficulty regaining potency. "Most patients can expect a return to regular physical activity within a few weeks, regardless of how the surgery's done, and good results with continence and potency," Dr. Klein said. A Medical News Today article, August 2007 Use It or Lose It A new theory about preserving erectile function after prostate surgery Erectile dysfunction after surgery to remove the prostate (radical prostatectomy) has traditionally been attributed to nerve damage that theoretically should heal over time. But it can take as long as two years for the nerves to recover enough for a man to have an erection without the aid of drugs or devices. By that time, other damage may have occurred, according to an article in the latest issue of Perspectives on Prostate Disease. The Harvard Medical School bulletin notes that when the penis is flaccid for long periods of time, it is deprived of a lot of oxygen-rich blood. Recent research suggests that this low oxygen level causes some muscle cells in the penis's erectile tissue to lose their flexibility. The tissue gradually becomes more like scar tissue, interfering with the penis's ability to expand when it's filled with blood. Therefore, the traditional advice given to men -- to wait for erectile function to return on its own -- may not be adequate. Simply put, erections seem to work on a use-itor-lose-it basis. To prevent the secondary damage that may occur if the penis goes too long without erections, researchers now think it's better to restore erectile function soon after prostate removal. Treatment options include using a vacuum pump device or taking erectile dysfunction drugs by mouth or by injection into the penis. According to Dr. Marc Garnick, editor in chief of Perspectives on Prostate Disease and a Harvard oncologist, "Although the evidence supporting this 'penile rehabilitation' isn't perfect, you may want to ask your doctor about the options. Such early intervention may help increase the odds that you will regain erectile function." A Medical News Today article, August 2007, www.medicalnewstoday.com/articles/79162.php 2 PDF created with pdfFactory Pro trial version www.pdffactory.com Know Your Surgeon and Understand Your Risks You've been diagnosed with localized prostate cancer, and after talking with your urologist, you've decided to undergo radical prostatectomy, or surgical removal of the prostate. Now that you've made a treatment choice, more questions remain: Which surgical technique is the best? Will it render me incontinent or impotent? What happens after surgery? However, one question may be the most important, according to a new study involving a Cleveland Clinic researcher: Who will do the surgery? "There's very clear evidence that shows that the experience of the surgeon is the most important factor in determining the likelihood of a cure, the return of continence and the return of potency," said Eric Klein, M.D., head of the Section of Urologic Oncology at Cleveland Clinic's Glickman Urological and Kidney Institute and one of the study's authors, according to the Cleveland Clinic's Men's Health Advisor. "The most important factor is finding the most experienced surgeon you can and querying him or her on their results." When opting for prostatectomy, it's important that you not only know your surgeon's experience, but also understand the risks and side effects of surgery and your long-term outlook. Prostate surgery: Who over how? For years, most urologic surgeons have used standard radical retropubic prostatectomy, an open surgery in which the surgeon removes the prostate through an incision (about five to eight inches long) in the lower abdomen. However, minimally invasive laparoscopic surgery is becoming more popular. In this more challenging operation, the surgeon makes five small incisions and uses a tiny camera and specialized instruments to remove the prostate. In a newer laparoscopic technique, robot-assisted surgery, the surgeon removes the prostate with the help of several robotic arms that mimic his hand movements and allow for more precision. The laparoscopic approach affords the surgeon a magnified view of the prostate. Advantages for the patient include less blood loss, shorter hospital stays and the potential for a faster recovery. However, these advantages may not matter to you as much a year or more after surgery, Dr. Klein said, and he advises his patients to look at the long-term picture. "You're going to care about whether you're cured, whether you're continent and whether you're potent. When you focus on those, the primary factor becomes experience of the surgeon and not the tools that are used to perform the surgery," he said. According to Dr. Klein, the recent study found that patients of surgeons who have