The Manitoba Prostate Cancer Support Group
Vol. : 170 - August 2005
Thought For Today
The Manitoba Prostate Cancer
Support Group encourages wives,
loved ones, and friends to attend
all meetings.
Feel free to ask basic or personal
questions without fear of
embarrassment. You need not
give out your name or other
personal information.
The Manitoba Prostate
Cancer Support Group does
not recommend treatment
modalities, medications, or
physicians. All information
is however freely shared.
___________________________
“Being defeated is often a temporary condition. Giving
up is what makes it permanent.”
-- Robert H. Schuller
Medical Advisors to
The Manitoba
Prostate Cancer
Support Group
___________________________________
J. Butler M.D.
Radiation Oncologist
In This Issue
Paul Daeninck M.D.
Pain Management
page 2
Graham Glezerson M.D.
Urologist
PROSTATE CANCER:
COPING W ITH PROSTATE CANCER
Alan Katz M.D.
Family Practitioner
page 3
Len Leboldus M.D.
Urologist
GROUNDBREAKING PROSTATE CANCER
RESEARCH FUNDED BY THE CANADIAN CANCER
SOCIETY ADDS IMPORTANT INFORMATION TO
PSA SCREENING ISSUE
SEXUAL FUNCTION PROBLEMS OR URINARY
INCONTINENCE STILL COMMON 5 YEARS LATER
P.S.A. TEST NOT THE MOST RELIABLE
Thanks!
___________________________
Cancer Information
Service
Call toll free: 1-888-939-3333
or 1-905-387-1153
page 6
MEN CAN'T PENETRATE
AFTER PROSTATE CANCER SURGERY
page 7
[email protected]
John Milner M.D.
Urologist
Gary Schroeder M.D.
Radiation Oncologist
page 4
page 5
Want to reach us by email ?
Ross MacMahon M.D.
Urologist
PSA TESTS CUT METASTATIC PROSTATE
CANCER BY 35%
When you call the toll free
number of the Cancer
Information Service, your
questions will be answered by
someone who understands
how confusing the subject of
cancer can be. All calls are
kept confidential
NEXT MEETING:
August 18, 2005
7-9 P.M.
Topic: T. B. A.
Location: AUDITORIUM of the Seven Oaks General Hospital - Leila & McPhillips
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The Manitoba Prostate Cancer Support Group Newsletter
Prostate Cancer:
Coping With Prostate Cancer
Facing a prostate cancer diagnosis can be overwhelming.
Your stress levels may skyrocket. You may worry about
finances. And you may be asking yourself hard questions,
such as whether to write a living will. With education and
supportive care, you will be able to deal with the many
issues and emotions you're facing.
The most important step you can take is to seek help as
soon as you feel you are having trouble coping.
Taking action early will enable you to understand and deal
with the many effects of your chronic illness.
Some tips to get you started:
* Do not hesitate to ask your doctor, nurse, or other
healthcare provider to repeat any instructions or medical
terms you don't understand. Your medical team should
always be available to answer your questions and address
your concerns.
* Make use of resources and support services offered by
your hospital and in the community. Learning more about
your disease will help you feel more at ease with your
treatment.
* Ask your family and friends to help you sort through the
information you receive.
* Talk with other patients and families about prostate
cancer and its treatment.
Many sources of help are available to provide support for
patients and their families. These include:
* Social workers. These professionals can help diminish
any concerns you and your family may have about your
diagnosis, treatment, or your personal situation. Social
workers can also provide education, counseling about
lifestyle changes, and referrals to community or national
agencies and support groups.
Your social worker can also help your family find
temporary lodging, provide information about community
resources, and help you with other needs.
* Individual counseling. Sometimes people have problems
that are better addressed in a one-on-one setting. By doing
individual counseling, you may be better able to express
sensitive or private feelings you have about your illness and
its impact on your life.
