LIFEBUOYthe

Dear Readers

As promised this edition of the “Lifebuoy” includes articles on low dose rate brachytherapy or “seeds”, as this year marks 10 years since this form of treatment for prostate cancer was introduced to St Vincent’s and the east coast of Australia. These articles have been written by Dr Peter Duval, a radiation oncologist at St Vincent’s and Pat, the first patient to have received this treatment. Also included are articles on the various research projects that are being conducted here at St Vincent’s in conjunction with the Garvan Institute. I hope to include a section on the research projects in each edition of the newsletter so that you can appreciate the wonderful and tireless work that is being conducted to help not only in the prevention but also in the treatment and management of the disease.

Our last support group meeting as expected was well attended and very interesting with A/Prof. Phillip Stricker speaking on robotic surgery. This is certainly a very exciting new technology and will no doubt continue to revolutionise surgery over the next few years. Michelle Pisani, a Physiotherapist will be guest speaker at our next meeting on August 7th. She will be speaking on keeping fit and healthy especially with prostate cancer. I encourage you to come and listen to Michelle as I am sure she will be able to offer helpful advice. The launch of the new television PCFA awareness campaign by Angry Anderson was held on June 4th in Sydney. The launch coincided with International Men’s Health Week and it was great to see so many supporters of the PCFA there to help in the fight against prostate cancer. Angry is a passionate supporter of the PCFA as one of his closest friends died last year from the disease. The commercials hopefully will encourage men to talk to their Doctor about their prostate.

The PCFA is holding its second Fathers Day Fun Run (or walk!) on Sunday September 2nd. The PCFA hopes to make this an annual and national event and I encourage as many of you to participate so that it is a fun and successful event. Support this great cause by joining in with your wife or partner, children, grandchildren, friends and work colleagues. For more information please contact the PCFA or visit their website.

Previously, the majority of our articles have been centred on localised prostate cancer so in our next newsletter it will feature an article by Joe, a patient who was diagnosed with advanced disease several years ago. I am sure that you will find his story not only interesting but inspiring. He underwent several different forms of treatment and he also was encouraged and followed several concepts by Dr Charles “Snuffy” Myers. Snuffy is a Doctor from the USA who developed prostate cancer whilst head of the National Cancer Institute of America. He has written several books and prostate forums. I will give more details of these and how to obtain them in the next newsletter.

Finally, I would like to thank the family and friends of the late Bob Beveridge for the memorial gift donations given in his honour. Also the late Peter Mathews for his generosity bequeathed in his will. These donations help in the ongoing research into prostate cancer.

Jayne MatthewsCo-ordinator St Vincent’s Prostate Cancer Centre

St Vincents Hospital

Prostate Cancer Support Group

affiliated with the

Prostate Cancer Foundation of Australia

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At St. Vincent’s (Private) Hospital the seed brachytherapy program has been in place now for ten years and almost 400 patients have successfully undergone this procedure using radioactive iodine seeds.

Pioneering groups in the USA have now published ten and fifteen year results and have confirmed the very high cure rate achievable with permanent seed implants, which in “early” prostate cancer, equals that of radical prostatectomy, namely 80-90% of patients are cured.

“Early” or “low risk” prostate cancer is when the PSA is less than 10, Gleason score (grade of the cancer) is 6 or less and the percentage of the biopsy cores involved with cancer is low. Other criteria that need to be met to qualify for the seed program are a normal cystoscopic examination, the volume of the prostate needs to be less than 40-45cc and the patient cannot have significant urinary outflow symptoms as measured with the AUA (American Urological Association) symptom scoring system.

The above parameters need to be met to qualify for Medicare rebate and hence for reimbursement by health funds for the cost of the radioactive seeds. Recently evidence has shown that selected patients treated with seeds for prostate cancer with the above criteria but with a Gleason score of 7 also have a very good prognosis but only if the score is 3+4, not 4+3. As a result Medicare will now also reimburse these patients.

The St. Vincent’s experience has achieved results so far that are at least as good as those referred to above, thanks to a dedicated team of Physicists, Urologists and Radiation Oncologists and to an excellent quality assurance program so essential in this type of work. To verify the quality of the implant, patients return four weeks after the implant to have a CT scan through the prostate region, the final geometry of the seeds is worked out which enables the physicist to recalculate the final radiation dose distribution throughout the prostate and give a measure of the quality of the implant based on the V100 (the volume of prostate that received 100% of the planned dose) and the D90 (the dose received by 90% of the prostate).

The seed program continues to attract many patients to St. Vincent’s in view of our large experience and its relative simplicity for the patient as it involves only an overnight stay and since we have been able to refine our technique very minimal urological side effects.

by Dr Peter DuvalP ERMANENT SEED BRACHYTHERAPYAN EXCELLENT TREATMENT FOR EARLY PROSTATE CANCER

PATRICK’S STORYAfter a regular check-up in late 1996 my PSA test results showed a marked increase which warranted a biopsy. The results of the biopsy indicated a number of small tumours, one of which was positive with a Gleason value of 7.

I was referred to A/Prof Phillip Stricker as a possible candidate for the new Brachytherapy method. This involves Radioactive Seed Implants into the prostate. I understood that this method provides internal radiation rather than the conventional external method which has some unpleasant ongoing side effects.

