theSt Vincent’s HospitalProstate Cancer Support Group

affiliated with the

Prostate Cancer Foundation of Australia LIFEBUOYBUOYBUOYDear Readers

On reflection, 2009 has been a busy and most fulfilling year. Being part of the ongoing research work conducted through the Centre and the Garvan Institute is, as always, most rewarding. In March I attended the American Urological conference in Chicago which was a real buzz. The lectures and presentations were very well delivered and interesting. The launch of the prostate cancer DVD “So, How Do You Choose” at Parliament House in Canberra was exceptionally successful and a real highlight of the year.

This year our support group meetings have covered many different topics and have been well attended. I thank all the speakers who have generously given their time to share their knowledge with us. Our last meeting held on November 4th was particularly well attended with just over 150 people. Dr Joe Enis was the guest speaker and it was a most interesting talk. The feedback has been overwhelming. A copy of his powerpoint presentation is in this newsletter.

Please note the dates of the support group meetings for 2010. Our first meeting kicks off with Dr Charles “Snuffy” Myers on Monday the 8th February at the Garvan Institute. Dr Myers will be speaking in Sydney, Melbourne & Brisbane. You will be required to register to attend. This can be done through the PCFA website www.prostate.org.au. For further details see page 8. Topics for the remaining meetings of 2010 are as yet to be finalised.

I would like to acknowledge all those who have generously donated to the St Vincent’s Prostate Cancer Centre throughout the year. In particular Lang & Sue Walker & the Walker Foundation, the “Paint a Rainbow Foundation”, the Freedman Foundation, Riversdale Mining Ltd and the late Sir Ian McFarlane. A special thanks also to those people who constantly support our Centre year after year. These donations allow ongoing prostate cancer research, community development such as the production of the DVD “So, How Do You Choose”, the continual upgrade of our website www.prostate.com.au, the production and distribution of this newsletter to over 1000 readers plus many other projects. I also wish to thank the family of the late John Turnbull for the memorial gift donation to the Centre in his memory. I look forward to having a holiday and to return feeling refreshed to face the challenges of 2010 and build on the work that is currently in progress. Finally, I would like to wish you all a wonderful festive season with your family and friends and may 2010 bring happiness and good health. Enjoy the read!

Jayne Matthews - Coordinator

I S S U E 4 2 0 0 9

prostate cancercentre

www.prostate.com.au

A robotic fellowship down under?

The robotic fellowship program was first introduced to St Vincent’s Private Hospital in 2008 under the supervision of A/Professor Phillip Stricker. It is formally accredited as a fellowship by the Urological Society of Australia and New Zealand (USANZ) and is funded through the St Vincent’s Prostate Cancer Centre.

Bonjour, je m’appelle Nicolas Doumerc...sorry…G’day, I’m Nicolas Doumerc, 34 years old and a fully certified urologist in France with a laparoscopy surgery background. I live in Toulouse, a city of

southern France well known for almost 3 reasons: Airbus (A380), Football (Stade Toulousain), Architecture (pink bricks). The choice to go overseas wasn’t an easy one, but I found 3 good reasons to do it: learning the robotic surgery in a high volume institution, travelling and experiencing the life “Down Under”, and…improving my English! So, as an Australian expression says, please excuse my French…sorry my English. My fiancée and I arrived on the 8th January 2009. We left London in a freezing winter and landed in Australia during a warm summer. Welcome to Australia, mate!

My fellowship year was dedicated to two main topics: learning the robotic prostate surgery and research in prostate cancer. The first difficulty I met (except the English language) was to learn the robot assisting. Despite my laparoscopic background, it was a really new technique to be confident with. Given that the quality of the assisting directly impacts the functional

and pathological outcomes of the surgeon, the help of my colleague and now friend Dr Carlo Yuen was crucial. Thus, case after case I became autonomous. Then, the second difficulty met was to adapt my assisting to 3 different surgeons’ techniques

(Dr Brenner, Dr Kooner and A/Prof. Stricker). The robotic fellow should be flexible in his assisting to meet the highest standards of each surgeon. The research aspect of my position was just as interesting as learning to use the robot. The high level of interaction between St Vincent’s Clinic, St Vincent’s Private Hospital and the Garvan Institute allowed me to deal directly with the largest database in the southern hemisphere. I do think that a modern health institution requires this partnership to improve the quality of healthcare provided to patients.

