Random thoughts from your editor
Prostate
cancer tests: in the "footsteps" of breast cancer testing
What about vitamin E?
Recovery
after PC Therapies: Life Quality
Double Suicide gene therapy: Hope for
hormone refractory cases
Expressive Writing for cancer patients
How do I interpret my
PSA?
Pet therapy
Prostate cancer tests:
follows breast cancer path
As I write this, breast cancer mammograms are
back in the news. Although it is a well established procedure for
early detection, some learned hands are still questioning its
validity. Something that comes under the heading of "not enough to
do". This questioning has been going on for over a decade, despite
the success of mammograms in saving lives. Now, the PSA and DRE
(digital rectal exam) are undergoing the same trials by fire, even though
prostate cancer deaths are dropping as a result of their use. Also,
the ultrasound imaging procedure is being attacked. According to Tom
Nuckols, Director, the critics seem to want certainty. They say
that testing doesn't always lead to a cure. True, but what medical
procedure does? We know that PSA testing, DRE and ultrasound exams
can save many. C'mon critics, let's cut the
carping.
For more
details see the US Too! website and especially: www.ustoo.org/2002ActionCall.html
Back to
Editor's Notes
What about vitamin E?
We hear a great deal about vitamin E, but we may not know much
about its use in prostate cancer. We hope to report more about its
effects on PC in future issues. Also, if you take vitamin E now, you
may wonder what amount is useful should it be effective as a cancer
retardant. A report in the Dallas Morning News for April 11, 2000,
discusses a variety of findings by the Panel on Dietary Antioxidants and
Related Compounds, and includes some information on vitamin E
dosages. They warn that antioxidants may not prevent cancer. However
if you are taking vitamin E, their recommended maximum daily dose is 1000
milligrams (mg), if you are 19 or older, and their recommended daily dose
is 15 mg. If you take more than the 1000 mg per day you run the risk of
stroke because the vitamin is an anticoagulant. Cuts or nosebleeds
may also be a problem for high levels of "E".
Back to Editor's Notes
Recovery after PC
Therapies: Life Quality
The November issue of the Int. Journal Of Rad. Oncology Biology and
Physics printed a report by Dr. R. Lee at Wake Forrest U. which has
generated a great deal of interest. The 90 patients studied reported
on their life quality at 1 month, 3 months and 1 year after
treatment. They were asked about sexual, urinary, and bowel dysfunction
as well as their physical and mental well being. Forty-four were treated with seeds (interstitial permanent source brachia therapy), 23 with external beam, and and 23 with radical
prostatectomy. Apparently there are no details of their relative
Gleason scores. There were significant decreases in the quality of
life in the first month following surgery and implant, but not after
external beam treatment. The only surprise, I think, is the result
for external beam, where the patients were said to have no change.
After a year, all three groups were reported to be back like they were
before their treatments. Based on my own post-surgery experience, I
think maybe there must have been some differences, but
the major result is that the outcomes were the same (statistically
speaking, not reported). As a survivor, I find that living one day at a
time and starting each day with a positive mental attitude are necessary
compensations for the effects of aging and of my cancer. For more details
about the study, see www.newsrx.com (there may be a charge to subscribe to
this online news letter - I didn't check).
Back
to Editor's Notes
Double
Suicide gene therapy: hope for hormone refractory cases?
Professor
Jae Ho Kim and associates at Henry Ford Hospital have used a cold virus to
carry a gene into prostate cancer cells. They then inject a
substance that cooperates with the new gene to kill themselves.
While promising, the use of the technique appears to me to be several years
away.
From Cancer Weekly
via News Rx.com
Back to Editor's Notes
Expressive
writing for cancer patients
An unattributed article in MD Anderson's
Network newsletter for winter 2002, reports on the value of
expressive writing for cancer patients. Rev. Steven Spidell, MDA
Chaplain, is quoted as saying, "In the process of becoming patients,
people often lose their stories. With the chaos and disruption, they
begin to tell the doctor's version of their story, the medical version,
not their own. They get tunnel vision and forget who they were
before. But people are fundamentally narrative-based. They
need to find meaning, make sense out of their disease." The author
tells us, "without doubt, being diagnosed with cancer causes chaos,
disruption and stress the effects of which may include hormonal and immune
changes, the narrowing of attention, falling into poor eating patterns,
not getting enough exercise, sleeping poorly, suffering from post
traumatic stress disorder and losing the overall quality of life.
