Prostate Cancer News The magazine is a publication of the Queensland Chapter, Prostate Cancer Foundation of Australia

Queensland Prostate Cancer News The magazine is a publication of the Queensland Chapter, Prostate Cancer Foundation of Australia. May 2011 Letter f...
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Queensland

Prostate Cancer News The magazine is a publication of the Queensland Chapter, Prostate Cancer Foundation of Australia.

May 2011

Letter from the Editor, Another research document on the subject of prostate cancer screening has been published in the British Medical Journal 31MAR11. The study by Gabriel Sandblom MD PhD and colleagues of the Karolinska Institute in Stockholm, Sweden, involved 1,494 Swedish men who were randomised to a screening group and were invited to have a prostate-specific antigen (PSA) test plus digital rectal examination (DRE) every three years between 1987 and 1996. A further 7,500 men were followed as controls.

screening but the small sample size didn’t give it statistical significance and there were other studies showing the benefits of annual testing.

Among the screened group 5.7% of men were diagnosed with prostate cancer compared with 3.9% of the control group but statistically there was no significant reduction in the risk of death from prostate cancer in the screened group when related to the controls. Additionally there was a fourfold increase in the number of prostatectomies within the screened men compared to the controls.

Dr Andrew Penman, CEO of Cancer Council NSW stated “I think the real message... is to urge men to talk about prostate cancer with their doctors and make an informed decision about screening”.

Alexandra Barratt, Professor of public health at the University of Sydney, said screened men were 50% more likely to be diagnosed with prostate cancer, a step that often pushed them to further tests and treatment but there were no tests that could to show if treatment was necessary.

The study reignited debate on the subject of prostate cancer testing. In The Australian, urologist David Malouf, president of the Urological Society of ANZ, claimed the study showed a slight trend towards reduced mortality among men given

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Resources: Web Links, Associated and Affiliated Groups.

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SPOTLIGHT ON Maryborough.

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Baldness and Prostate Cancer.

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Blokes and Pelvic Floors.

Men also need to be able to make an informed decision about treatment; not always an easy decision when you’ve just received a cancer diagnosis.

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Short Cuts.

Wishing You Low PSA’s and Good Heath.

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John Stead.



Editor.

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www.cancerqld.org.au www.prostate.org.au

Parental Cancer Research. PCFA Report.

ABC Professor Russell Interview.



T 1300 65 65 85 T 1800 22 00 99

May 05-08

Brisbane Truck Show www.truckandmachineryshow.com.au

May 07

Gold Coast Triathlon www.prostate.org.au

May 15

Ride the Range www.ridetherange.org.au

May 19-22

Sactuary Cove International Boat Show

May 26

Australia’s Biggest Morning Tea www.biggestmorningtea.com.au

Aug 20-21

Ride to Conquer Cancer www.qimr.edu.au

Sep

International Prostate Cancer Awareness Month www.prostate.org.au www.pcfa.org.au

New Agent Orange Study.

Pathology in Practice; Hip Fractures and EBRT. Palliative Care Response; Inhibiting Disease Metastasis.

Secondary Cancers and Radiotherapy; Brisbane Program: Privacy: Contact Us: Disclaimer.

Calendar of Events 2011 Cancer Council Queensland Prostate Cancer Foundation of Australia

In this issue

[email protected]

The Queensland Chapter of the Prostate Cancer Foundation of Australia is grateful for the generous support of Cancer Council Queensland, in the printing of this magazine. The content of this magazine is selected by the Queensland Chapter of the PCFA. Cancer Council Queensland does not necessarily endorse, or otherwise, any content contained within this publication.

Resources

Cancer Council Queensland www.cancerqld.org.au Research to beat cancer and comprehensive community support services. Cancer Council Helpline Ph 13 11 20 8am-6pm Monday to Friday. www.cancerqld.org.au/cancerHelpline Andrology Australia www.andrologyaustralia.org Ph 1300 303 878 Andrology Australia is the Australian Centre of Excellence in Male Reproductive Health. HealthInsite www.healthinsite.gov.au Your gateway to a range of reliable, up-todate information on important health topics.

Prostate Cancer Foundation of Australia www.prostate.org.au Phone 1800 22 00 99 Assistance with the experience of diagnosis and treatment for prostate cancer. Queensland Chapter www.pcfa.org.au Information, patient support materials, and contacts for advice on living with prostate cancer in Queensland. Cochrane Library www.cochrane.org Australians now have free access to the best available evidence to aid decision-making.

APCC Bio-Resource www.apccbioresource.org.au The national tissue resource underpinning continuing research into prostate cancer. Australian Prostate Research Centre – Queensland www.australianprostatecentre.org Research, collaborative opportunities, clinical trials, industry news. Mater Prostate Cancer Research Centre www.mmri.mater.org.au Comprehensive information for those affected by prostate cancer, including the latest research news.

Lions Australian Prostate Cancer www.prostatehealth.org.au The first stop for newly diagnosed men seeking information on the disease.

Prostate Cancer Support Groups in the Queensland Chapter There are 23 PCSGs in the Chapter with a total membership of approximately 3,300 men. Peer Support Group Contact Beenleigh Peter Keech Brisbane Peter Dornan Bundaberg Rob McCulloch Capricorn Coast (Yeppoon) Jack Dallachy Central Qld. (Rockhampton) Lloyd Younger Far North Qld. (Cairns) Jim Hope Gladstone Geoff Lester Gold Coast North John Caldwell Gold Coast Partners Maggie Angus Gold Coast Central (Evening Group) Alex Irwin Gympie and District Ray Cheasley Hervey Bay (Pialba) Ros Male Ipswich Terry Carter Mackay John Clinton Maryborough Leoll Barron Mount Isa Tony McGrady Northern Rivers (Alstonville) Pat Coughlan Northen Rivers (Lismore) Warren Rose Sunshine Coast (Maroochydore) Rob Tonge Toowoomba David Abrahams North Queensland (Townsville) Bob O’Sullivan Twin Towns & Tweed Coast Ross Davis Whitsunday (Proserpine) Dave Roberts The news sheet for any group should have the meeting details for its neighbouring groups.

Associated Support Groups Group Beaudesert Kingaroy

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Contact Carmen O’Neill RN Robert Horn

Phone 07 5541 9231 07 4162 5552

Phone 0407 070 194 07 3371 9155 07 4159 9419 07 4933 6466 07 4928 6655 07 4039 0335 07 4979 2725 07 5594 7317 07 5577 5507 07 5569 2021 07 5482 8879 07 4125 6701 07 3281 2894 07 4942 0132 07 4123 1190 07 02 6622 1545 02 6684 2201 07 5446 1318 07 4613 6974 0405 274 222 07 5599 7576 07 4945 4886

Sponsor Beaudesert Health/Gold Coast Toowoomba/Sunshine Coast

SPOTLIGHT ON Maryborough Unlock the past in the charming old port city of Maryborough. From the mid 1800s to Federation, Maryborough was one of Australia’s main immigration ports for thousands of new settlers. The remnants of its fascinating past are easily recognisable in its colonial architecture, magnificent riverside parks, ghost tours, theatre, heritage characters and events. Many of the stately colonial buildings from that time remain-lovingly reinvented as three first class museums, Gatakers Artspace, restaurants and cafes. The original wharf district is now an exceptional heritage precinct called “Portside” and was recently voted as one of the “must do”experiences in Queensland. Maryborough has a fascination with all things Mary -it grew around the Mary River and is the birthplace of Mary Poppins author, Pamela Travers. Maryborough Sugar, Hyne & Son Timber, EDI Rail along with many Government Departments form the basis of solid employment in the District.