Brachytherapy images supplied by Oncura

Why buy when you can

borrow !We are constantly expanding our library. Please call the Prostate Cancer Centre on 02 8382 6530 to borrow books or DVD’s or when you attend our support group meetings.

by Dr Peter Duval

Meetings for 2007 – Mark these in your diary! ■ Tuesday August 7th - Michelle Pisani “Fighting Fit for Prostate Cancer” ( note the day and date change )

■ Wednesday November 14th - Speaker to be confirmed

Upcoming PCFA Activities.The PCFA is constantly organising events to further prostate cancer education, awareness and raising funds for ongoing research. Note these NSW activities in your diary:

■ July 13: ANZIFF – insurance industry fundraising luncheon

■ September 2: Fathers Day Five – community fun run at Sydney Olympic Park

■ September 16: PCFA Men’s Health Promotion conference Sydney

■ November: “Movember” get sponsored to grow your moustache to raise awareness and funds for prostate cancer.

Check the PCFA website for further details.

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During December 1996 various tests were carried out and it was decided that we could proceed with the Brachytherapy treatment A plan was formulated which involved the assessment of the seed requirements and hormone treatment for two months.

At this time I was fortunate to hear that a distant relative in Seattle had undergone Brachytherapy some ten years previously. I was able to talk to him and I received a glowing report of his successful result with minimal effects to his lifestyle since the procedure. He also advised that the famous golfer Arnold Palmer was one of the early success stories.

At the time of my procedure in February 1997 my PSA had risen to 19.7 which naturally was a concern. The Low Dose Rate Brachytherapy was performed by A/Prof Stricker at St Vincent’s hospital. I recall that it took something like three hours to insert about seventy seeds into the prostate. After an overnight stay in the hospital I was able to resume all my normal activities with minimal side effects.

Over the past ten years regular annual PSA tests are consistently around 0.1 or virtually non existent. I am particularly grateful to Dr Graeme Morgan for the initial referral and especially to A/Prof Phillip Stricker who gave me the confidence to try something very new to Australia and to achieve such a remarkable end result for my ongoing well being and healthy lifestyle. I also must mention the support I received from Jayne Matthews at the surgery and of course to my wife Dee who stood by me during the decision-making and the pre and postoperative periods.

I am convinced that the key to my successful outcome was the early detection and the prompt response by the medical fraternity when the initial indicators became known. I only hope that other men can be aware of the indicators and take the appropriate action as soon as possible.

The Cancer Genetics team at the Garvan Institute of Medical Research, headed by Dr Vanessa Hayes, has been investigating the role of genes involved in the activation and action of sex hormones and risk to prostate cancer.

There are currently only three known risk factors of prostate cancer, namely older age, ethnic origin (with African-Americans having the highest incidence rates and Asians the lowest), and a family history of prostate cancer. Although a number of environmental factors such as smoking, hair dye and ultraviolet radiation have been implicated in other cancer types, no single environmental risk factor has been confirmed to either increase or decrease risk of prostate cancer. Ones genetic make-up is therefore believed to play a pivotal role in predisposing men to prostate cancer.

It is well known that prostate cancer is hormone regulated. Recent studies have therefore focused on the genes that control male hormone action and function. To understand what predisposes men to develop prostate cancer, scientists need to study large numbers (in the thousands) of men of a similar age with and without prostate cancer. Comparing the two groups in order to discover associations with genetic markers. This is known as a case-control study. The Cancer Genetics team at the Garvan, together with collaborators from the Cancer Council of Victoria (under the leadership of Prof. Graham Giles), has assessed genes of hormone regulation in DNA extracted from over 1,600 Australian men with or without prostate cancer. They have identified a number of genetic markers located in genes that regulate testosterone action as being significantly associated with prostate cancer risk or disease progression. They also found a strong genetic association with male patterned balding, a condition regulated by male hormones. By identifying which genes predispose men to prostate cancer, researchers can utilise this information to develop hormone-based therapeutic targets.

Current knowledge on the role, if any, of benign prostatic hyperplasia (BPH) on conferring risk to prostate cancer is uncertain. Dr Hayes together with the urologists at the St Vincent’s Hospital, are collecting blood samples from patients diagnosed with this benign condition. The purpose of this study will be to determine if genetic predisposition to BPH versus prostate cancer differs, thus giving researchers further insight into the genetic basis of both these conditions.

The way to diagnose most cancers including prostate cancer is by a biopsy of the affected area. The method that a biopsy of the prostate is performed is via the transrectal (rectum/back passage) technique. For many years this has been an effective way to diagnose prostate cancer however it has not been without its problems. Some of the possible complications of the biopsy are septicaemia (infection), bleeding, pain, urinary retention and sampling error.

To minimise these possible complications the Urologists at St Vincent’s since 1999 have started to perform the majority of prostate biopsies via the transperineal (perineum/between the scrotum and rectum) technique. These biopsies are performed under a light general anaesthetic therefore making the procedure much more comfortable for the patient, enabling more regions of the prostate to be sampled and lessen the chance of infection. Through the Prostate Cancer Centre, one of the research projects that is currently being undertaken is evaluating early and late complications following transperineal prostate biopsies performed by A/Prof. Phillip Stricker and Dr Phillip Brenner. During the last five months, over one hundred men have been interviewed via telephone following their biopsy. To date there have been no serious complications with no readmissions to hospital. The requirement of analgesia or bleeding post biopsy has been low.

At this stage of the research it appears that this form of biopsy technique is a safe method with a low incidence of any major or minor complications.

If you have been diagnosed with BPH and would like to participate in this study, then we would appreciate it if you could contact Sr Anne-Maree Haynes at 92958335.

What prediposes men to prostate cancer ?

Prostate biopsies

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