Studies now being conducted show that when people have a chance to tell
their deepest story, it can help relieve the sustained stress that has a
profound effect on their physiological well being." The author notes
that expressive writing's effects far can exceed the benefits of some
wished-for "magic bullet" drug in this way. One of the NIH
institutes has funded Dr. Lorenzo Cohen of MDA to investigate why
emotional expressive writing is beneficial to overall health. Dr.
Cohen reports that emotional expression has been shown to: 1) help patients
adjust to trauma; 2) reduce stress; 3) improve psychological adjustment; and
4) positively impact immune function. Results of Dr. Cohen's study
showed that writing helped patients have "increased vigor, less overall
sleep disturbance, better sleep quality, longer sleep duration, and less
daytime dysfunction compared to the control group (to be
continued). Next month's
issue will discuss how some others see this program and opportunities to
participate.
Back to Editor's Notes
How do I
interpret my PSA?
The following discussion of PSA is excerpted from a panel
discussion by MD's at the Prostate Cancer Association (Ottawa-Carlton
General Meeting, April 20, 2001 as summarized in the newsletter from the
Manitoba Prostate Cancer Support Group). The panel members were Dr.
C. Morash, Dr. S. Huan and Dr. L. Eapen. The following is a partial
copy:
The General Case
Theoretically, PSA should be undetectable after a radical
prostatectomy. Therefore further treatment should be
considered at any level of PSA reading. The treatment decision, as
to type and at what PSA level to start depends on each individual case,
and is the area where there is much uncertainty. It has become
apparent over the last several years that earlier is better than later,
but how early is early enough and how much better, remains unclear.
We also need to consider quality of life and side effects in the decision.
What PSA level (after radiation) is considered
safe?
It is the PSA profile, rather than
the absolute number, that counts. But after radiation treatment,
generally a PSA level that is less than one, and stays less than 1.5
subsequently, most likely indicates successful treatment.
Is there a post-treatment stable PSA
that indicates no recurrence?
Unfortunately, there is no time period beyond which then is no chance of
recurrence. However, if there is a recurrence after prostatectomy or
radiotherapy, for majority of patients, it occurs within 7 years.
Paradoxically it seems that patients whose PSA fall more gradually after
radiotherapy have a more durable remission.
What are the options if PSA rises after
radical Prostatectomy?
The
options are do nothing, watch and wait, undergo radiation therapy, or take
hormonal therapy.
Why does PSA rise after being zero for several
years after radical prostatectomy?
This
means that not all of the cancer cells were removed with the prostate.
Either some cells were left behind in the prostate area, or some cells
escaped the prostate before it was removed. Those cells always
produced PSA, but at an undetectable level. Through cell division
over months or even years, the cell mass eventually grows large enough
that the PSA is produced at detectable levels. Very rarely,
especially using state-of-the-art techniques, benign prostatic tissue is
left behind.
Why does PSA rise after radical prostatectomy and a
negative pathology report?
The pathologist
examined the tissue from the surgery and saw that the cancer was entirely
confined within the prostate. Despite this favorable report, the
rising PSA shows that the patient still has cancer. Cancer cells
would have escaped, through the blood or lymphatic system, before the
prostate was removed (i.e. these cells would have escaped prior to
surgery, probably quite unlikely during surgery). The only way that
we know that cells escaped is some time after the surgery when PSA becomes
detectable.
What does rising PSA after radiation treatment
mean?
A rising PSA after local radiation indicates that the treatment was
unsuccessful. The reasons could be that the cancer in the Prostate
has not been eradicated, or it has been eradicated but unfortunately there
has been metastasis to the lymph nodes or the bones, or a combination of
both. The rising PSA profile may suggest whether or not the occurrence
localized in the prostate alone. If it is, local salvage therapies, such
as prostatectomy, cryosurgery, or hyperthermic are possible, but these
treatments are difficult to administer and even more difficult for the patient to
undergo.
Back to Editor's Notes
Pet therapy
My wife
recently bought a puppy. My brother asked me, "It's her dog, but
whose is it really?". Anyway, Cocoa the mini-dachshund is a major
comfort. But before you rush out and get one of your own, I must
warn you. She is as much trouble to raise as a new baby-with one
exception: no diapers. Tom tells me that Cocoa is the best people trainer
he has ever seen!
Back to Editor's Notes
Jerry Bylander - Newsletter
Editor |