• Dr Nazim Ahmad, a Urologist new to Maryborough / Hervey Bay. • Ms Eileen Franklin GP Links. • Ms Deborah Hannam Naturopath. • Geoff Milburn and Helen Stark from Sullivan Nicholaides Pathology who showed us the workings of the Lab. Our group has formed links with others in the community mainly through friendships. We were invited to assist with a Melbourne Cup function organised by QUOTA who nominated Prostate Cancer Foundation of Australia (PCFA) as their charity. We followed up with a MEN’S WELLBEING EVENING with 138 in attendance to hear from: • Dr Boon Kua visiting Urologist & Surgeon “WHAT’S NEW! Procedural Surgery”. • Mr James Rossiter, local Physiotherapist PRE-POST Procedures. • Mr Leoll Barron, Men’s Health Ambassador Speaker.

Some of our members and their wives enjoyed the “True Blue” Fashion Parade last November.

Our Prostate Cancer Support Group meets in the Wesley Auditorium on the first Monday of each month from February to December. We are very appreciative of the fact that the Maryborough Uniting Church has taken us under their banner and included us in their insurance protection and also for the opportunity to use the Wesley Auditorium which is a great venue for our meetings. Our group comprises mainly men over the age of 60 and their partners who have been or are in the process of having treatment for Prostate Cancer. Our aim is to raise the awareness of men over 40 about the risks and signs that can lead to Prostate Cancer and to support those diagnosed. We have a large number of books, DVDs, and brochures as well as toiletries that are available to those who attend. Our 4th Anniversary Celebrations saw 42 in attendance at our Christmas Party last December.

This above group with Dr Tom Dunn a local GP also presented at the Brolga Theatre as part of Maryborough’s Pub Crawl celebrations where the PCFA was the 2010 charity.

Speakers at the Prostate Cancer Information Night at Brolga Theatre before the “Pub Crawl” were (L to R) Leoll Barron, Dr Tom Dunn, James Rossiter and Dr Boon Kua.

Several members assisted at a “TRUE BLUE” Fashion Parade where once again PCFA was the chosen charity. Some volunteers were pleased when the Menswear Shop withdrew and our only task was to assist the ladies who modelled clothes from a local boutique. A fun time was had by all for good cause.

Our meetings alternate between a Guest Speaker and “group sharing” sessions. Recent Guest Speakers have included: • Carole Chapman from Alzheimer’s Australia. This variation from the Prostate Cancer theme proved very successful with 48 attending which was our highest for the 2011 year so far. • Paul Kinbacher a local Pharmacist on conventional treatment and alternative medicines.

Des Hansen, Leoll Barron, Alan Phillips & Bevan Brett with the models at the “True Blue” Fashion Parade.

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SPOTLIGHT ON Maryborough Continued... Following training by some of our members we are now part of the BUNNINGS SAUSAGE SIZZLE roster and hope to increase awareness as well as gaining financially. We also assisted the local Bike Riders groups from Bundaberg, Hervey Bay and Maryborough who raised over $4000 with their “Ride for Prostate” from Apple Tree Creek to Woodgate by providing morning tea and cooking lunch. We continue to have a FUN TIME with a variety of activities. However our group members were saddened at the sudden death from a heart attack last December of Des Hansen, one of our foundation and very supportive members. Des was one of the men who bravely escorted the models at the “True Blue” Fashion Parade a few weeks earlier. His advice and encouragement will be missed by all.

Carolyn and Des Hansen. Des died suddenly on 16 December 2010. Story By: Bevan Brett and Leoll Barron,Co-Co-ordinators, Maryborough Prostate Cancer Support Group.

Losing Hair at 20 Is Linked to Increased Risk of Prostate Cancer in Later Life, Study Finds ScienceDaily 16FEB11 — Men who start to lose hair at the age of 20 are more likely to develop prostate cancer in later life and might benefit from screening for the disease, according to a new study published online in the cancer journal Annals of Oncology. The French study compared 388 men being treated for prostate cancer with a control group of 281 healthy men and found that those with the disease were twice as likely as the healthy men to have started going bald when they were 20. However, if the men only started to lose their hair when they were 30 or 40, there was no difference in their risk of developing prostate cancer compared to the control group. The study found no association between early hair loss and an earlier diagnosis of prostate cancer, and nor was there any link between the pattern of hair loss and the development of cancer. Until now there has been conflicting evidence about the link between balding and prostate cancer; this is the first study to suggest a link between going bald at the young age of 20 and the development of prostate cancer in later life. Professor Philippe Giraud (M.D., PhD), Professor of Radiation Oncology at the Paris Descartes University (Paris, France) and at the European Georges Pompidou Hospital (Paris, France), who led the research, said: “At present there is no hard evidence to show any benefit from screening the general population for prostate cancer. We need a way of identifying those men who are at high risk of developing the disease and who could be targeted for screening and also considered for chemo-prevention using anti-androgenic drugs such as finasteride. Balding at the age of 20 may be one of these easily identifiable risk factors and more work needs to be done now to confirm this.” Androgenic alopecia, sometimes known as male pattern baldness, is common in men, affecting 50% throughout their lifetime. A link has been established between baldness and androgenic hormones, and androgens also play a role in the development and growth of prostate cancer. Finasteride blocks the conversion of testosterone to an androgen called dihydrotestosterone, which is thought to cause hair

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loss, and the drug is used to treat the condition. It has also been shown to decrease the incidence of prostate cancer. From September 2004 Prof Giraud and his colleagues asked the men in their study to answer a questionnaire about their personal history of prostate cancer (if any) and to indicate on four pictures any balding patterns that they had at ages 20, 30 and 40. The pictures showed four stages of hair loss: no balding (stage I), frontal hair loss (receding hairline around the temples), vertex hair loss (a round bald patch at the top of the head), or a combination of both types of hair loss (stage IV). The men’s doctors were also asked to provide a medical history of their patients, including any diagnosis of prostate cancer, age at diagnosis, stage of the disease and treatment. The study ran for 28 months. The men with prostate cancer were diagnosed with the disease between the ages of 46 and 84. Dr Michael Yassa (M.D.), currently Assistant Professor at the University of Montreal (Montreal, Canada) and a radiation oncologist at the Maisonneuve-Rosemont Hospital in Montreal, but who previously worked as a radiation oncology Fellow at the European Georges Pompidou Hospital, said: “There were only three men with stage III and none with stage IV hair loss at the age of 20, but the data revealed that any balding at stages II-IV (37 cases and 14 controls) was associated with double the risk of prostate cancer later in life. This trend was lost at ages 30 and 40. “We were unable to find an association between the type or pattern of hair loss and the development of cancer. This might be due to the very low prevalence of stage III and IV hair loss at the ages of 20 and 30 in our study.” The researchers say the link between baldness and the development of prostate cancer is still unclear. “Further work should be done, both at the molecular level and with larger groups of men, to find the missing link between androgens, early balding and prostate cancer,” said Dr Yassa.

