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Archive for the ‘FUTURE PROSPECTS’ Category

US PROSTATE CANCER FOUNDATION: This year’s annual conference of the American Society of Clinical Oncology was uneventful and thus somewhat disappointing  in terms of findings that would suddenly lengthen the survival of men with advanced prostate cancer in 2011. READ MORE>

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UK TELEGRAPH: Survival rates for cancer patients have doubled in a generation, bringing hope that diagnosis of the disease is not the death sentence once feared. READ MORE>

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URO TODAY: As overall life expectancy grows, clinicians will be confronted more often with diseases that will not affect survival and possibly even quality of life for older people. Prostate cancer is an example of this. READ MORE>

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NEW PROSTATE CANCER INFOLINK: When it comes to prostate cancer, one of the really key issues taxing the medical oncology community over the past few days has been: “How do we need to start thinking about the future treatment of advanced prostate cancer?” READ MORE>

Mike Scott provides a list of new drugs and treatments that are now approved or in prospect for treating advanced prostate cancer.

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My PC Adventure – PART 24:

Cliche is true – cancer makes you re-evaluate

April 13, 2010

A year ago, I lay in bed at home in the mornings and stared out the window at blue skies, wishing I could be under them.

I’m looking through a different sort of bedroom window as I write this – the window of the campervan, and we’re parked beside Orewa Beach, north of Auckland.

Pohutukawa boughs frame a view beyond green and straw-coloured kikuyu and marram grass, out to the end of Whangaparaoa Peninsular, Tiritiri Matangi Island and the hill tips of Great Barrier Island popping up into the horizon of the Hauraki Gulf.

OREWA SUNRISE: Portents of rain over Great Barrier Island.

It’s a year post-prostatectomy.

We’re on holiday for a few weeks, and this April there is the same Indian summer weather, but no catheter, no bright new scar slashing the lower abdomen, no need to hold back from coughing, laughing or leaping off the bed to go for a walk.

The only “slashing” these days is at the urinal, when the flow never fails to mimic that of  mythical 18-year-olds.

The year has passed with many highlights:

  • The birth of Oliver Thomas Tucker, first grandchild (thank you Megan and Kirk).
  • Two PSA undetectables.
  • A journalism graduation dinner I was actually able to attend last month (rather than imagine from the haze of anaesthetic recovery, as happened last year).
  • A return to fitness, following walks and a change of diet to reduce red meat.
  • A couple of months’ membership of the Prostate Cancer Foundation of NZ.
  • Six months of blogging about prostate cancer, then “retirement” apart from occasional blogs. The site had 70,000 hits in the year, with about 20,000 people reading My PC Adventure.
  • Many kind messages from readers, who seem to appreciate the candour of my account.
  • Selling our house and buying a campervan, and so far several tours to beautiful parts of NZ.  We may never own another property, having fallen in love with being on the road.
  • Most important – the support of friends, colleagues and family.

YOUNG OLLIE: Me and Lin with Oliver Tucker - grandparenthood is such a bonus.

I’m now more aware than ever how widespread is the prostate cancer “epidemic”, and without compunction will ask every 40-plus male I meet  whether he gets himself tested.

An early stop on this current trip was at Palmerston North (the place John Cleese said made him suicidal) to visit my mate Lance, who is halfway through external beam radiation treatment for low grade prostate cancer. His prognosis is good.

I have one disappointment – lack of news about the NZ Parliament Health Select Committee inquiry into prostate cancer detection. It started with a hiss and a roar in September, but nothing has been heard so far this year.

My state of mind is rarely troubled by thoughts of whether or not I am “cured” of prostate cancer. It just doesn’t figure.

What scar?

However, now and again there are reminders. An acquaintance who had his prostatectomy a decade ago told me recently he was suddenly suffering peeing problems, apparently caused by scar tissue resulting from radiation he had all those years ago.

And just yesterday I had to sit down for a few minutes after feeling a bit dizzy. But that may have been an over-zealous intake of resveratrol (erm, pinot noir) the night before, and absolutely nothing to do with anything else. But you do wonder for a moment.

For those who are curious but too polite to ask, “functionality” is fine. Erection firmness is as good as ever, although the lost inch is still a little disconcerting.

Libido is normal – ie, it disappears with work stress and goes berserk during holidays.

Orgasms are just as enjoyable and intense as before, and a lot less messy, of course. No more careless maps of Asia on the bottom sheet.

The only bad in my life is stress from work. I continue the task of rebuilding Whitireia Journalism School into a half-decent hall of learning, but at times the workload is immense.

In February and March this year I found myself toiling seven days a week every week just to meet the demands of graduating 28 diploma students.

As I enter the last quarter of my life, I’m thinking seriously about how to avoid doing that for too much longer.

That’s one of the upsides of getting cancer: you take a hard look at your lifestyle.

And the view. There’s a couple of kite surfers out there on the sea. Our spell of 15 straight days without rain is about to end, by the look of the gathering nimbus and the feel of the breeze.

Bugger cancer – I’m off for a walk.  See you later.

READ the full story here: MY PC ADVENTURE

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JUNE 12: NEWSDAY: Hope for a better prostate cancer test, potential new uses for a largely discredited lung cancer drug and a warning for breast cancer patients all emerged last week from a meeting of the American Society of Clinical Oncology in Orlando, Florida. READ MORE>

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MAY 31: NEW PROSTATE CANCER INFO-LINK: The future of prostate cancer detection may lie in complex assays systems that can test for several markers at the same time and use the accumulated data to assess prostate cancer risk. READ MORE>

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MAY 22: PROSTABLOG NZ:  How many questions did you ask your doctor when you got the news you have prostate cancer? A dozen? More?