performed more than 1,000 prostatectomies are about 10 percent more likely to be cured of their cancer than those whose surgeons have done 250 to 999 of the procedures and 30 percent more likely than those whose surgeons have done fewer than 50. He said preliminary data from another multi-center study in which he participated suggest that men who underwent open surgery had better potency results than those treated with laparoscopic or robotic surgery. "The point it makes to me is there's nothing magical about a laparoscope or a robot," he said. "It's still the surgeon who decides where to cut and where not to cut while doing the surgery." After your surgery If you're like the majority of prostatectomy patients with low or intermediate-risk prostate cancer, you'll receive a favourable pathology report after your surgery and require no additional treatment. You'll follow up with your urologist shortly after surgery and return periodically for blood tests to measure prostate specific antigen (PSA). However, if the pathology report reveals lingering cells that may be cancerous, you may need external-beam radiation therapy or other systemic treatments once you recover from surgery, usually about three to six months later. What You Can Do: вЂў Ask your surgeon about the number of prostatectomies he or she has performed and the results of those procedures. вЂў Have your doctor explain the risks and benefits of prostatectomy and other treatments, such as radioactive seed implants (brachytherapy) and external-beam radiation therapy. вЂў Prostatectomy causes sterility, so if you still hope to father children, talk to your doctor about banking your sperm before surgery. A Medical News Today article, August 2007. A study in the Journal of the National Cancer Institute (USA) comparing the experience of prostate cancer surgeons with their surgical outcome has revealing findings. The findings, taken over 16 years, compared over 7,700 patients treated with a radical prostatectomy by 72 surgeons. The results showed that the risk of recurrence after 5 years of patients treated by surgeons who had performed 10 operations was 17.9%. For those who had completed 250 operations it was 10.7%. There was no significant improvement in surgeons who had done more than 250 prostatectomies. Thus patients treated by inexperienced surgeons were 70% more likely to have recurrence than those treated by the more experienced. It is of concern that, in the UK, the minimum number of prostatectomies required by surgeons is just 5 per year. Higher PSA levels in summer may lead to more biopsies Men who undertake the prostate specific antigen (PSA) test in the summer, are more likely to have a subsequent biopsy than men tested at any other time of the year. A new study, published in European Urology shows that concentrations of PSA are higher in the summer, resulting in a higher likelihood of referral for a biopsy of up to a quarter. вЂ�вЂ™We show that being screened during the summer increased by 23% the likelihood of having a higher PSA than the cut-off value (for biopsy),вЂ™вЂ™ the authors write. вЂ�вЂ™It may be prudent to confirm any isolated test result before biopsy, and even more so if this was obtained in summer.вЂ™вЂ™ They add вЂ�вЂ™The present observation is troubling as it suggests that rigid PSA cut-offs are ill-adapted to routine clinical practice.вЂ™вЂ™ The authors say that measurement of PSA serum concentrations is central to all programmes for the early detection of prostate cancer but that the influence of season on PSA concentrations has been little investigated. They looked at the relation between meteorological data and total PSA testing (which measures nanograms of PSA per millilitre of blood) as well as free PSA testing (which measures the percentage of PSA that is not bound to proteins in the blood) in 8644 men aged 55 to 70 in the French arm of the European randomized study of screening for prostate cancer (ERSPC). Significantly higher PSA concentrations (P=0.001) were found in the summer (total PSA 1.87ng/ml), than in autumn (1.71ng/ml), winter (1.42ng/ ml), or spring (1.38ng/ml). This report was published in the BMJ August 2007 issue. 