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August 2005
2
Also, mental healthcare providers are available to create
a treatment plan to meet your specific needs. Strategies can
be designed to help you regain a sense of control over your
life and improve your quality of life. At times, if depression
is present, medicines other than those treating the physical
illness may be prescribed.
* Support groups. Support groups are a very useful sharing
experience. They provide an environment where you can
learn new ways of dealing with your illness. Sometimes,
others who have been through similar experiences can
explain things differently than your healthcare providers.
You may also want to share approaches you have
discovered with others. And you will gain strength in
knowing that you are not facing hardships alone.
Remember that others may share information or
experiences that do not apply to you. Never replace your
doctor's advice with that given by another patient.
* Financial counselors. Financial counselors are available
through your hospital and can help answer questions you
may have about financial issues related to your medical
care.
Other Considerations
Information about advance directives, such as living wills
and durable power of attorney for healthcare, are
available to you.
A living will expresses someone's right to refuse or accept
medical treatment that artificially prolongs his or her life.
This document is prepared while the person is fully
competent, in case he or she becomes unable to make this
decision at a later time.
A living will provides clear instructions regarding a
person's choice of extended medical care. The durable
power of attorney gives you the right to appoint another
person to speak for you if you become incapable of
expressing your medical treatment preference. An attorney
should devise this document so that it conforms to state
laws and court precedents.
Finally, you may ask, should you write a will? Yes. No one
likes to think about his own mortality, but everyone should
have a will to ensure that those who survive you will know
how to carry out your wishes. This document should be
prepared with your attorney.
Reviewed by the doctors at The Cleveland Clinic Urological Institute.
Edited by Charlotte E. Grayson, MD, WebMD, April 2005.
www.manpros.org
...
The Manitoba Prostate Cancer Support Group Newsletter
Groundbreaking Prostate Cancer Research
funded by the Canadian Cancer Society
adds important information to PSA
screening issue
Men should continue to discuss risks
and benefits of PSA test with doctors.
08 July 2005
VANCOUVER - Canadian researchers have found that
screening men with the Prostate Specific Antigen (PSA)
test before any symptoms of cancer are evident may reduce
their risk of getting metastatic prostate cancer by 35 per
cent. Funded in part by the Canadian Cancer Society (an
investment of almost a half million dollars), the new
research is published today in the Journal of Urology.
“At the Canadian Cancer Society we are encouraged by the
results of this study,” says Barbara Kaminsky, CEO of the
Canadian Cancer Society, BC and Yukon Division. “For
years we have had reason to believe that PSA screening
would lead to earlier diagnosis, earlier treatment and
ultimately better outcomes for men. Now, we are beginning
to acquire evidence that substantiates this point of view.
Since 1998, we have been lobbying the provincial
government to make PSA testing accessible, at no cost, to
men 50-70 years of age.”
Presently PSA Screening is not covered under Health
Insurance BC (formerly named Medical Services Plan of
BC).
In this population-based case-controlled study, medical
records and self-reported data from 236 men with
metastatic prostate cancer were compared to those of 462
men who did not have prostate cancer, or whose prostate
cancer had not metastasized. The history of PSA screening
as well as factors including age, weight, smoking and
alcohol use were also compared between the two groups of
Toronto-area men.
“We found a significant reduction in metastatic prostate
cancer among men who were screened early with the PSA
test. As death from prostate cancer is often due to its spread
or metastases to other parts of the body, this study adds to
the body of evidence that screening - before any symptoms
of prostate cancer are present - can reduce the risk of death
from this disease," says Dr. Vivek Goel, professor of health
policy, management and evaluation at the University of
Toronto.
August 2005
3
“Screening for prostate cancer is a complex issue, so these
results are clinically important for men and their doctors,”
adds lead author Dr. Jacek Kopec of the University of
British Columbia in Vancouver. “While more research is
needed, this study also suggests that screening with the
PSA test may be especially effective in reducing the risk of
metastaic prostate cancer in younger men.”