I can’t remember now, even though it was less than six months ago, but I’m guessing it would barely have broken double figures, even by the time I was on my third visit to the urologist.

Did you know there are at least 28 queries you should probably make, and another 22 if you’re looking at brachytherapy?

I know this from an excellent new book on prostate cancer just published by the Michael Dattoli and his colleagues in Florida – The Dattoli Blue Ribbon Prostate Cancer Solution:  How to survive and thrive without surgery (February, 2009).

DattoliBk 1It’s a 260-page manual on the latest techniques for treating prostate cancer, most of it written by Dattoli, whose pen portrait in the back says he is “a board-certified oncologist with more than 20 years of brachytherapy experience and has performed thousands of prostate implant procedures…a noted author and speaker in this complex field of medicine.”

Aha, perhaps I hear you say:  he’s biased towards radiotherapy and hence the tilt at surgery in the book title.

Maybe. I’m hardly in a position to judge, being merely a humble prostate patient, although one who has done a fair bit of journalistic investigation into the topic during recent recovery “downtime”.

This book seems to me to be very thorough in its examination of prostate treatments, research, survival and success rates, issues and dilemmas, and refers to every branch of the burgeoning field of treatment I’ve so far come across.

The case he puts for radiotherapy/brachytherapy and combined drug treatments (if needed), in the second half of the book, seems convincing to me.

Essentially, he’s saying that advances in radiotherapy equipment and techniques make its use so accurate and effective that people with aggressive tumours and/or cancer that’s got out of the prostate box are better served by his approaches than surgery or some of the many experimental but unproven (long-term) therapies now on offer (in the US, anyway).

The book reinforces for me how crucial it is to discover prostate cancer at the earliest possible time, since it is one version of cancer that can conceivably be “cured” when discovered at its least developed and aggressive stage.

At that point, it seems surgery is still as good an option as Dattoli’s approach, although he attacks the notion that getting it cut out is an end to the matter. It may not be, even with contained, low-aggression varieties like mine.

The book explores, and partially dismisses, many of the newer approaches, such as cryotherapy (freezing the tumour), hyperthermia (heating it), HIFU (high intensity focused ultrasound), many new drugs (because there is no long-term research done yet) and most versions of surgery.

He strongly advocates the latest approach to radiotherapy – four dimensional (the fourth is motion) intensity modulated (rather than short, high dose) radiation therapy (4D IG IMRT) – which he uses at his clinic, the Dattoli Cancer Center and Brachytherapy Institute of Sarasota, Florida.

With this complex treatment mode, he says the centre can achieve a very precise radiation attack on the tumour(s) with little collateral damage and few long-term after effects (depending, of course, on the patient).

It sounds very expensive. Pictures in the book show space-age technology, which obviously doesn’t come cheaply.

In a couple of discussions in the book, Dattoli borders on the disingenuous when he says centres using other kinds of expensive gear push its efficacy partly because they have big investments to recover.

That said, his record seems impressive, and 14 years of results are highly praised in an “independent” review by Charles E. Myers Jr MD, founder and director of a body called the American Institute of Diseases of the Prostate:

“Many men with intermediate to high-risk cancer treated [by Dattoli] with radiation to the prostate gland and pelvic lymph nodes with external beam radiation and seeds remain free of disease out to 14 years…Radiation therapy is consistently more effective when combined with androgen withdrawal. Faced with these facts, I can only conclude that radiation therapy can kill prostate cancer stem cells or in some way arrest their ability to go on to establish metastatic disease.”

Even ignoring the book’s main thesis (the superiority of 4D IG IMRT), it contains usefully detailed outlines of all aspects of prostate cancer, written in superbly accessible language. Everything is explained and translated for the layperson.

That alone makes it worth the read, although it’s not a quick read, given the fact-heavy nature of the explanations.

It contains other helpful material, including a guide to the foods we should eat (out goes my four-red-meat-meals-a-week diet) and a rundown on the latest drugs being trialled and/or used.

As a footnote, I should add that nothing I read in this up-to-date resource on prostate cancer makes me think I made the wrong decision electing radical prostatectomy. For me, it still feels 100% the right way to go. I believe I was well advised.

Further footnote: I’m interested to know how many of the treatment techniques canvassed by Dattoli are available in NZ. I suspect we trail by a long way, but perhaps there’s some advantage to that: we can observe how various developments pan out in what is undoubtedly the prostate capital (well, country) of the world.

And those 28 questions? I’ve reproduced them here, for those many men in the future who are going to get the bad news:

 Dattoli 1

Dattoli 3Copies of the book can be obtained from:

Dattoli Cancer Foundation, 2803 Fruitville Road, Sarasota, Fl 34237, US.

They cost about $US23 with postage included.

Read a 15-page extract from the book where Dattoli discusses hormone therapy: HERE>

Go to the Dattoli website HERE>

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MAY 15: US NATIONAL CANCER INSTITUTE BULLETIN:  The number of US cancer cases is expected to increase dramatically over the next two decades – particularly among older adults and minorities – but prostate cancer is not among the fastest risers.

According to a study published in the Journal of Clinical Oncology, the total cancer incidence is projected to rise by about 45 percent, from 1.6 million in 2010 to 2.3 million in 2030, the study found.

This will be driven largely by cancer diagnoses in growing populations of older Americans and minority groups. The study projects a 67 percent increase in cancer incidence among older adults, compared with an 11 percent increase for younger adults. A 99 percent increase is expected among minorities, compared with a 31 percent increase for whites. Certain difficult-to-treat cancers, such as liver, stomach, pancreas, and lung, will likely be among those with the highest relative increases in incidence.  READ MORE>

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