3 PDF created with pdfFactory Pro trial version www.pdffactory.com Prostate Cancer Screening (part 1) by Dr Louis Denis This article first appeared in the newsletter of the European Oncology Nursing Society and Louis Denis has kindly given permission for it to be published in PMS. The second part will appear in PMS4. Louis Denis is Director of Oncology at the Oncology Centre Antwerp (OCA), Antwerp, Belgium. He is also secretary of Europa Uomo the European Prostate Cancer Coalition of patient support groups One ounce of prevention is worth a pound of treatment remains a popular idea in many cultures. It is certainly true that this statement applies to a number of public health threats such as speed control and seat belts to prevent car accidents, smoking cessation programs, and information on lessening the risk of sexually transmitted diseases such as HIV disease. However, prevention of cancer remains controversial and prevention of prostate cancer even more so. Prostate cancer was somewhat neglected in the previous century for three reasons: it was usually incurable after diagnosis, it was a disease of the elderly, and hormonal treatment brought relief in the great majority of cases. This situation changed drastically with the introduction of Prostate Specific Antigen (PSA), a simple blood test that indicates the risk for having prostate cancer. Simultaneously we saw the development of the biopsy gun, allowing multiple painless biopsies of the prostate gland, and trans-rectal ultrasound (TRUS) offering accurate positioning of the biopsy needle in the different regions of the prostate. A star technique was born resulting in thousands of publications extolling the virtues of this diagnostic procedure. Cancer Screening The enthusiasm for the hypothesis overcame caution and most people forgot that the U.S. Food and Drug administration took one year to approve the use of PSA in diagnosing progressive disease but needed five years to approve PSA as a diagnostic marker for prostate cancer. No heed was taken to the complex reality that screening results in over detection, increases false positive and false negative results, and can lead to over treatment. A classic case is the neuroblastoma screening in 1996 in Japan with a five-fold increase in incidence, surgery and identical mortality (1). We all know the difficult course in judging the advantages of breast cancer screening in women over 50 and the debate in screening from the age of 40. TRANSBIG, the international translational research network linked to the Breast International Group (BIG), makes it clear that it aims to develop individualized breast cancer treatment and reduce over treatment in breast cancer estimated to range from 10 to 20% of cases (2). Recent results of a failed lung cancer screening test received media interest. In this case, a CT scan detected lung cancer 144 times in 3.246 people. More than 300% of the expected cases and a 1000% increase in surgery resulted from this trial ending up with the same mortality rate achieved without screening (3). Table 1: Principles of screening for cancer в™¦ The disease should be an important health problem в™¦ The disease should have a detectable preclinical phase в™¦ The natural history of the lesions identified by screening should be known в™¦ There should be an effective treatment for such lesions в™¦ The screening test should be acceptable and safe (Adapted from AB Miller, 1996) The public health experts and epidemiologists recognised the danger of simplistic thinking and described the principles of screening which were condensed to five points by Anthony Miller in 1996 (see Table 1). The use of correct definitions is important: screening is the systematic examination of asymptomatic men to detect and hope to cure localised disease in a given population. Screening is not intended to fit the need of the individual patient. Here it is more appropriate to use case finding, cancer testing or early diagnosis. To be blunt you donвЂ™t need to be Einstein to use a test that finds more cancer and if you treat all cancers you will save lives. The question is how many lives are saved and at what price of human suffering and health costs? Currently, one needs to operate on 17 to 22 men to save one life leaving half of those treated impotent and a fourth of those patients incontinent (4) which leaves the benefit of such procedures in doubt. Europa Uomo, the European coalition against prostate cancer, believes that quality of life is of utmost importance and that the indication for curative treatment which is aggressive should be limited to younger patients with potentially fatal disease вЂ“ in reality, only a fraction of the total number of men diagnosed with prostate cancer. The Miller Principles applied to Prostate Cancer An important health problem Prostate cancer is the leading cancer in males (20.3%) in Europe. This figure may be influenced by the frequency of use of the PSA test which had a similar effect as mammograms did in breast cancer. Still the number of deaths has risen 16% since 1995 due to the rapid increase in the number of men reaching older age. The figures for incidence (new cases/year) of 237,800, mortality rates of 85,200, and the prevalence of cancer of 2 million men in the EU makes prostate cancer management a priority in public health (5). A Detectable