The PSA test is a blood test used to detect and follow the
progress of prostate cancer. While this antigen is normally
found in small quantities in the blood, prostate problems
such as cancer can cause PSA levels to rise.
The results of this study will add to the body of evidence
about the PSA test. Presently there are two other large,
ongoing trials that will also validate these findings where
findings will be available in the coming years.
Prostate cancer is the most frequently diagnosed cancer
among Canadian men. This year, an estimated 3,200 men in
British Columbia and the Yukon will be diagnosed with
prostate cancer and 580 will die of the disease.
“The Canadian Cancer Society is fighting prostate cancer
on all fronts,” says Kaminsky. “In 2004-2005 researchers in
BC received more than half a million dollars in funding to
support current prostate research. In total, the Canadian
Cancer Society provided close to $2 million for prostate
cancer research across the country.”
Kaminsky continues, “the Canadian Cancer Society also
offers many other services to help people who are living
with cancer – we have a toll-free information line, our
website is home to information on cancer, and we offer
peer support for people living with cancer.”
The Canadian Cancer Society recommends that all men
over the age of 50 years discuss with their doctor the
potential benefits and risks of early detection of prostate
cancer using the PSA test so that they can make informed
decisions about their health.
The Canadian Cancer Society is a national communitybased organization of volunteers whose mission is to
eradicate cancer and to enhance the quality of life of people
living with cancer. When you want to know more about
cancer, visit our website www.cancer.ca or call our tollfree, bilingual Cancer Information Service at 1 888 9393333.
...
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The Manitoba Prostate Cancer Support Group Newsletter
Sexual Function Problems or Urinary
Incontinence Still Common 5 Years Later
By Miranda Hitti
WebMD Medical News Reviewed By Michael Smith, MD
on Wednesday, May 25, 2005
Two new studies show that sexual or urinary function
problems are still common five years after prostate cancer
treatment.
May 25, 2005 -- Two new studies show that sexual or
urinary function problems are still common five years after .
prostate cancer treatment.
The studies, presented at the American Urological
Association's annual meeting, looked at the long-term effects
of prostate cancer surgery or radiation..
Changes After Surgery
The first study included 1,288 men with prostate cancer
whose cancer had not spread beyond the prostate. They all
had prostate cancer surgery.
Before surgery, 87% said they had no problem with urinary
controlurinary control and 81% said they had erections firm
enough for intercourse. Those numbers fell in the months
and years after surgery.
Six months after surgery, half of the men said they had
occasional urinary leaks after surgery; those numbers didn't
change much during the five-year study. Nearly one in four
said they had total urinary control, but this improved to 35%
at the end of the study. Fewer reported frequent leaks or no
urinary control.
Six months after surgery, 89% of the men said their erections
weren't firm enough for intercourse and 70% said sexual
function was a "moderate to big problem." After five years,
71% still had erections that were not firm enough for
intercourse, say the researchers, who included David F.
Penson, MD, MPH, an assistant professor of urology at the
University of Washington.
The researchers say Viagra was the most commonly reported
erectile aid, with 43% of the men saying they had ever used
it. Among Viagra users, 45% said it helped "somewhat" or
"a lot." Viagra is manufactured by Pfizer, a WebMD
sponsor.
August 2005
4
Radiation vs. Surgery
The second study was smaller and took a different
approach. Instead of focusing only on prostate cancer
surgery, it compared surgery to prostate cancer radiation.
The study included 137 men with prostate cancer who were
randomly assigned to one of the treatments. They were
followed for two years by researchers including Savino Di
Stasi, MD, PhD, of Rome's Tor Vergata University.
Quality-of-life scores dropped significantly for the men in
the surgical group in the first month after surgery. But after
that, their quality of life rebounded; both group's scores
were similar to those before treatment. Quality of life
included measures of bowel, urinary, and sexual functions.
Sexual Function Trends
Both groups had some setbacks in sexual function.