What’s a typical agenda of a robotic fellow? The robotic assisting was shared with the second robotic fellow Dr Carlo Yuen. Thus, I usually assisted 4 procedures or so a week. The remaining time was used to carry out research studies as my paper has just been published in the British Journal of Urology International “Should open experienced prostatic surgeons convert to robotic surgery? The real learning curve of a single surgeon over 3 years.” N.Doumerc, C.Yuen, R.Savdie, B.Rahman, K.Raziah, R.Pe Benito, AM. Haynes, J. Matthews, P.Stricker. Research and clinical meetings (radiology and onco-pathological) helped me not to lose my general urological reasoning in a very specialised environment like St Vincent’s Prostate Cancer Centre. Finally, I was involved in the public hospital roster - 1 or 2 days on call a week. Thus, I experienced the management of urological emergencies in a public Australian healthcare centre.

What have I learnt? Firstly, the management of patients in a very specialised centre was very interesting to observe and to learn about. I was particularly amazed by the time spent to inform patients before and after the surgery. Frenchies should improve especially in that area! Secondly, the high level of the robotic surgeons’ experience was a very precious asset for a young robotic surgeon like me: knowing all the assistant difficulties and how to fix them is crucial, avoid the mistakes of the early learning curve when considering a new technique is precious as well. I do think that nothing could replace the experience of high volume centres.

What’s coming up for me? Paradoxically, this robotic fellowship year will benefit me next year. My institution has recently bought a robotic device and I’m expected as a consultant to start the robotic programme. In my country, few robotic surgeons have previously completed a fellowship year dedicated to the robotic-assisted laparoscopic prostatectomy. However, when considering the introduction of a new technique, the most difficult part is to complete your own learning curve - my real learning curve is still ahead! But I hope that my laparoscopic background combined with my fellowship in St Vincent’s Private Hospital will dramatically shorten this learning curve. To tell you the truth, I hope my agenda will allow other

educational tasks... such as travelling to the Red Centre, the Top End and the Kimberley!

To conclude, I would say that more than just a simple year in my training, it was one of the best years of my life and I want especially to pass my sincere gratitude to St Vincent’s Prostate Cancer Centre and its donors.

use the robot. The high level of interaction between St Vincent’s Clinic, use the robot. The high level of interaction between St Vincent’s Clinic, use the robot. The high level of interaction between St Vincent’s Clinic, use the robot. The high level of interaction between St Vincent’s Clinic, St Vincent’s Private Hospital and the Garvan Institute allowed me to deal St Vincent’s Private Hospital and the Garvan Institute allowed me to deal St Vincent’s Private Hospital and the Garvan Institute allowed me to deal directly with the largest database in the southern hemisphere. I do think directly with the largest database in the southern hemisphere. I do think that a modern health institution requires this partnership to improve the that a modern health institution requires this partnership to improve the quality of healthcare provided to patients.

What’s a typical agenda of a robotic fellow? The robotic assisting was shared with the second robotic fellow Dr Carlo Yuen. Thus, I usually assisted shared with the second robotic fellow Dr Carlo Yuen. Thus, I usually assisted shared with the second robotic fellow Dr Carlo Yuen. Thus, I usually assisted 4 procedures or so a week. The remaining time was used to carry out research studies as my paper has just been published in the British Journal research studies as my paper has just been published in the British Journal of Urology International “Should open experienced prostatic surgeons convert to robotic surgery? The real learning curve of a single surgeon over convert to robotic surgery? The real learning curve of a single surgeon over 3 years.” N.Doumerc, C.Yuen, R.Savdie, B.Rahman, K.Raziah, R.Pe Benito, AM. 3 years.” N.Doumerc, C.Yuen, R.Savdie, B.Rahman, K.Raziah, R.Pe Benito, AM. Haynes, J. Matthews, P.Stricker. Research and clinical meetings (radiology Haynes, J. Matthews, P.Stricker. Research and clinical meetings (radiology and onco-pathological) helped me not to lose my general urological and onco-pathological) helped me not to lose my general urological reasoning in a very specialised environment like St Vincent’s Prostate reasoning in a very specialised environment like St Vincent’s Prostate Cancer Centre. Finally, I was involved in the public hospital roster - 1 or Cancer Centre. Finally, I was involved in the public hospital roster - 1 or 2 days on call a week. Thus, I experienced the management of urological 2 days on call a week. Thus, I experienced the management of urological emergencies in a public Australian healthcare centre.