Preclinical Phase Prostate Cancer is characterized by a long (10 to 20 years) sub-clinical stage. Considered as one of the strong arguments for screening, the long sub-clinical 4 PDF created with pdfFactory Pro trial version www.pdffactory.com stage is also an argument to avoid diagnosing prostate cancer without symptoms in men with a life expectancy limited to 10 years. Indeed after the first diagnosis it takes another 10 to 15 years to die of the disease. With a mean life expectancy of + 77 years in the EU it would seem reasonable from a screening point of view to not screen men over age 70. Table 2: Prostate specific problems among Dutch prostate cancer survivors and an age matched norm population in percentages The establishment of PSA > 4 ng/ml as the cut-off risk factor (now considered outdated) prompted a tsunami of biopsies resulting in increased incidence. The detection of smaller tumours including indolent cancers, led to a significant shift in the stage of cancer detected and a lower mean age of patients at the time of diagnosis (6). In simple words, PSA directed biopsies anticipate the clinical diagnosis by 10 years and the majority of patients in the PSA era present with earlier stages and few with metastatic disease. (Adapted from TF Mols, 2007) However, 50% of patients do not need immediate treatment, 30% will probably never need treatment and 25% of those that we treat have locally advanced disease (7). The natural history of identified cancers The facts look easy to understand. Prostate cancer starts at age 30 and half of all men have some type of precancerous lesion (prostate intraepithelial neoplasia - PIN) or microscopic cancer that can only be identified by a meticulous histologic examination on autopsy or surgical specimen by the age of 50. The percentage of these minicancers increases with age. At age 80, a man has an 80% chance of having a microscopic cancer. These histologic cancers are called latent since they donвЂ™t seem to act like cancer. However some of these cancers controlled by our body defences do grow very slowly and given enough time can be detected usually at a size of 0,5 cc in up to 30% of men by age 60 in the western world. Only one third of these (10% of men in the western world) develop prostate cancer with symptoms. After a long disease course, metastasis is detected after 7 to 10 years and 2% to 4% of patients die of their cancers after 10 to 15 years. The detectable number of cancer by biopsy is variable in different parts of the world: there is much less cancer in Asiatic countries and much more in AfricanAmericans which raises the question of genetic determination and/or lifestyle as a possible contributing factor of cancer. These figures show that most small cancers remain latent and that screening must lead to over detection and possibly over treatment. There is no guarantee that these mini cancers will never become aggressive over the remaining years of a lifetime. Generally speaking, a relaxed policy is indicated over the age of 65 but extra caution advised in the age range of 50 to 65. It is understandable that this point of uncertainty can be used pro or against screening practice and lies at the base of a continuing controversy between public health experts and clinicians. в™¦ Incontinence urine в™¦ Incontinence bowel в™¦ Erectile dysfunction Treated Norm 23 - 48% 4% 5 - 14% 2% 40 - 74% 18% There should be an effective treatment There is no doubt that surgery, radiation (external or internal) and other forms of treatment by cold (cryosurgery) or by heat (high focused ultrasound) can destroy the prostate and all cancer limited to the gland. The preferred treatment policy of the last century was seek and destroy. Based on our increased knowledge and experience we now aim treatment to focus and control. Approximately 50% of screen-detected cancers do not need treatment meaning patients could be saved from the side-effects of obliterating the prostate. Treatment side effects are decreasing through improvements in technique both in surgery and radiation therapy but they remain substantial if one observes the reported side effects in a study of 964 patients alive 5 to 10 years after primary treatment based on UCLA-EPIC and SAC questionnaires (Table 2) (8). The screening test should be acceptable and safe There is no dispute that the serum PSA test, used to indicate the risk of having prostate cancer, is acceptable to the patient and safe to perform. It was readily accepted by the medical profession and is now a widespread test used routinely in aging men. However, the PSA is not specific for prostate cancer but for prostate diseases which then produces increasing numbers of false positive and false negative test results causing anxiety for the patients