BLOKES’ BITS BELOW the BELT

Research Team: Wendy Hayes, Gillian Marcham, Imina Nahon. Led By: A Professor Pauline Chiarelli, (Dip Pgysio (Sydney Uni), MMed Sc, PhD, FACP). Associate Professor Pauline Chiarelli is the Program Coordinator in the Discipline of Physiotherapy, School of Health Sciences at the University of Newcastle. She is Australia’s first Physiotherapist Continence Advisor and was awarded Masters and PhD degrees for her research to determine the prevalence of incontinence and the effectiveness of pelvic floor exercises as a means of overcoming incontinence problems.

But how can pelvic floor muscles assist in alleviating these problems and what do they do?

A/Prof. Chiarelli was due to speak to the Brisbane Prostate Cancer Support Network in January but her presentation was cancelled because of flood problems in and around Brisbane. She kindly agreed to return in March and talk to the Brisbane Group about prostate cancer and incontinence, the effectiveness of male pelvic floor exercises in combating incontinence problems, especially following radical prostatectomy, how to identify the pelvic floor muscle and perform the exercises.

Joined by the Pelvic Floor: Pelvic Floor Exercise Pioneers Pauline Chiarelli and Peter Dornan (Convener of the Brisbane Support Group)

Continence problems can be characterised by a number of symptoms, often referred to as lower urinary tract symptoms (or LUTS). These include: • Frequency. • Urgency. • Nocturia (Frequent night-time voiding). • Hesitancy. • Intermittent Stream. • Terminal Dribble. • After Dribble. • Urinary Incontinence. LUTS problems tend to increase as men age but they can also be caused by benign enlargement of the prostate gland (benign prostate hyperplasia or BPH), which is associated with ageing, where the enlarged prostate can put pressure on the bladder and/ or “squeeze” the urethra and/or cause bladder outlet obstruction. BPH is not necessarily associated with prostate cancer however tumour growth within the prostate can produce similar symptoms to those caused by BPH. As men get older LUTS are reasonably common and a Swedish study (refer to next slide) showed that at some time about half the men in the 45 to 79 age group suffered from LUTS problems.

The pelvic floor muscles in men support the bladder and bowel and are attached to the pubic bone in the front, stretch back to the tailbone and surround the urethra and rectum. They assist in bladder control, bowel control and erectile function so they are V.I.P. muscles.

Why look at pelvic floor muscles in men?

The bladder is a muscular sac. When you urinate the urine doesn’t drain out through the urethra, it’s pushed. Men have two sphincter muscles which close the urethra, one situated at the neck of the bladder where it joins the prostate (the preprostatic sphincter) and the other towards the base of the prostate and these relax to open the urethra when there’s a need to urinate. With ejaculation the preprostatic sphincter stays closed forcing the ejaculate down the urethra rather than up into the bladder. Similarly the rectum is also controlled by two sphincters, the internal and external anal sphincters, which keep the rectum closed until it’s a convenient time to expel faecal matter or wind. When you lift a heavy weight, dance a jig or sneeze or carry out any other activity that increases abdominal pressure the pelvic floor muscles tighten up to help the sphincters do their job. If the pelvic floor muscles are not up to scratch it’s quite likely that leakage will occur.

Continued...

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BLOKES’ BITS BELOW the BELT Continued... Good pelvic floor muscles also assist with erectile function. They are active when the penis is erect, keeping pressure on the deep veins to stop blood escaping and assisting with a pumping action during ejaculation. When a man has a radical prostatectomy there can be a number of problems which may affect the urinary tract. Whilst the surgeon will do all that is possible to preserve continence, at the end of the operation only one urinary sphincter will remain. The surgery could affect the bladder neck which may be a short-term or long-term problem. Even with a nerve-sparing prostatectomy the nerves that control urinary and erectile functions will have undergone considerable trauma and will need time to recover. The urethra will have been shortened by around the depth of the prostate gland, possibly up to 4cm and the remaining sphincter may need time to recover. Obviously the urinary tract needs all the help it can get to begin normal functioning again! Following a radical prostatectomy nearly all men will suffer a degree of incontinence but most will settle down within 3 – 6 months or less with a small percentage taking up to a year and a few having ongoing difficulties. If radiotherapy is used to treat prostate cancer there can also be nerve and tissue damage which could result in bladder and bowel problems whilst the treatment is in progress and which may settle down within a few months of treatment cessation or, again, may be ongoing and require further intervention.

You should be able to feel a tightening in groin and be able to see your scrotum firming and rising slightly and your penis should contract and rise at its base. Your abdomen should also firm up. Hold this position for as long as possible and then relax briefly before beginning the procedure all over again, and again. In the early stages you may tire quickly but with practice you’ll be able to hold on for an increasing amount of time. At the end of each contraction try to attempt a sharp upward pull before relaxing (a maximal contraction). When you’re confident you’ve got the right muscles try doing the exercises sitting down and then standing. If standing in front of a mirror you’ll see your penis contracting and rising as you engage the muscles. Also when standing, if you have your legs slightly apart and point your toes inwards (pigeon toed) it will help you avoid tightening the anal sphincter. As you progress try to hold each cycle as long as possible (count the seconds so you can follow your progress). If you can hold for six seconds, for instance, try six cycles of six seconds with only a brief interval between them. Once you can, go to seven seconds and seven cycles and work your number up to around ten, but remember to include those maximal contractions in your routine. These are better than either prolonged contractions or lots of contractions. This exercise programme should become a part of your everyday activities. As men age the urethra will often “sag” and following urination some urine will “pool” in the sagged area only to pop out when bending or sitting or some other activity that puts pressure on the groin. This can be overcome by pushing upwards behind the scrotum to void the last few drops but, instead, try to empty the last drops with a big pelvic floor squeeze and lift. Doing this each time you urinate helps with the exercises.

Because the pelvic floor muscles play such a vital role in continence it’s important that they are in good shape. Men should be encouraged to begin pelvic floor exercises well before they begin prostate cancer therapy and to continue with them, post-treatment, for the rest of their lives. This is particularly so for men who will undergo a prostatectomy to ensure they can get back to a continent state as soon as possible following surgery. But how do you find and exercise your pelvic floor muscles? For those beginning pelvic floor exercises Pauline Chiarelli recommends you begin by stripping off and lying down, so there’s no pressure on the pelvic floor. With knees bent and your back propped up high enough so there’s no strain on your abdominal muscles when you reach down between your legs, hold a mirror so that you can see your genital area. Using your lower abdominal muscles and without contracting your anal sphincter, try to pull your testicles up into your abdomen.