What have I learnt? Firstly, the management of patients in a very specialised centre was very interesting to observe and to learn about. I was educational tasks... such as travelling to the Red Centre, the Top End and educational tasks... such as travelling to the Red Centre, the Top End and educational tasks... such as travelling to the Red Centre, the Top End and particularly amazed by the time spent to inform patients before and after the surgery. Frenchies should improve especially in that area! Secondly, the high level of the robotic surgeons’ experience was a very precious asset To conclude, I would say that more than just a simple year in my training, To conclude, I would say that more than just a simple year in my training, To conclude, I would say that more than just a simple year in my training, for a young robotic surgeon like me: knowing all the assistant difficulties it was one of the best years of my life and I want especially to pass my it was one of the best years of my life and I want especially to pass my

sincere gratitude to St Vincent’s Prostate Cancer Centre and its donors. and how to fix them is crucial, avoid the mistakes of the early learning sincere gratitude to St Vincent’s Prostate Cancer Centre and its donors. curve when considering a new technique is precious as well. I do think that curve when considering a new technique is precious as well. I do think that curve when considering a new technique is precious as well. I do think that nothing could replace the experience of high volume centres.

What’s coming up for me? Paradoxically, this robotic fellowship year will What’s coming up for me? Paradoxically, this robotic fellowship year will What’s coming up for me? Paradoxically, this robotic fellowship year will

Dr Myers’ Approach to Advanced PC

•! Several cancers, even if metastatic, can now be cured. Only possible if first achieve a complete remission

•! Complete remission possible in advanced PC, even with metastatic disease

•! So first step in managing advanced PC is try to attain a complete remission

(PSA< 0.01, CT and bone scans clear)

Dr Myers’ Approach to Advanced PC

•! But in PC, attaining complete remission isn’t a cure. Some patients have microscopic deposits of cancer that will regrow over time

•! So second step is to start a program to help maintain complete remission by keeping any remaining cancer cells dormant as long as possible

Attaining Complete Remission

•! To attain complete remission, many with advanced PC need hormone therapy at time of surgery or radiotherapy, others after these have failed

•! HT essential for the few who present with metastatic disease

•! Diet, supplements and lifestyle changes help hormone therapy achieve these goals

Attaining Complete Remission

•! Prostate cancer cells need testosterone and DHT to survive and thrive …

•! These combine with androgen receptor in PC cells to promote cancer cell growth

•! Most testosterone produced in testes, but some made from androgens produced in adrenal glands

•! Testosterone can be converted to DHT. DHT is 10 times stronger

Intermittent First Line HT •! Start with intermittent first line HT, initially

for 12 months. Aim to suppress influence of male hormones on prostate (Lucrin/Zoladex, Cosudex/Anandron and Avodart/Proscar)

•! Diet, supplements and lifestyle changes important part of this program…

•! After first cycle of treatment ends, some remain in complete remission for years

Intermittent First Line HT

•! Lucrin/Zoladex stop testosterone production in testes (but DHT levels often unchanged)

•! Effectively suppress testosterone in > 90%

•! Cosudex/Anandron (antiandrogens) prevents any remaining testosterone, DHT combining with androgen receptor

•! Combining Cosudex and Lucrin improves clinical effectiveness of Lucrin by 20%...

Brighter Future

Hormone Therapy, Diet, Supplements

aAdvanced Prostate Cancer

My Story

•! Diagnosed 7 years ago, aged 55, with PC, multiple metastases

•! Early signs of spinal cord compression

•! PSA 554

•! Given < 3 years to live

•! Last 2! years PSA < 0.01 and no mets following first- then second- line HT

•! Last 1! years on maintenance program…

Dr Joe Enis

Intermittent First Line HT

•! Proscar/Avodart block DHT formation…

•! By adding Avodart to Lucrin and Cosudex, response more rapid and more complete

•! After first course completed and Lucrin, Cosudex suspended, continuing Avodart helps delay next cycle

Intermittent First Line HT

•! First cycle continued 12 months to allow maximum tumour shrinkage. Resume as soon as PSA next begins to rise

•! Important to reduce PSA to < 0.01. If not, PC regrows rapidly as testosterone recovers

•! Most complete 3-7 cycles before they become hormone resistant

•! Benefits of IHT: fewer side effects, may delay onset hormone resistance

Side effects of First Line HT

•! Hypertension, hyperlipidemia, diabetes, leading to cardiovascular disease

•! Impaired sexual function •! Breast symptoms •! Weight gain •! Loss of muscle bulk, strength •! Osteoporosis •! Depression, poor concentration

Intermittent Second Line HT

•! If first line HT not enough to produce complete remission (often the case in metastatic disease), or after it has failed, go straight to second line HT …