Right after treatment, sexual function was significantly
better in the radiation group. However, sexual function
improved over time in the men who got surgery, while it
declined to a modest but significant extent in the radiation
group, says the study.
Two years after treatment, 70% of the men in the surgery
group had erectile dysfunction, erectile dysfunction,
compared with 61% who had received radiation.
Urinary, Bowel Function Results
The men who had surgery reported significantly worse
urinary function than the radiation group. The surgical
patients' urinary function improved during the first year
after their operation. Two years after surgery, one in 10 of
the men who had surgery was incontinent, compared with
3% of the radiation patients.
The opposite was true for bowel function. Two years after
treatment, more than one in four men in the radiation group
(27%) had bowel dysfunction, compared with 6% of the
surgery patients.
Treatment Options
Besides surgery or radiation, some men opt for "watchful
waiting" - closely monitoring the disease, which often
spreads very slowly, says the ACS.
Earlier this month, Swedish researchers reported that in
men with early prostate cancer who had prostate cancer
surgery, men with early prostate cancer who had prostate
cancer surgery, there was a significant cut in deaths from
prostate cancer and risk of the spread of cancer. However,
the death risk for all of the men wasn't very high over 10
years. Those findings appear in The New England Journal
of Medicine's May 12 issue.
(Continued on page 5)
www.manpros.org
The Manitoba Prostate Cancer Support Group Newsletter
August 2005
5
(Continued from page 4)
Men with prostate cancer should talk to their doctors about treatment risks,
benefits, and any side effects they experience.
About Prostate Cancer
Prostate cancer is the most common type of cancer found in U.S. men
(except for skin cancer), says the American Cancer Society (ACS). The
ACS estimates that there will be about 232,000 new cases of prostate
cancer in the U.S. this year, with about 30,350 men dying of the disease.
The death rate for prostate cancer has been dropping, says the ACS. A
man's risk of prostate cancer increases with age.
SOURCES: American Urological Association 2005 Annual Meeting, San Antonio, May 21-26,
2005. American Cancer Society: "How Many Men Get Prostate Cancer?" American Cancer
Society: "How Is Prostate Cancer Treated?" WebMD Medical News: "Early Prostate Cancer: Is
Surgery Best?""Early Prostate Cancer: Is Surgery Best?"
© 2005 WebMD Inc. All rights reserved.
...
P.S.A. test not the most reliable
BOSTON, June 20 (UPI)
Findings by U.S. cancer experts show the socalled P.S.A. test for prostate cancer may not
be as reliable as previously thought.
The prostate-specific antigen test "is just not
as discriminating as we thought it was," the
New York Times reported Monday, quoting
Dr. Michael J. Barry, a professor of medicine
at Harvard Medical School.
Until now, a patient with a simple P.S.A.
reading of 4 or less was deemed to be cancer
free. However, all bets are off now, the
Times said.
Experts suggest the P.S.A. not be the single
focus of prostate cancer screening, but rather
one piece in a puzzle with other risk factors.
Doctors are being told to be more open to the
idea that some men may be better off
forgoing treatment and instead be monitored
regularly for changes in their tumor's growth.
The developments have emerged from a
series of medical papers over the last year,
the report said. It began after one expert
found that biopsies revealed prostate cancer
in as many as 15 percent of men with P.S.A.
levels below 4.
But prostate cancer is so common that
biopsies can reveal it in most middle-aged
and older men if doctors look hard enough.
“ I’m sorry, but I don’t work on a ‘you-showme- yours-and-I’ll-show-you-mine’ basis ”
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Copyright 2005 by United Press International. All Rights
Reserved.
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The Manitoba Prostate Cancer Support Group Newsletter
Men can't penetrate
after prostate cancer surgery
Nearly 90% of men are unable to achieve an erection
sufficient for penetration for sexual intercourse after
prostate cancer surgery, according to this month's
Journal of Urology.