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It also helps to develop “The Knack”. This is great for men who may leak a small amount of urine when there’s some pressure applied to their abdominal muscles in such situations as coughing, lifting the shopping into the car, swinging the golf club, etc. To develop “The Knack” squeeze up hard and cough at least three times in a row each time you visit the loo. Once you’ve got it, just remember to do it before each of these activities and you’ll prevent or minimise any leakage. If you have any doubts about the exercises or identifying the pelvic floor muscles it’s a good idea to make an appointment with a physiotherapist who specialises in male continence problems so that you’ll know you’re on the right track. Two good sources of information are a Pauline Chiarelli DVD “PELVIC FLOOR EXERCISES FOR MEN” and a book “CONQUERING INCONTINENCE” by Peter Dornan. Both these are available from the Prostate Cancer Foundation of Australia, contact details are on Page 2.

Largest Agent Orange Study Shows Increased Prostate Cancer Risk Steven Fox / Medscape Today / 01MAR11 Orlando, Florida — Vietnam veterans who were exposed to the defoliate Agent Orange are 49% more likely than nonexposed veterans to be diagnosed with prostate cancer. That’s according to results from one of the largest studies to date examining that association. The study was presented here at the 2011 Genitourinary Cancers Symposium, and adds to a mounting body of evidence implicating the defoliate in the development of prostate cancer. “Even when numerous other risk factors were accounted for, exposure to Agent Orange increased risk significantly,” principal author Nathan Ansbaugh, MPH, told Medscape Medical News in an interview. “In our study it carried just as much risk as positive family history and even more risk than age,” he said. Mr. Ansbaugh, along with colleagues from the Oregon Health and Science University, in Portland, conducted the retrospective study in association with the Portland VA Hospital. Prime Time for Diagnosis “This is an especially important finding,” Mr. Ansbaugh explained, “because Vietnam veterans are reaching the age when we would consider them at highest risk of developing prostate cancer.” He said clinicians would do well to keep the association in mind when screening Vietnam veterans for prostate cancer. The researchers used clinical data from 2720 veterans referred to the Portland VA Hospital for prostate biopsy between 1993 and 2010. In addition to checking for Agent Orange exposure, they evaluated several covariates, including prostate-specific antigen density, results of digital rectal exams, age at biopsy, family history, body mass index, race, and medication use. Then, using multiple logistic regression, they compared risk factors for men found to have prostate cancer with those for men whose biopsies were negative. Mr. Ansbaugh and his group report that 896 men (32.9%) were found to have prostate cancer. After adjustment for all significant confounders, the researchers reported that veterans with prostate cancer were 49% more likely to have been exposed to Agent Orange than men who didn’t have cancer (odds ratio, 1.49; 95% confidence interval [CI], 1.06 to 2.11; P = .022). Mr. Ansbaugh acknowledged that it’s difficult to quantify previous exposure to Agent Orange — which contained the known carcinogen dioxin — because it’s essentially based on patient reporting. “How much Agent Orange was used in the area where they were? How long were they there? Those are important questions, but difficult questions to answer,” he said.

“The result is that you end up having individuals who say they were exposed who may have not been. Or maybe they were, but they didn’t have significant exposure levels. Or you have individuals who are kind of cluttering that nonexposed group who didn’t say they had exposure or didn’t really know,” he said. “It’s one of the inherent limitations of the study.” In previous years, numerous studies have been carried out looking at Agent Orange and prostate cancer. Although the results have consistently pointed to Agent Orange as a risk factor, the significance of findings has varied. “It’s only been in the past few years that we’ve seen such a strong association. We think that’s because Vietnam veterans are now into their 60s – the time when prostate cancer is often diagnosed,” Mr. Ansbaugh said. Younger Age at Diagnosis Exposure to Agent Orange was also associated with younger age at diagnosis. Men found to have prostate cancer were roughly 5 years younger at diagnosis than men without exposure. The average age at diagnosis for men exposed to the defoliate was 61.4 years (95% CI, 60.0 to 61.2), compared with 66.1 years (95% CI, 65.6 to 66.6) in unexposed men. “While that interaction between Agent Orange exposure and age wasn’t found to be significant in the multivariate model, our finding is similar to another study 3 years ago [Cancer. 2008;113:2464-2470], and warrants further attention,” Mr. Ansbaugh said. Why is Agent Orange associated with the development of prostate cancer? “It’s not at all clear,” said Mr. Ansbaugh, “since many men were exposed and haven’t developed prostate cancer. We think there are probably some host factors at work here. It could be that exposure to Agent Orange functions as more of a promoter, a trigger mechanism for prostate cancer.” Limitations of Retrospective Studies Commenting on the study, Mike Scott, cofounder of Prostate Cancer International, a Web service that provides online science-based patient services, said the findings add to the increasing evidence of an association between the defoliate and prostate cancer. But like Mr. Ansbaugh, he acknowledged the limitations of the study. “The trouble is, when you come down to the individual patient level, there’s really no way to show positive proof of an association. You can’t collect prospective data because you don’t have the evidence before you,” he said. “It’s similar to higher levels of myeloma that we’re seeing in people who were exposed to debris in the World Trade Center. We can’t correlate their illness to anything specific, so very likely there are host factors that figure into the development of the disease.” He added that “with ever more information becoming available on the human genome, I wouldn’t be surprised if we find out that there are certain genetic traits or genetic translocations that are necessary to interact with Agent Orange and trigger the development of prostate cancer.”

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RESEARCH RESULTS In Queensland Prostate Cancer News last year we published details of a PhD research project being undertaken by Janelle Levesque of Charles Sturt University in which she sought to recruit participants for the study. The research project was titled Investigating Parental Cancer: Psychological Benefits, Emotional Reactions and Involvement in Caregiving. Janelle obtained a suitable sample to enable her to perform the analysis and thanks all those who participated. Below is a summary, including the key findings, of the research.

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PCFA REPORT NEW CEO: Following the resignation of Andrew Giles, PCFA’s CEO for the past seven years, a new CEO has been appointed and commenced working with PCFA at the end of March. He is Dr Anthony Lowe who comes to the Foundation with a strong record in commercial management. Dr Lowe joins PCFA following service with the National Breast Cancer Foundation where he was Chief Operating Officer. ARL MASTERS: On Thursday/Friday/Saturday the 10th/11th/12th March the 5th. Annual “ARL Masters” Tournament was held at the Runaway Bay Junior Rugby Leagues Club on the Gold Coast. From humble beginnings five years ago this event has grown from an initial 200 players to 1,450 players participating in this year’s event. The players’ ages ranged from 35 to 55-plus, an excellent demographic fit where prostate cancer awareness is concerned. The event is an ongoing partnership between the ARL Development Team, the many players and PCFA and all agree that it slots perfectly into PCFA’s awareness-education target group.