•! Get on to this early, don’t wait for disease to take hold. All therapies most effective when tumour volume is small

•! Diet, supplements and lifestyle changes still important

Intermittent Second Line HT

•! Most doctors use one or two agents eg another antiandrogen and Ketoconazole. Rarely use oral Estrogen because of its major vascular complications …

•! Usually use these separately, happy if PSA halves. Only 25-50% achieve this

•! Response usually lasts months not years. Less with second drug as resistance develops to each in turn

Intermittent Second Line HT

•! Dr Myers uses Ketoconazole, Leukine, Estrogen patches, all together, as this is best way to avoid drug resistance …

•! Multi-targeted therapy successful in other diseases where resistance a problem eg TB, malaria, HIV

•! Used together, complete remission much more frequent, often lasts years and patients survive a lot longer

Intermittent Second Line HT

•! First cycle of second line HT given for

12 months

•! Ketoconazole suppresses adrenal androgen production. Half dose just as effective. Used alone, PSA halved in 50%...

•! Leukine improves immune response against PC. Combined with Ketoconazole, 75% achieve halving of PSA. Usually well tolerated (expensive, must be imported)

Intermittent Second Line HT

•! Estrogen skin patches suppress testosterone production. Avoids major vascular complications seen when Estrogens first used orally…

•! When patches added to Ketoconazole and Leukine, PSA halves in 80%. Even with metastatic PC, 50% may achieve a complete remission. This may last years…

Chemotherapy

•! Chemotherapy only considered if hormone therapy can’t achieve full remission

•! Often unnecessary, or at least greatly delayed

•! More effective when cancer volume reduced by earlier treatment

Maintaining Complete Remission

•! At diagnosis, all PC patients have cancer cells in blood, 80% in bone marrow

•! Only small portion of these cells survive in a dormant state. May re-emerge years later as metastatic disease

•! In time, up to one third may relapse following surgery …

•! Relapses may occur as late as 22 years or more after surgery

Maintaining Complete Remission •! At present no way of knowing who will recur

and who won’t •! Thus wise to think about PC as a lifelong

problem, like diabetes & hypertension •! Once in complete remission, start program to

reduce risk of recurrence •! Includes changes to diet and lifestyle, •! Relatively non toxic agents to help keep cancer

cells dormant

Maintaining Complete Remission

The following agents are thought to keep cancer cells dormant in 3 ways…

•! Prevent new vessel formation – Avodart, Celebrex •! Promote immune attack – Leukine •! Reduce ability of cancer to grow and spread

– Resveratrol •! Possible role for Statins

Maintaining Complete Remission

Dr Myers has successfully applied this maintenance program to 3 groups

•! Those currently in complete remission following RP or RT, but at high risk of cancer recurring

•! Those with metastatic disease currently in complete remission following HT

•! Those on ‘active surveillance’

Causes of death (PC " 65 years)

•! 40% will die from prostate cancer

•! 30% will die from cardiovascular disease

(1st line HT may contribute to this)

•! 12% will die from other cancers, esp. colon

•! The same dietary and lifestyle factors that increase risk of PC also increase risk of heart disease and colon cancer

•! Mediterranean diet and lifestyle changes greatly reduce impact of all 3 diseases…

Obesity

•! Increases risk of developing more aggressive prostate cancer, cardiovascular disease, other cancers, esp. colon cancer

•! Increases risk of recurrence following RP •! Weight gain common in men on first line HT •! Weight loss helps reverse all these problems.

Aim for BM1 # 25 …

Exercise •! Regular aerobic exercise also reduces risk of

advanced prostate cancer, cardio- vascular disease and colon cancer

•! It will reduce some side effects of first line HT - weight gain, muscle weakness, osteoporosis

•! Need minimum of 30 minutes daily. A brisk walk will do…

Stress

•! Stress may hasten the development and progression of PC

•! Hormones released during stress may stimulate growth of PC and reduce immune response against it

•! Relaxation in the form of meditation, gardening, walking or listening to music may help

Autopsy Studies •! PC as common in Japan as USA and many

western countries, but death rate from PC 90% lower in Japan

•! When Japanese men migrate to USA, death from PC increases toward that of local population, in proportion to time they have lived there

•! Suggests environmental factors contribute to development of PC

Role of Fats

•! Prostate cancer cells, unlike many other cancers, depend on fat, not glucose, for energy

•! US and Japanese diets differ greatly in the amount and type of fat they eat

•! Two fatty acids strongly associated with advanced PC are arachidonic acid and alpha linolenic acid…