or a false sense of security. The development of a number of derivatives to increase the positive predictive value (PPV) shows that PSA testing is not very reliable (in the clinical accepted ranges from 4 to 10 ng/ml). Free screening with PSA is unreliable as laboratory blood analysis must be performed within 2 to 3 hours of drawing blood samples. More reliable are repeated tests over time to evaluate the kinetics of PSA. References (1) Welch HG (2004): Should I be tested for Cancer? Maybe not and here's why. (2) Straehle C et al: Transbig - Tailored Treatment for Breast Cancer, Poster 4th UICC world Cancer Conference for Cancer Organisations, Dublin вЂ“ Ireland, November 17-19, 2004. (3) International Herald Tribune: CT scan for lung cancer is called risky, March 4, 2007 (4) SchrГ¶der F, Albertsen P: The Motion: There is Evidence That Prostate Cancer Screening Does More Good than Harm, European Urology 50: 377-380, 2006. (5) Boyle P et al: Estimates of the cancer incidence and mortality in Europe in 2006, Ann Oncol 18: 581-592, 2007. (6) Aus G et al: Prostate Cancer Screening Decreases the Absolute Risk of Being Diagnosed with Advanced Prostate Cancer - Results from a Prospective, Population-Based Randomized Controlled Trial, European Urology 51: 659-664, 2007. (7) Roehl KA et al: Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3.478 consecutive patients: long-term results, J Urol 172: 910-914, 2004. (8) Mols TF: Psychical and psychological well-being among long-term cancer survivors, Universiteit Tilburg, 2007. The 2nd part of this article on Prostate Cancer Screening will be in Feb 08 issue 5 PDF created with pdfFactory Pro trial version www.pdffactory.com Clinical Trial VITAL 2 Phase III Randomised Study to compare Docetaxel in combination with GVAX verses Docetaxel and Prednisone Vaccine Development Cell GenesysвЂ™ GVAX vaccine for prostate cancer is designed to stimulate a systemic anti-tumour immune response against the patientвЂ™s prostate cancer. It has two components, PC-3 and LNCaP cells, which are administered at the same time. Each has a prostate carcinoma cell line that has been genetically modified to secrete GM-CSF, a hormone that activates the immune system to recognise, target and destroy the prostate cancer cells that persist or recur following hormone therapy. The vaccine is injected into the skin. Eligibility Criteria Males greater than 18 years of age who: в™¦ Have a confirmed diagnosis of or clinical history consistent with adenocarcinoma of the prostate. в™¦ Have metastatic prostate cancer deemed to be unresponsive or refractory to hormone therapy (after discontinuation of anti-androgen therapy). в™¦ Are taking any level 3 pain medication or level 2 pain medications for cancer-related pain. в™¦ Have NOT had taxane chemotherapy Aiming to recruit 600 patients Study Arms Patients will be treated for approximately 27 weeks. Arm 1: this group receives docetaxel + GVAX vaccine every 21 days for up to 10 study vaccinations. Arm 2: this group receives docetaxel and prednisone every 21 days for up to 10 treatments. In both arms docetaxel is administered intravenously on first day of each 21-day cycle. Locations / Contacts Royal Marsden, Sutton - Ruth Woode-Amissah 0208 661 3070 Mt Vernon, Middlesex - Jessica Milner 01923 844534 Royal Surrey, Guildford - Hardev Pandha 0208 725 0811 Also - Cambridge > Leeds > Scunthorpe > Preston Nottingham > London www.clinicaltrials.gov/ct/show/NCT00133224?order=17 Prostate Research Campaign UK вЂњABC of Prostate DiseasesвЂќ Masterclass held at Southampton Rose Bowl on 5th October 2007 Prostate Research Campaign UK have run successful вЂњABCsвЂќ elsewhere in the country over the past two years, and this was the seventh вЂњspecialist master-classвЂќ aimed primarily at Practice Nurses and GPs, the aim being to focus on the first point of call for patients, and to provide excellent up-to-date information on Prostate Diseases. A GP may typically have 4 or 5 prostate patients, and some GPs may have had their training some time ago, so a вЂњrefresherвЂќ is very useful. Over 100 attended from Hampshire, Sussex, Dorset, Isle of Wight, Wiltshire, Somerset, and Surrey. There was roughly a 50% split between GPs and Nurses. PCaSO was a major sponsor for the event, providing 50% of the cost. As a patient led awareness group, this provided excellent publicity. Each delegate pack included PCaSO and PMS newsletters, information booklets, awareness leaflets, and a PCaSO pen, along with various leaflets from Prostate Research Campaign. Along with PRC, Astra-Zeneca and sonofi-aventis Oncology, PCaSO also had an impressive display stand. The conference opened with a joint introduction by Brig. John Anderson, Chief Executive of PRC UK and Sandy Tyndale-Biscoe, chairman