Masters Getting Stuck Into the Action

Around $10,000 was raised over the three days from registration fees and donations, with $3,000 going to PCFA for research and awareness programmes and $7,000 to Queensland and Victorian flood-damaged clubs to assist in restoration work and replacement of equipment. Many long-lost muscles and hamstrings were discovered during the event ensuring that the free player massage tent was kept busy, with the masseuses getting a better workout than the players. Watch out for the 2012 event. It’s a marvellous opportunity for those who sit in front of the telly telling the RL players how it should be done to come and put their words into action and help a great cause at the same time.

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The “Old Boys” Rekindle Their Skills at the ARL Masters.

APP2011 was held at the Gold Coast Convention and Exhibition Centre during mid-March. This is the annual Australian Pharmacy Professional Conference and Trade Exhibition. PCFA took the opportunity during the Conference to launch their new Patient Information Pack. The Pack contains booklets and other information for all men newly diagnosed with prostate cancer to give them guidance and resources for their way ahead.

PCFA’s Alison Bannan Demonstrates the New Patient Information Pack at APP2011.

QUEENSLAND CHAPTER CONVENERS’ CONFERENCE & WORKSHOP: From the 24th. to the 26th. March inclusive the PCFA Queensland Chapter Conference and Workshop was held at Cancer Council Queensland’s head office in Brisbane. A joint effort between PCFA and Cancer Council Queensland (CCQ), Conveners and Members of the Queensland Chapter Prostate Cancer Support Groups from all parts of Queensland and Northern New South Wales spent three days catching up on the latest information and trends in prostate cancer research and treatment of both the disease and its side effects, networking with each other and discussing the way ahead. The Conference was officially opened by PCFA National Board Chairman, Graeme Johnson, and many topics and exchanges were covered in the following days.

A highlight was the awarding of certificates for exemplary service to two of the Chapter’s Support Group Conveners, Jim Hope and Len Lamprecht. Both of these men have worked tirelessly to promote awareness of prostate cancer and assist those who have been diagnosed with the disease. Jim Hope, together with a small group of survivors and a couple of wives, began the Far North Queensland Group (Cairns) in 2001 and from an initial 20 members this Group now numbers over 260 and covers a large area South to Mission Beach, Tully and Innisfail, then to the tablelands, Ravenshoe, Malanda, Atherton and Mareeba and North to Cooktown and Port Douglas. Len Lamprecht became the inaugural Ipswich Convener when the Group was formed in March 2004. He organised prostate cancer awareness meetings in many of the surrounding areas (Boonah, Esk, Toogoolawah, Gatton) and made many contacts within the local medical and business communities who he could call on to assist the Group achieve their aims. In 2009 Len stood down as Convener but he is still an active member of the Ipswich team. From the start both Jim and Len were ably supported by their wives, Val and Margaret. Tragically Val has passed on but Margaret is still an active player within the Ipswich Group.

Other highlights of the Conference were John Kara from Global Technology discussing the use of computer technology to assist the Groups; Professor Colleen Nelson from the Australian Prostate Cancer Research Centre-Queensland talking about multidisciplinary team clinics for advanced prostate cancer; Brisbane-based urologist Greg Malone on the subject of implants to overcome incontinence and erectile dysfunction; Professor Jeff Dunn, CEO of CCQ, looked at the problems we face as the population ages and cancer diagnoses increase; Martin Palin of Palin Communications on how to deal with the media; Sally Wall, a bereavement councillor from Brisbane South Palliative Care Service, presented a grief and loss session; Suzanne Chambers, Professor of Preventative Health at Griffith University spoke about meeting the psycho-social needs of men with prostate cancer; Sarah Constantine, CCQ Community Support Manager, looked at access and equality for rural cancer patients; Tina Skinner from the University of Queensland’s School of Human Movement Studies looked at the importance of exercise following prostate cancer therapy; CCQ Staffers Alex Woodland, Karen Bucholz, Roslyn Melmeth, Rachael Curtis and Renee Bardsley all assisted in keeping participants on track and along with Conveners, Support Group Members and Chapter Councillors ensured all left with many new ideas and increased knowledge of what lies ahead.

2011 Conveners’ Conference & Workshop Participants.

THE HEALTH REPORT – ABC RADIO NATIONAL – 14MAR11 Professor Pamela Russell AM PhD is Head of Biomedical Imaging and Prostate Cancer Models at the Australian Prostate Cancer Research Centre – Queensland and is a member of the Institute of Health and Biomedical Innovation. Last year she was Prostate Cancer Foundation of Australia’s Outstanding Researcher of the Year. She has been working on various aspects of bladder and prostate cancer since 1984 and prior to that on immunology, specialising in autoimmune disease. Below is a transcript of an ABC Radio National interview between Professor Russell and Dr Norman Swan. Ed. Norman Swan: This week a conference in Sydney celebrates the career and work of one of Australia’s leading prostate cancer researchers who, with her colleagues, is close to a very different kind of treatment. Pam Russell is a professor at Queensland University of Technology’s Australian Prostate Cancer Research Centre in Brisbane. Pam Russell: For the last several years I’ve been working with people from CSIRO and we developed a gene therapy which we hope will be a gene medicine for late stage prostate cancer. An

approach called gene directed enzyme pro drug therapy which is a little bit complicated. Norman Swan: A mouthful. Pam Russell: Yes but what it means is that we put a gene which expresses an enzyme which can break down a prodrug which is a non-toxic form of a drug into a toxic form which can then kill cancer cells locally. Norman Swan: So in other words you swallow a drug which is like a sleeper, to use a spy analogy, and then you only wake it up when it gets to the cancer cell with this gene therapy? Pam Russell: That’s a good analogy. We use an enhancer and a promoter from genes that are only expressed in prostate cancer together with... Norman Swan: These are like control mechanisms for how actively the gene turns out proteins, messages? Continued...

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THE HEALTH REPORT – ABC RADIO NATIONAL –14MAR11 Continued.... Pam Russell: Yes, that’s right. DNA throughout the body is the same in every cell but the liver cells and the hair cells and you know the eye cells seem to do very different things and look very different. And the way that happens is that we have switches on those cells, which can turn them on and off. and that’s the promoter. and we also have switches which can raise or lower the volume. and those are enhancers and other elements. So what we’ve done is to trap that bit of technology to put it in front of the gene which we want to turn on only in the prostate cancer cells, well, only in prostate, actually, and not elsewhere in the body. Norman Swan: And you give it an extra function which is to turn on the drug itself where it matters.

drug that we’ve chosen, it can easily transfer between different cells, so we don’t have to get the gene into every cell in the prostate in order for it to work. Norman Swan: How much testing has been done and where is this at? Pam Russell: We’ve done a lot of testing actually, we’ve done testing in tissue culture and then we’ve used different animal models to test. And the first lot of testing we did was to use human prostate cancer cells that were injected into nude mice where they formed tumours. Then we treated those with one single dose of the gene therapy and found that we were able to virtually ablate the tumours.