Bad Fats

•! Arachidonic acid found in red meat, pork, dairy fat and egg yolk

•! Alpha Linolenic Acid (ALA) found in many vegetable oils eg canola and esp. flaxseed oil. Also found in walnuts and pecans

•! Most of these foods typically found in many western diets

Diets that suppress PC growth

•! OKINAWAN DIET Lots of fish, fruit, vegetables, grains and soy. Little red meat, eggs and dairy products

•! MEDITERRANEAN DIET (Crete) Lots of fish, fruit, vegetables, grains, legumes, olive oil, nuts and red wine. Little red meat, eggs and dairy products

•! Mediterranean diet studied most, easiest to adhere to over time

HALE Project

•! When > 2,000 healthy Europeans aged 70-90 adopted four healthy changes over ten years (Mediterranean diet, brisk walking, moderate alcohol, no smoking)

•! Risk of death from all cancers (incl. prostate) and from cardiovascular disease reduced by two-thirds!

Lyon Diet Heart Study

•! 600 admitted to ICU with first heart attack randomised to Mediterranean or control diet

•! After only 4 years, patients on Mediterranean diet had 50% fewer deaths, 50% fewer new heart attacks and 60% fewer new cancers

Saxe Study

•! Among a group of men with recurrent PC after RP, Mediterranean diet plus stress management increased PSADT by 2/3

•! This took them from a high risk of death at 10 years, to a very low risk…

Mediterranean Diet

•! Important for all patients with PC, regardless of severity, past or future treatment

•! Slows PSADT in most by 2/3

•! Once disease has metastasized, difficult to obtain durable, complete remission without these diet and lifestyle changes

Mediterranean Diet

•! High fat diet (30-40% fat), best reduced to < 20% when treating PC

•! Emphasizes good fats: omega 3 fats (fish) and monounsaturated fats (olives, nuts)

•! Excludes bad fats: omega 6 (red meat, egg yolk, dairy fats) and omega 3 fats from plants (vegetable oils, eg canola and esp. flaxseed)

•! Also rich in antioxidants

Meat

•! No red meat or pork. More dangerous when burnt (browned or blackened) esp. hamburger meat, as it forms chemicals that damage DNA which may aggravate prostate cancer …

•! Chicken and turkey good, but must be skinned and trimmed. When burnt, DNA changes less likely with poultry (or fish)

Eggs and Dairy

•! Avoid egg yolk (incl. mayonnaise), but egg white excellent source of protein

•! Avoid dairy fat, but skim milk, non-fat cheese and ice cream fine

•! Avoid margarine (ALA)

•! Avoid milk chocolate, but dark chocolate fine

Fish •! Fish ! twice a week reduced risk of recurrent

cancer following RP by 2/3

•! Fish ! four times a week halved risk of getting metastatic PC

•! Fish best eaten 5 times per week

•! Best grilled, baked or poached. Benefits lost if fried in unsafe oil. If fried, use olive, avocado or hazelnut oil

•! Avoid heating till browns or blackens

Fish

•! Fish caught wild in cold ocean waters best eg tuna, cod, salmon, trout, herring, sardines. Obtain healthy omega 3 fatty acids (EPA, DHA) from algae they eat

•! Other fish fine but no benefit for PC •! Salmon and trout farmed here. May be fed flaxseed

(ALA), but salmon can’t convert this to EPA, DHA, trout can

•! Salmon may only be good wild not farmed…

Nuts and Oils

•! Pistachios, almonds, cashews, macadamia and hazelnuts very good (monounsaturated fats, antioxidants). Don’t skin or roast. Avoid walnuts and pecans (ALA).

•! Olive oil, avocado and hazelnut oils very good (monounsaturated fats, antioxidants), but avoid vegetable, canola and esp. flaxseed oil (ALA)

Fruit and Vegetables •! All fruit and vegetables good, should form

bulk of diet. Don’t add too much to total calorie intake. esp. olives, avocados, tomatoes (best as juice or cooked).