/24-7PressRelease/ - ROSEVILLE, IL, June 28, 2005 Ninety-nine percent of the 440 men reported about in this
month's Journal of Urology (Nehra et al., June, 2005) were
dissatisfied with their erections after prostate cancer
surgery, despite the fact that all the men had so called
"nerve-sparing" radical prostatectomies.
Almost 90% of the men were unable to achieve an erection
sufficient to penetrate for sexual intercourse. The study
notes that patients with erectile dysfunction suffer loss of
self-esteem, depression, and anxiety.
The 440 men were from 58 different medical centers
through the United States and Canada, and were
participants in a randomized, placebo controlled, doubleblind study.
The study showed that undergoing prostate cancer surgery
resulted in severe sexual dysfunction for the 440 men.
The study tested if vardenifil (Levitra) could help such men
achieve satisfactory erections. Only 24 - 28% of the men, a
minority, reported being satisfied with their post-surgery
erections after taking the erection enhancing medication,
and the men suffered headaches, vasodilation, rhinitis,
sinusitis, dyspepsia, and nausea from taking the medication.
The study authors noted that quality of life is "profoundly
compromised" in men who suffer erectile dysfunction after
prostate cancer surgery.
"Prostate cancer surgery never cures men of prostate cancer
because the radical prostatectomy always comes with a
price," says Dr. Bradley Hennenfent, author of the new
book, "Surviving Prostate Cancer Without Surgery."
August 2005
6
Dr. Hennenfent points out that, "A true cure returns men to
normal health without damaging them. However the radical
prostatectomy always makes men sterile, and often causes
smaller penises, sexual dysfunction, impotence, and
incontinence."
"Even worse," says Dr. Hennenfent, "The radical
prostatectomy failed to increase overall survival in one
randomized controlled study after 23 years of follow-up,
and only extended life for five percent of men in another
randomized controlled trial after 10 years of follow-up."
"The results of prostate cancer surgery are dismal," says Dr.
Hennenfent. His book, "Surviving Prostate Cancer Without
Surgery" shows why nerve-sparing surgery doesn't really
spare the nerves.
Dr. Hennenfent has seen five uncles suffer from prostate
cancer and has seen them treated by various methods. He
co-founded the Prostatitis Foundation (www.Prostatitis.
org), founded the Epididymitis Foundation (www.
EpididymitisFoundation.org), and founded the Acoustic
Neuroma Foundation (www.AcousticNeuromaFoundation.
org). He previously published "The Prostatitis Syndromes."
"Surviving Prostate Cancer Without Surgery" can be found in
fine bookstores everywhere. Biblio Distribution (800-462-6420)
and Roseville Books/Rayve Productions (888-492-2665)
distribute the book. It's $19.95, a trade paperback, 334 pages, 34
chapters, ISBN Number: 0-9717454-1-2, and was published
January 15, 2005. Twenty-seven illustrations and cartoons are
included within the book, which also includes an extensive index.
www.SurvivingProstateCancerWithoutSurgery.org.
E-Mail: [email protected]
Press Release Contact Information:
Arnold Romanofski
Roseville Books
PR Consultant
140 N. Main Street
Roseville, Illinois
USA 61473
Voice: 206-350-1242
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The Manitoba Prostate Cancer Support Group Newsletter
Study: Prostate Screening Saves Lives
PSA Tests Cut
Metastatic Prostate Cancer by 35%
By Daniel DeNoon
WebMD Medical News Reviewed By Brunilda Nazario,
MD on Friday, July 08, 2005
July 8, 2005 -- The PSA prostate cancer screening test
saves lives, a new study shows.
For men with no symptoms of prostate trouble, PSA
screening cuts the risk of deadly metastatic prostate cancer -- cancer that spreads through the body -- by 35%.
The finding comes from a study comparing 236 men with
metastatic prostate cancer with 462 age-matched men without metastatic cancer. University of Toronto researcher
Vivek Goel, MD, and colleagues report the findings in the
August issue of The Journal of Urology.