Pam Russell: That’s exactly right, yes. Norman Swan: So after the gene therapy which uses a virus to carry the gene into the person they inject a harmless chemical which is then activated where it’s needed in the prostate itself. You might have noticed that Pam Russell emphasised the genetic manipulation is to the prostate itself, not the cancer. That’s because prostate cancer isn’t just one disease and therefore it’s hard to target genes in the tumour itself. Pam Russell: We know that most prostate cancers are in fact multi-focal. There might be even five different prostate cancers within the one prostate. Norman Swan: Really, so a man with prostate cancer just in the one man may have five different types of cancer? Pam Russell: That’s right; they’ve actually probably started from different cancer stem cells in each of those foci which are in the tumour. Norman Swan: So how do you know what gene to target then if there isn’t a cancer gene in prostate cancer?

Norman Swan: You’re destroying the whole prostate gland in the end aren’t you? Pam Russell: Yes we are, in the long term it would be nice just to destroy prostate cancer cells and not normal prostate cells. Not only did we test in nude mice but we tested in animals that are called transgenic which developed prostate cancer, they are mice. We’ve injected those with the gene therapy and shown that we can inhibit the prostate cancer with a single dose at a time when they’ve already started to develop prostate cancer and that also gives prolongation to their survival. And that local injection of the gene therapy is able to knock out metastases or lumps of tumour that grow in the lung. So the therapy has the added advantage that not only is it targeted and safe but we get this what’s called a bystander effect where we get a local bystander effect which was the sort of amplification that I mentioned before through the drug being able to penetrate into the nearby cells and we get this distant bystander effect. So what we believe is that this localised therapy which is going to be given directly into the prostate will have an effect at least on micro clusters or clusters of tumour cells which are circulating in the body and perhaps growing somewhere else. Norman Swan: So how near is this to the clinic?

Pam Russell: First of all we inject it into the prostate so it’s not going somewhere else. Norman Swan: Ah, so you just don’t inject it in the arm and hope it gets to the prostate, you’re actually right there? Pam Russell: Yes. But in order to make it safe and only make it turn on in prostate cells we use these gene switches from genes that are only expressed in the prostate. Norman Swan: So you’re bathing the whole prostate gland and catching the cancers at the same time? Pam Russell: That’s right, and when the prodrug is bathing the prostate and getting turned into the toxic drug which can kill the cancer cells, when it turns into the drug because it’s a very small

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Pam Russell: It’s very near, all of the necessary pre-clinical testing has been done and it was to go to clinical trial in about 2008 and unfortunately about 2 days before the first patient was coming in to be treated the global financial crises hit. The therapy is owned by a company called Broadvector and everything has been approved and if they can get enough money it will still go ahead. Norman Swan: Let’s hope they can, Professor Pam Russell is at Queensland University of Technology’s Australian Prostate Cancer Research Centre in Brisbane. All of the studies involved collaborators from the Prince of Wales Hospital in Sydney, the University of NSW and the CSIRO and the papers are on our website.

Short Cuts Prostate cancer test is “twice as good” say researchers 01MAR11 – Scientists say they have developed an improved test for prostate cancer. Researchers at the University of Surrey say their check is more accurate and less invasive than the current tests. The new method could be widely available within 18 months, they say. Cancer Research UK has welcomed the findings, but says more work is needed. Scientists at the University of Surrey have discovered that prostate cancers secrete a chemical called EN2 that can be found in a urine test. Their findings from a study of 288 patients, published in the journal Clinical Cancer Research, suggest this is better than the PSA check at detecting cancers, with far fewer false positives. Major cancer project to get underway 08MAR11 – Australian scientists are to embark on a major study of what makes cancer so hard to beat, as part of more than $100 million in research grants announced on Tuesday. The project, which received $21.3 million under the latest round of National Health and Medical Research Council (NHMRC) grants, will investigate the way cancer cells ignore the signals that otherwise prompt the body’s normal cells to kill themselves off when needed. Researchers will also examine the way some tumours appear to be powered by a handful of “rogue stem cells” which can escape some conventional tumour-focused treatments and trigger a relapse Sydney Morning Herald. Broccoli May Help Fight Cancer Growth 11MAR11 – Broccoli may help fight cancer by blocking a defective gene associated with tumour growth, according to new research. Previous studies have heralded the potential cancer-fighting ability of broccoli and other cruciferous vegetables such as cauliflower and watercress. But researchers say until now they didn’t know the secret behind the vegetables’ anticancer attributes. In a new study, researchers found compounds in broccoli and other cruciferous vegetables called isothiocyanates (ITCs) appear to target and block mutant p53 genes associated with cancer growth. The report was published in the Journal of Medicinal Chemistry. Prostate Cancer – Rural Australian Men Less Likely To Survive 19MAR11 – Survival rates for prostate cancer are poorer for rural men than urban men, according to a study in the Medical Journal of Australia. The study by Associate Professor Peter Baade from Cancer Council Queensland and colleagues, showed an overall increase in rates of prostate-specific antigen (PSA) screening and radical prostatectomy, reductions in mortality and improvements in survival throughout Australia. Prostate cancer ‘gene test’ hope - 09FEB11 – Experts believe they can develop a genetic screening test that can tell doctors which men with prostate cancer need aggressive treatment. Early trial results for Cancer Research UK suggest men with high levels of cell cycle progression (CCP) genes have the most deadly tumours. The CCP test could potentially save men with milder forms of the disease from unnecessary treatment. Largescale studies are now needed, the Lancet Oncology journal reports. New Guidelines Developed for Patients With Low-Risk Prostate Cancer Who Are Receiving Androgen Deprivation Therapy 19MAR11 – Men with prostate cancer who are being treated with androgen deprivation therapy are at increased risk of osteoporotic fractures, type 2 diabetes and possibly cardiovascular events, a new set of management guidelines states. The guidelines, published in the Medical Journal of Australia, were developed to guide assessment and management of bone and metabolic health in men with non-metastatic prostate cancer who are being treated with androgen deprivation therapy (ADT). Men with diabetes aged 40 to 64 years have most elevated risk of prostate cancer 21MAR11 (HealthDay News) – The incidence of prostate cancer among men in Taiwan is increasing, and men with diabetes are at an increased risk of prostate cancer, according to research published in the March issue of Diabetes Care. Bowel cancer sufferers predicted to rise – Australia’s incidence of bowel cancer is predicted to surge by 50 percent over the next decade. Cancer Council Australia chief executive Professor Ian Oliver said lifestyle as well as population trends would drive the increase and it underscored the need for an effective means to combat the disease. Sydney Morning Herald 22MAR11. Cancer Turns Out to be a Protein Aggregation Disease 28MAR11 – Protein aggregation, generally associated with Alzheimer’s and mad cow disease, turns out to play a significant role in cancer. In a paper published in Nature Chemical Biology, Frederic Rousseau and Joost Schymkowwitz, both from VIB, Vrije Universiteit Brussel and K.U. Leuven describe that certain mutations of p53, an important tumour suppressor, cause the protein to misfold in a way that the proteins start to aggregate. This not only disrupts the protective function of normal p53, but of other related proteins as well. New Cancer Drug Discovered at U-M Heads to Clinical Trials – Researchers at the University of Michigan Comprehensive Cancer Center have developed a new drug called AT-406 with potential to treat multiple types of cancer. A study, published in the Journal of Medicinal Chemistry 28MAR11, showed that AT-406 effectively targets proteins that block normal cell death from occurring. Blocking these proteins caused tumour cells to die, while not harming normal cells. The researchers believe the drug could potentially be used alone or in combination with other treatments. Screening may be excessive in older men who have low life expectancies (HealthDay News) – Age and life expectancy are strong predictors of prostate-specific antigen (PSA) screening, which appears to be administered excessively to older men with limited life expectancy. Michael W. Drazer of the University of Chicago Medical Center and colleagues examined data from the 2000 and 2005 National Health Interview Survey to determine the rates and predictors of PSA screening in older men in the United States. They defined PSA screening as a PSA test as part of a routine examination in the past year. The research was published online in the Journal of Clinical Oncology 28MAR11. Above Information Sourced from Cancer Daily News