•! Dark red/purple fruit esp. good eg dark grapes, berries and pomegranates

•! Cabbage family (best raw) very important: cabbage, cauliflower, broccoli, brussel sprouts, onions and radish

Grains and Legumes

•! Grains good eg bread, cereal, pasta, rice. Eat in moderation because of their high caloric value

•! Legumes good eg beans, peas, lentils

Red Wine

•! Red wine better than white

•! One glass of red wine a day reduced risk of high-grade PC by 2/3

•! Red wine contains several useful ingredients, esp. Resveratrol

Antioxidants

•! Oxidative damage is a major factor in development of PC, and in time, more aggressive disease

•! Antioxidants help prevent PC and manage established disease

•! Foods containing antioxidants: fruit, vegetables, nuts, olive oil, dark chocolate

Caution

•! Patients who do worse than expected are commonly obese, don’t exercise and/or continue to consume red meat …

•! Patients who do better than expected commonly follow a healthy diet and exercise regularly

Supplements

•! Vitamin D *

•! Pomegranate *

•! Lycopene

•! Fish Oil *

•! Vitamin E (gamma or delta)

•! Selenium (as Selenium- yeast)

•! Soy Isoflavones *

Vitamin D

•! Giving 2,000 IU Vitamin D daily to men who’d relapsed following surgery or radiotherapy almost doubled PSADT

•! Recommend 4,000 to 5,000 IU daily. 2,000 IU daily may do if routine sun exposure…

•! Must monitor blood levels, aiming for upper half of therapeutic range

Pomegranate

•! Giving 250 ml pomegranate juice daily to men who’d relapsed following surgery or radiotherapy almost quadrupled PSADT..

•! Pomegranate is a strong antioxidant •! Keep in cool, dark place and refrigerate once

opened

•! Take 250 ml pomegranate juice daily

Lycopene •! Adding low dose Lycopene to first line HT

doubled frequency of complete remission in men with metastatic PC

•! Giving Lycopene for several weeks prior to RP reduced extent of disease found at surgery

•! Lycopene is a strong antioxidant •! 10 mg Lycopene tds seems optimal

Vitamin E •! Giving low-dose alpha Vitamin E to a normal

group of men reduced death rate from PC by 40% after only 5-8 years

•! Vitamin E is a strong antioxidant •! Best given as gamma or delta (not alpha) in

dose of no more than 200 IU daily

•! May cause bleeding tendency, esp. at higher doses. Stop prior to surgery

Selenium •! Giving Selenium (as Selenium-yeast) to a

normal group of men reduced death rate from PC by 2/3 after 10 years

•! Selenium is a strong antioxidant •! Best given as Selenium-yeast in dose of 200

mcg daily

•! Avoid if diabetic

•! SELECT trial…

Caution

•! Radiotherapy acts in part by causing oxidative damage to its target

•! Antioxidants Vitamin E, Selenium, Lycopene, Pomegranate should be avoided whilst receiving radiotherapy

Fish Oil

•! Fish oil supplements not as good as fish. Take 2,000 IU twice daily, at least on non-fish days

•! Keep in cool, dark place and refrigerate once opened

•! Avoid if has fishy odour

Soy Isoflavones

•! Metastatic PC uncommon in countries where soy intake high

•! Giving 100 mg twice daily to men who’d relapsed following surgery or radiotherapy slowed PC growth in 84%

•! Take 100 mg twice daily •! Monitor PSA carefully in beginning

DR CHARLES ‘SNUFFY’ MYERS IN AUSTRALIA FEBRUARY 2010

VENUES: Sydney 8 February, 7-9pm, Garvan Institute 384 Victoria Street Darlinghurst Brisbane 10 February, 3-5pm, Queensland Conservatorium of Music 16 Russell Street South Bank Melbourne 11 February, 4.30pm-6.30pm, RACV Level 17 Function Room, 501 Bourke Street Melbourne TOPIC: Advanced Prostate Cancer – How to Tailor Treatment for Your Disease

COST:$10.00 (including GST) Including refreshments - served at the venue 30 minutes prior to commencement of the event.

BOOKING: Online only at www.prostate.org.au. (Due to expected demand tickets are only available via online pre-purchaseSeats are limited so book early to secure your place at these special events. Groups bookings available.

prostate cancercentre

The Prostate Cancer Foundation of Australia and St Vincent’s Prostate Cancer Centre are honoured to welcome Dr Charles ‘Snuffy’ Myers to Australia.

Dr Charles Myers opened the American Institute for Diseases of the Prostate in 2001 to provide men with comprehensive treatment of all stages of prostate cancer. The Institute draws patients from all over the world. Dr Myers is the Medical Director of the Institute and President of the Foundation for Cancer Research and Education. He draws upon his wealth of experience as Chief of Clinical Pharmacology at the National Cancer Institute at the National Institutes of Health and Director of the Cancer Center at the University of Virginia. He has published over 250 research papers in the clinical and basic sciences of cancer and other diseases. Dr Myers speaks frequently to patient groups and physicians. He is editor of the Prostate Forum and has written several books on prostate cancer.