of PCaSO. The quality of the speakers at the event was first class. Bill Dunsmuir, consultant urologist at Ashford and St. Peters Hospital, Chertsey, gave an excellent detailed presentation on how the prostate and PSA inter-relate, and gave a summary of the three main diseases and their symptoms. Prof. Roger Kirby, Professor of Urology and Director of Postgraduate Education at St. Georges Hospital, London. has personally undertaken more than 1000 radical prostatectomies, including 50 with the da Vinci robot. Having talked about the advantages of the new PCA3 test, his main presentation showed in live close-up detail, the process of a robotically assisted prostatectomy, with the use of the 3D camera. Heather Payne, consultant in Clinical Oncology at the Middlesex Hospital, gave a presentation on the treatment of both locally advanced and advanced prostate cancer, outlining the methods of radiotherapy, and discussing hormone and chemotherapy treatments. Dr Brian Wells, a consultant psychiatrist and himself a prostate cancer sufferer, spoke of the problems and support needed for patients and their families when faced with a diagnosis. Ted Clucas, a prostate patient and also a trustee of PRC UK, outlined his вЂњjourneyвЂќ as a patient, speaking frankly about his experiences of diagnosis and treatment. Prostate Research Campaign UK are planning four вЂ�ABCsвЂ™ next year, including two in the west at Plymouth and Cardiff. Support groups in that area would be well advised to get involved. 6 PDF created with pdfFactory Pro trial version www.pdffactory.com New Pathology Factor may help Treatment Decisions Deciding on the appropriate treatment decision is a very difficult time for men newly diagnosed with prostate cancer. They are worried that if they make the wrong decision that the cancer will progress. Analysis of a new factor as part of the Gleason score may help men and their doctors decide if they need more aggressive treatment. US News& World Report has an article that discusses a new report in the Journal of the American Medical Association. (JAMA). They say: вЂњThe less it looks like normal tissue, the more aggressive [the cancer] is,вЂќ Patel explained. They then add up the two numbers to arrive at a Gleason score. A score of 7 calls for treatment such as radiation therapy, Patel said, while higher scores indicate an even more dangerous tumour. In the new study, the Brigham and WomenвЂ™s team looked for a third pattern of disorder from another part of the samples. Such disorderly patterns are found in about 5 percent of cases but usually are ignored. disorderly third pattern. In fact, the failure time for men with a Gleason score of 7 and the third pattern of disorderly cells was the same as for men whose cancers had a Gleason score of 8 or greater. Design, Setting, and Patients From 1989 to 2005, 2370 men with clinical tumour category 1c to 3b, node-negative, and non-metastatic prostate cancer underwent definitive therapy with surgery or radiation therapy with or without hormonal therapy. A pathologist with expertise in genitourinary cancers assigned Gleason scores to the prostate needle biopsy specimens. Cox regression was used to assess whether a significant association existed between the presence of tertiary grade 5 in men with Gleason score 7 disease and time to recurrence compared with men with Gleason score 7 without tertiary grade 5, Gleason score 5 to 6, or 8 to 10 disease, adjusting for known prognostic factors and treatment. The results and conclusions from the JAMA abstract are: GRADING OF PROSTATE CANCER When a biopsy confirms the presence of cancer, the next step, called grading, is to determine how aggressive the cancer is. The most common cancer grading scale runs from 1 to 5, with 1 being the least aggressive form (tissue cells look normal). Known as the Gleason scores, these numbers (which refer to the appearance and activity of cancer cells) may be helpful in determining which treatment option is best. The Gleason score adds the grades of the two most prevalent patterns of cells. Therefore, scores may range from 2 (non-aggressive cancer) to 10 (very aggressive cancer). The eventual spread of the tumour is dependent on the aggressive nature of the prostate cancer cells. The time to what physicians call вЂњPSA failureвЂќ averaged five years in these men, compared to 6.7 years in men with a Gleason score of 7 but no Results. Men with Gleason score 7 and tertiary grade 5 disease had a significantly shorter time to PSA failure than men with 7 without tertiary grade 5 (median time, 5.0 vs 6.7 years, respectivel) or score of 6 or less (median time, 15.4 years). However, a significant difference was not observed when these men were compared with men with Gleason score 8 to 10 disease (median time, 5.1 years). Conclusion. In this study population, men with prostate cancer having biopsy Gleason score 7 and tertiary grade 5 had a higher risk of PSA-failure when compared with men with Gleason score 7 without tertiary grade 5 and had a comparable risk with men with Gleason score 8 to 10. Ref: PSA Failure Following Definitive Treatment of Prostate Cancer Having Biopsy Gleason Score 7 With Tertiary Grade 5 Abhijit A. Patel, MD, PhD; Ming-Hui Chen, PhD; Andrew A. Renshaw, MD; Anthony V. DвЂ™Amico, MD, PhD New Treatment for Prostatitis Prostatitis is a condition most men rarely discuss because of its embarrassing symptoms. Sufferers often have urinary frequency, genital pain and cannot sit without increasing their pain. Sexual activity usually makes the pain worse. Prostatitis is the only one of the big three prostate diseases вЂ“ prostate cancer and BPH are the others вЂ“ that strikes men at their sexual peak. It is poorly understood and often unsuccessfully treated. A new treatment for prostatitis has been developed at Stanford University Urology Department. Rather than treating it as a disease of the prostate gland, the Stanford treatment focuses on relaxing chronic tension and releasing spasm in the pelvic muscles. The Stanford treatment pioneers a self-administered physical therapy done inside and outside the pelvic floor. It identifies over 60 trigger points inside and outside the pelvis that can refer pelvic pain and symptoms. The protocol simultaneously trains patients in a specific method to relax the pelvic floor and to modify the tendency to tighten the pelvis under stress. The researchers report a high level of symptom relief, when the muscles of the pelvis become soft and relaxed through a self-administered physical therapy. More details can be found at: www.pelvicpainhelp.com This article was taken with permission, from the Newsletter of the Prostate Research Campaign UK, Issue No.30 7 PDF created with pdfFactory Pro trial version www.pdffactory.com PROSTATE MATTERS SOUTH Southern Region Meetings & Events 2007 19th Nov - Cornwall PSA meeting at Knowledge Spa, Room G01, Royal Cornwall Hospital, Treliske, Truro, 7pm. www.tpsa.org.uk 24th Nov - Somerset PSA meeting & AGM at the Albemarle Centre, Taunton, 10.30 to 12.30pm. Two or three men will share their personal stories & a urology nurse will accept questions NEDPSA North & East Devon Prostate Support Ass. 27th Nov - PCaSO Basingstoke group meeting, ARK Centre, North Hants Hospital, 6.30pm 28th Nov - Dorset PSA meeting, Merley Community Hall, Harrier Drive, www.nedpsa.org.uk Somerset Prostate Support Association Merley, Wimborne, 7.30pm 4th Dec - Torbay PSA Christmas Lunch, Dainton Golf Club, 12 noon 12th Dec - PCaSO Southampton group meeting, TauntonвЂ™s College, Southampton, 6.30pm. Speaker - Dr Christian Ottensmeier will talk on вЂ�Update on Prostate Cancer ResearchвЂ™ www.somersetprostatecancer.org.uk DORSET PSA www.prostatecancersupport.info 2008 10th Jan - PCaSO Regional meeting, Ferneham Hall, Fareham, 2pm. Three or four men will share their personal stories and talk about their experiences. 16th Jan - Prospect meeting, BAWA Centre, Southmead Road, Bristol 7.30pm Speaker is Paula Bond, Macmillan Cancer Support Development Co-ordinator for South West PCaSO Prostate Cancer Network 21st Jan - Cornwall PSA meeting at Knowledge Spa, Room G01, Royal Cornwall Hospital, Treliske, Truro, 7pm. 23rd Jan - Dorset PSA meeting, Merley Community Hall, Harrier Drive, Merley, Wimborne, 7.30pm www.pcaso.com 24th Jan - NEDPSA meeting, ISCA Centre, Summer Lane, Whipton, Exeter, 10 to 12.30pm. CORNWALL PROSTATE SUPPORT ASSOCIATION (CPSA) 29th Jan - PCaSO Basingstoke group meeting, ARK Centre, North Hants Hospital, 6.30pm 24th or 31st Jan - Torbay PSA meeting at Livermead House Hotel, Torbay Sea Front, 10am. Speaker will be a leading Consultant Urologist from Torbay Hospital. P rospect PROSTATE CANCER SUPPORT GROUP 6th Feb - PCaSO Southampton group meeting, TauntonвЂ™s College, Southampton, 6.30pm. 18th Feb - Cornwall PSA - meeting at Knowledge Spa, Room G01, www.prostatecancer-help.org.uk Royal Cornwall Hospital, Treliske, Truro, 7pm. 26th Feb - PCaSO Basingstoke group meeting, ARK Centre, North Hants Hospital, 6.30pm General Disclaimer This newsletter is providing news, information, personal memoir and opinion about prostate cancer. It also reports, quotes and cites published medical views and research findings about prostate problems. Anyone who wishes to embark on any dietary, drug, exercise or other lifestyle change intended to prevent or treat a specific disease or condition, should first consult with and seek clearance from a qualified health care professional. 8 PDF created with pdfFactory Pro trial version www.pdffactory.com