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PATHOLOGY IN PRACTICE Most readers of this magazine will have had past involvement with pathology services to diagnose or monitor health issues and will have ongoing involvement for current and future monitoring of disease progression and other health matters that may arise from time-to-time. But what is pathology and what do pathologists do? The Royal College of Pathologists of Australia (RCPA) advise that there are nine different disciplines of pathology. Anatomical Pathology: Anatomical pathology is the branch of pathology that deals with the tissue diagnosis of disease. Anatomical pathologists need a broad-based knowledge and understanding of the pathological and clinical aspects of many diseases. The tissue on which the diagnosis is made may be biopsy material taken from a patient in the doctor’s surgery, operating theatre, ward or during an autopsy. Chemical Pathology: Chemical pathology is another discipline in the field of pathology which deals with the entire range of diseases. It encompasses detecting changes in a wide range of substances in blood and other body fluids. Clinical Pathology: A clinical pathologist is familiar with the major aspects of the clinical branches of laboratory medicine. They are usually trained in chemical pathology, microbiology, haematology and blood banking.

General Pathology: A general pathologist is familiar with the major aspects of all branches of laboratory medicine described above. Genetic Pathology: Genetics is the most recent discipline to emerge in pathology. The revolution in genetics, and our knowledge of genetic disorders, has been precipitated by the very rapid advances which have occurred in recombinant DNA (rDNA) technology, which allows the sequencing of the genetic make-up of individuals. Haematology Pathology: Haematology is another rapidly developing discipline which deals with many aspects of those diseases which affect the blood such as anaemia, leukaemia, lymphoma and clotting or bleeding disorders. Immunopathology: Immunopathology is a specialty, like haematology, which often involves both laboratory medicine (the testing of specimens collected from patients) and clinical practice (interviewing, examining and advising patients about clinical problems). Microbiology: Microbiology deals with diseases caused by infectious agents such as bacteria, viruses, fungi and parasites. Microbiologists have roles both in the laboratory and directly in patient care. Further information about the various disciplines is available on the RCPA website (www.rcpa.edu.au).

Forensic Pathology: Forensic pathology is the subspecialty of pathology that focuses on medicolegal investigations of sudden or unexpected death.

DOCTORS REVEAL STRUGGLES WITH PALLIATIVE CARE Michael Slezak New research provides sensitive insights into the barriers Australian doctors perceive in referring cancer patients for palliative care. There was disagreement among doctors about when patients should be referred and for what reasons, according to a telephone survey of 40 doctors involved in the care of people with advanced cancer. For example, most doctors did not report taking psychosocial symptoms into account.

Poor patient-clinician communication was identified as an important barrier to accessing specialist palliative care, with the authors suggesting doctors might be using ambiguous language to try to “protect patients from pain”.

One oncologist for instance, reported focussing on the “physical symptom control area” when assessing a patient’s need for palliative care.

One colorectal surgeon said many doctors had “terrific difficulty in articulating the terminal nature ofthe patients’ illness” because they tended to use indirect language.

The same doctor said they would refer patients with psychosocial symptoms to a mental health specialist rather than to palliative care

The study authors warned that “in the long-term, nondisclosure can cause heightened fear, anxiety and confusion, unrealistic expectations of treatment and inappropriate decisions regarding end-of-life care”.

And one respiratory physician said in relation to psychosocial issues: “I think that’s a role of palliative care that perhaps I haven’t thought of sufficiently.” Doctors also disagreed over whether palliative care was compatible with other treatments. “Palliative care can’t go hand in hand with pursuing active treatment,” remarked a surgical oncologist.

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On the other hand, a haematologist said: “I’ll say to them, ‘Look, we might get the palliative care services involved for two reasons. Firstly, they provide good support. Secondly, you know, symptom control.’ Often they’re very good with providing support for chemotherapy symptoms, analgesia – refining it, anti-nausea support.”

They concluded it was important that all aspects of a patient’s life, their mood and quality of life as well their physical symptoms, be examined when considering referral for end-of-life care. Journal of Palliative Medicine 2011; doi:10.1089 jpm.2010.0259.

INHIBITING DISEASE METASTASIS BY TRAPPING PROSTATE CANCER CELLS When prostate cancer stem cells (CSCs) were enclosed in selfassembling nanomaterials made of peptides (SAP), the SAP stopped cancer stem cell colony formation and also stopped the division of cancer cells in laboratory cultures (in vitro). According to the international team of researchers who built and tested the nano-sized traps and published their results in a recent issue of Cell Transplantation (20:1), which is freely available on-line here, the cancer cells grew and multiplied after they were “liberated” from their SAP prisons. In their article, the researchers suggested that CSCs may be the origin of prostate tumor metastasis, making them an “ideal target” for inhibiting disease metastasis. The group’s previous work in building nanomaterials showed that by using SAPs they were able to control the proliferation, elongation and maturation of cells in vitro. “In this study, we have shown that prostate CSCs can be placed into stasis for an extended period of time without causing them to differentiate,” said study corresponding author Dr. Rutledge Ellis-Behnke of the Heidelberg University-based Nanomedicine Translational Think Tank. “If cells are prevented from migrating away from the treatment, they could be subjected to additional targeting.” For the researchers, the isolation of cancer cells with stem-like characteristics “provides solid evidence” that CSCs may exist within the tumor. Additionally, CSCs may account for some treatment failures when treatments are unable to successfully target cancer