"If this is the benefit PSA testing provides, it is going to
warrant the risks involved for most men," Goel tells
WebMD. "In young men with no risk factors, PSA testing
may not be indicated, even at this level of benefit. For men
over 50, I think it will be. And for younger men with a family history of prostate cancer or other risk factors, it will be
indicated."
PSA Debate
PSA -- prostate specific antigen -- is a chemical marker
made only by cells of the walnut-sized prostate gland. The
first sign of prostate cancer can be a spike in blood levels of
PSA. A regular PSA test can detect early prostate cancer.
But the test is controversial. Low PSA levels don't necessarily mean a man is cancer-free. And high PSA levels
don't necessarily mean a man has dangerous prostate cancer. Nevertheless, many American men get regular PSA
tests -- which go hand in glove with digital rectal exams -to screen for early prostate cancer.
Unfortunately, PSA test results remain a matter of interpretation. Doctors tend to refer men for prostate biopsy if they
have a PSA score of 4 or more. But that cutoff is arbitrary - and not particularly meaningful, says Charles A. Coltman
Jr., MD, associate chairman for cancer control and prevention of the Southwest Oncology Group in San Antonio.
In this week's issue of The Journal of the American Medical Association, Coltman and colleagues reported the results of a study of some 8,600 men who underwent PSA
testing. All the men in the study agreed to have a prostate
biopsy -- whether or not they had a high PSA score.
August 2005
7
"It was astonishing," Coltman says. "We found individuals
with prostate cancer at every range of PSA --from 4 down
to 0.1. And a substantial number of them had high-grade
prostate cancer. In fact, some of these cancers were in men
who had gone through seven years of PSA and digital rectal
exams and were found to be normal in all respects."
What's a Man to Do?
The American Cancer Society recommends that men over
50 -- or high-risk men over 45 -- discuss with their doctors
whether they should begin annual PSA tests and digital rectal exams. Men at high risk include blacks and those with a
family history of prostate cancer. Men at especially high
risk -- those with multiple first-degree relatives who have
prostate cancer -- may wish to begin this conversation even
earlier, at age 40.
Even though he's not blind to its faults, Coltman says that
men should discuss PSA testing with their doctors.
"I don't think one should dissuade a man from prostate
screening, because in fact the screening may show the PSA
is elevated and his prostate gland is abnormal," he says.
"But doctors must understand that we are going to rewrite
the book. Because if PSA is less than 4 or even less than
2.5, you cannot be totally confident there is not a problem."
Coltman suggests that current PSA cutoff levels may be appropriate for men not at high risk. For those in high-risk
groups, he suggests that doctors seek biopsies when they
detect prostate abnormalities -- even if a patient's PSA is
below the current cutoff.
Deciding on prostate cancer screening is a matter of weighing the benefits against the risks. The benefit: catching a
deadly prostate cancer while it is still curable; the risk: unnecessary biopsy and, perhaps, surgery or radiation therapy
for cancer that would never have been a problem if it hadn't
been detected.
Large studies are under way to help men make this difficult
decision. But results won't be available for a long time.
"We don't expect results before the end of this decade -- or
well into the next decade," Coltman says.
SOURCES: Kopec, J.A. The Journal of Urology, August 2005; vol 174
(pre-publication copy). Thompson, I.M. Journal of the American Medical Association, July 6, 2005; vol 294: pp 66-70. Vivek Goel, MSc, MD,
FRCPC, professor, public health sciences and health policy management
and evaluation, University of Toronto, Ontario. Charles A. Coltman Jr.,
MD, associate chair, cancer control and prevention, Southwest Oncology
Group, San Antonio.
© 2005 WebMD Inc. All rights reserved.
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FUTURE MEETINGS:
M.P.C.S.G.
Manitoba
2005
August 18, 2005 7-9 P.M.
Topic: T. B. A.
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