Dr Myers' lecture tour is supported by the Prostate Cancer Foundation of Australia and St Vincent’s Prostate Cancer Centre.

I attended two sexual health conferences in Europe mid 2009. The first conference in June was the World Association of Sexology meeting in Gothenburg Sweden. This conference covered the social and psychological aspects of sexual health as well as some discussion over physical issues. There were lectures on the chemistry of sexual behaviour, the effects of cancer on male and female sexual function, the health problems of obesity, diabetes and cardio-vascular disease affecting sexual function and finally a seminar on premature ejaculation and the new treatment for this condition.

The second conference in July was in the beautiful city of Paris, it was the World Health Organisation Consultation on Sexual Dysfunction. All aspects of male and female sexual dysfunction were covered. Committees were formed to investigate and present their findings on the prevalence and evidence based treatments of all conditions. Of particular interest to me was the committee’s presentation on sexual rehabilitation post prostate cancer treatment. All the modalities of treatment were discussed and surprisingly none have yet been shown to be superior for the long term recovery of post treatment sexual dysfunction. As the statistics are constantly being reviewed, that may change by the next meeting in 4 years.

This means that any type of treatment a man is on for sexual rehabilitation is superior than not being on any treatment at all. Despite the fact that some treatments result in an earlier return of erectile function (eg penile injection therapy), the long term benefits of all treatments still needs clarification. I hope to be in Paris in 2013 to find out.

Dr Michael Lowy - Men’s Health Physician40-42 Grosvenor Street Bondi Junction Ph: 02 9387 6966www.sydneymenshealth.com.au

My name is Shalyce Corney, I am 17 years old and in year 12 at St Clare’s High School in Taree. My dad is a patient of A/Professor Phillip Stricker and was treated earlier in the year for prostate cancer. A couple of weeks ago Dad asked me what I was getting him for Father’s Day, and when I said that I didn’t know, he said that I should take any money that I was going to spend on him and donate it to the Prostate Cancer Foundation of Australia to raise awareness and money for research.

Dad showed me a newsletter called the “Lifebuoy”, and in it I saw that you can choose a day in September and get people to dress up in blue and give a gold coin donation. I decided to try this at my school. I arranged a meeting with my principal and gave him the information and we have organised for the “out-of-uniform” day to be held on Wednesday 16th September.

My dad told me to let you know what I was doing. I organised for posters to be sent from the Foundation and spoke in front of my entire school to let them know what the day was about and my Dad’s story. Everyone was very receptive and I had people coming up to me, telling me that their pop, grandad or uncle had gone through a similar thing.

Yours sincerely

Shalyce Corney

Dear Jayne Matthews

Footnote: I have since received another email from Shalyce informing me about the day and that they raised $800. Well done St Clare’s High School and especially Shalyce for taking the initiative and making a difference.

Sexual Health Conferences - 2009

Making A Difference Meetings for 2010

Check www.prostate.com.au for details

n Monday February 8th - Dr Myers at Garvan Instituten Wednesday May 12th - tban Wednesday August 11th - tban Wednesday November 10th - tba

All meetings are held in the Clinic Function Room, Level 4 St Vincent’s Clinic 438 Victoria Street (Cnr Victoria & Oxford Sts) Darlinghurst. NSW Car parking available - entry via Barcom avenue

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St Vincent’s Private Hospital Urology Ward

In this, our Centenary year, St Vincent’s Private Hospital has been busy maintaining a high standard of patient care. During 2009 it applied for Magnet Accreditation. This is an international gold standard granted to healthcare facilities that demonstrate excellence in care provision, recognising in particular, the high quality care delivered by the nurses. In 2010 SVPH aspires to become the first private hospital outside the USA to become a Magnet Designated facility.

In May, St Vincent’s Private Hospital in conjunction with the NSW Urological Nurses Society (NUNS) hosted the annual NUNS study day. Approximately 100 nurses from around the state attended with presentations from Urologists from St Vincent’s Clinic, a researcher from the Garvan Institute and St Vincent’s Private nurses. The day was a wonderful success and the hospital and in particular the Level 9 nurses were very proud of their efforts. An exciting partnership with the Notre Dame University located opposite St Vincent’s campus also hopes to provide the hospital with the opportunity for future educational collaborations.

In addition to our involvement with extended care programs, the Level 9 staff are proud to be a part of community education and awareness when it comes to health issues, and participated in the Movember Campaign aimed at raising the awareness of men’s health issues. Sponsored by Beyond Blue and the Prostate Cancer Foundation of Australia, Level 9 manned Movember displays in the foyers of both the St Vincent’s Private Hospital and St Vincent’s Clinic from 23rd to 30th November 2009.