stem cells, which may be resistant to chemotherapy drugs. Too, CSCs have been found to be more invasive than non-CSCs. The authors speculated that by injecting the material directly into the tumor, it may be possible to stop the spread of metastatic cells. The research team also suggested that trapping CSCs in the nanomaterial would allow for loading of the SAP with chemotherapy agents, thus offering an increased effectiveness of a localized treatment when targeted cancer cells were unable to ‘escape’ their chemical enemies. This approach for treating metastatic hormone refractory prostate cancer (HRPC) - a cancer for which all current therapies fail - may offer hope as a successful treatment. “The goal of cancer therapy is to reduce the ability of cancer cells to divide and migrate,” said Dr. Ellis-Behnke. “Accordingly, we have shown that SAP can completely inhibit a prostate CSC from selfrenewal while preserving its viability and stem cell properties.” Their study concluded that SAP may be “an effective nanomaterial for inhibiting cancer progression and metastasis.” “The ability to sequester cancer stem cells in SAP to prevent the spread of a prostate cancer is a big step toward finding effective treatments for cancer,” Shinn-Zong Lin, professor of neurosurgery at China University Medical Hospital, Taiwan and chair of the Pan Pacific Symposium on Stem Cell Research where this work was first presented. “It will be of considerable interest to see how this technology develops.”

THREE DIMENSIONAL EXTERNAL BEAM RADIOTHERAPY FOR PROSTATE CANCER INCREASES THE RISK OF HIP FRACTURES BACKGROUND: Hip fracture is associated with high morbidity and mortality. Pelvic external beam radiotherapy (EBRT) is known to increase the risk of hip fractures in women, but the effect in men is unknown. METHODS: From the Surveillance, Epidemiology, and End Results (SEER)Medicare database, 45,662 men who were aged ≥66 years and diagnosed with prostate cancer in 1992-2004 were identified. By using Kaplan-Meier methods and Cox proportional hazards models, the primary outcome of hip fracture risk was compared among men who received radical prostatectomy (RP), EBRT, EBRT plus androgen suppression therapy (AST), or AST alone. Age, osteoporosis, race, and other comorbidities were statistically controlled. A secondary outcome was distal forearm fracture as an indicator of the risk of fall-related fracture outside the radiation field. RESULTS: After covariates were statistically controlled, the findings showed that EBRT increased the risk of hip fractures by 76%

(hazards ratio [HR], 1.76; 95% confidence interval [CI], 1.382.40) without increasing the risk of distal forearm fractures (HR, 0.80; 95% CI, 0.56-1.14). Combination therapy with EBRT plus AST increased the risk of hip fracture 145% relative to RP alone (HR, 2.45; 95% CI, 1.88-3.19) and by 40% relative to EBRT alone (HR, 1.40; 95% CI, 1.17-1.68). EBRT plus AST increased the risk of distal forearm fracture by 43% relative to RP alone (HR, 1.43; 95% CI, 0.97-2.10). The number needed to treat to result in 1 hip fracture during a 10-year period was 51 patients (95% CI, 31-103). CONCLUSIONS: In men with prostate cancer, pelvic 3-D conformal EBRT was associated with a 76% increased risk of hip fracture. This risk was slightly increased further by the addition of short-course AST to EBRT. This risk associated with EBRT must be site-specific as there was no increase in the risk of fall-related fractures in bones that were outside the radiation field. Cancer 2011. © 2011 American Cancer Society.

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RELATIVE RISK HIGHEST FOR ORGANS RECEIVING MORE THAN 5Gy BUT OUTWEIGHED BY BENEFITS Only a small proportion of second cancers are attributable to radiotherapy for primary tumours in adults. Amy Berrington de Gonzalez, D.Phil from the National Cancer Institute in Bethesda and colleagues estimated the proportion of second cancers attributable to radiotherapy from 15 cancer sites routinely treated with radiotherapy. The study cohort comprised 647,672 adult cancer five-tear survivors, aged 20 year or older, from the U.S. Surveillance, Epidemiology and End Results cancer registries who were treated with radiotherapy for a first primary invasive solid cancer. The study was published online in The Lancet Oncology 30MAR11 (HealthDay News).

Brisbane PCSG - 2011 meeting program

- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley.

Mornings at 9.30am (Odd months).

Evenings at 7.00pm (Even months).

May 11

June 8

“Dr Bob Webb RBWH - Hyperbaric Medicine; Managing the Side-Effects of Treatment”.

“Dr Michael Gillman - Erectile Dysfunction”.

Partners of Men with Prostate Cancer meet on the 4th Wednesday of each month between 6pm and 8pm at Cancer Council Queensland’s Gregory Terrace building. Members come together to share, learn and support each other in a warm open environment. Light refreshments are provided and there is parking underneath the building. For more information ‘phone Karen Ward on (07) 3356 8106.

Contact Details

Queensland Prostate Cancer News Mail: PO Box 201, Spring Hill Qld 4004 Email: [email protected] Phone: via Cancer Council Helpline 13 11 20 Prostate Cancer Foundation of Australia and Queensland Chapter Council Mail: 1/145 Melbourne Street, (P.O. Box 3420) South Brisbane Qld 4101 Email: [email protected] Phone: 07 3166 2140.

Disclaimer Council (ie. the Council of the Queensland Chapter) accepts no responsibility for information contained in this magazine. Whilst the information is presented in good faith, it may contain information beyond the knowledge of Council and therefore cannot be taken to be the opinion of Council.

Important privacy information You have received this magazine because you have provided your contact details to Cancer Council Queensland or to a Prostate Cancer Support Group (PCSG). The primary purpose of collecting your contact details was to enable support, resources and information to be offered to you as a person affected by or interested in prostate cancer. Your contact details are held in th e local office of Cancer Council Queensland. Cancer Council Queensland ensures compliance with the Privacy Act, and does not use or disclose your details except as you might reasonably expect. You may access your details and you may request that we correct or amend (ie. update) or delete your details.

LAST WORD

The information in this magazine is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.

If you are a member of an affiliated PCSG you will initially receive by post or email your local group’s news-sheet, the monthly Queensland Prostate Cancer News (QPCN), and the national quarterly Prostate News. You may also receive other communications from time to time such as advice on upcoming symposia, news or surveys from research establishments, details of open clinical trials, and guidelines being reviewed. You may ‘opt-out’ of any of these services at any time, ie. you will no longer receive any material of that type, by letting us know your wishes. QPCN is available online at http://www.pcfa.org. au/qld/newsletter.htm. Should you receive multiple copies, please let us know which address(es) to remove from which mailing list(s).

A masochist was in the mood to indulge himself and was letting his fingers do the walking through the listings of the local, somewhat more kinky establishments to enquire what they might be able to offer. “I want to be thoroughly hurt and humiliated and leave feeling that I’m the lowest possible form of life” he told the receptionist at one location. “What can you offer?” The receptionist informed him they could cater to his whims for $50. “Wow, only $50, what do I get for that!” The receptionist replied, “a baggy green cap and a cricketer’s shirt”.

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