NEWSLETTER KEEPING UP WITH THE TIMESThe “Lifebuoy” newsletter was first published in 1996 by a group of men from St Vincent’s Hospital along with A/Prof Phillip Stricker & Jayne Matthews who felt that there was a need for support for men diagnosed with prostate cancer. How things have changed since that first short-run edition. The newsletter has had a design makeover and its print quality improved since it is now produced by offset print. Lifebuoy’s print run is now over 1200 and is published as a PDF on our website www.prostate.com.au.

In 2000 the newsletter previously published by the St Vincent’s Prostate Cancer Support Group joined forces with the Prostate Cancer Foundation of Australia (PCFA) and became known as the “Prostate News”. In 2006 Jayne Matthews decided that the St Vincent’s Prostate Cancer Support Group should once again have its own newsletter so the “Lifebuoy” was relaunched.

Our current “Lifebuoy” is published quarterly. To assist us to maintain accurate records, comply with privacy policies and control costs we are databasing subscribers. In 2010 subscribers will be able to elect to receive the newsletter via email. You can do this now by completing and filling the return the form below. It would also be appreciated if you change address or do not wish to receive the newsletter any longer that you inform us.

Jacinta VanderpuijeClinical Nurse Educator, Level 9

A productive 2009 has resulted in the publication of numerous manuscripts and conference presentations. This research would not be possible without many men donating biospecimens and completing the quality of life questionnaire. We are truly grateful for that.

High Quality Data + High Quality Specimens = High Quality Research

One area of great interest to scientists at the Garvan Institute is personalised medicine, which is the ability to diagnose disease, predict outcomes and provide therapy that is particularly suited to a patient. Our scientists are also identifying more reliable markers of clinical prostate cancer progression and which treatments respond to a particular therapy. For example, the protein gene AZGP1 was discovered by Garvan scientists. It is present in the epithelial cells of the prostate. It was discovered that decreased or absent expression of this gene in cancer tissue is associated with poor outcomes. We are in Phase 3, a prospective trial, of validating its use in routine clinical practice.

Dr Richard Savdie (above) has completed a fantastic year of urology research at the Garvan whilst completing a Master of Surgery at University of Sydney. Congratulations to Richard on his innovative research and his successful appointment to the Urological Training Scheme.

Manuscripts for 2009n Stage migration in localized prostate cancer has no impact on the post radical prostatectomy Kattan nomogram. BJUI Jun 2009n Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for a single surgeon over 3 years. BJUI Aug 2009

n High dose rate brachytherapy compared to open radical prostatectomy for the treatment of high-risk prostate cancer: 10 year biochemical relapse-free survival. Presented.n A role for GATA-2 in transition to an aggressive phenotype in prostate cancer through modulation of key androgen-regulated genes. Oncogene Aug 2009.n Nerve sparing effect on positive margin in radical prostatectomy. Submitted.

September 2005Unique visitors - 386Number of visits - 642Pages - 1980 [ 3.08 per visit ]

September 2009Unique visitors - 2189Number of visits - 2876Pages - 11900 [ 4.13 per visit ]

The St Vincents Prostate Cancer Centre website started about seven years ago. The GBI Creative team took it on in 2005 with a brief to improve its usability. The site underwent major transformations. On completion we monitored the stats to see if our work, especially in the area of search engine optimisation, was being received

positively. Whilst an increase in public awareness and diagnoses no doubt contributed to the rise in user numbers, we like to think that our web development played an important part. Check the web-stats that follow:

We take ‘Pages’ as our most valuable metric. In four years these have increased six fold. Consequently, there have been more enquiries sent via the ‘second opinion’ and ‘general enquiries’ forms.

The web is a constantly evolving place and prostate.com.au will need to change to meet best-practice web development standards. For 2010 we have scheduled various code upgrades that will improve usability and accessibility across all browsers. In the second quarter work will commence on a content management system to allow staff to populate the site as they require.

Is the website succeeding? Well, it is clear that the site is most popular in Australia, serving almost ninety percent of its pages to Australians - about 10,000 pages per month. And whilst the rate of growth has slowed a little, the numbers are all still growing. So we are confident in saying that the website is succeeding and moving in the right direction.

prostate.com.au

at theProstate Cancer Research

GARVAN INSTITUTE

Urology Fellow

Anne-Maree HaynesClinical Research Coordinator, Prostate Program

L O O K I N G B A C K O N

2009