"What are  Your  Questions and  Concerns  About  Prostate  Cancer?"

Tuesday Evening, March 18, 2003
Texoma Medical Center
Denison, Texas

6:30 PM - Social & Coffee
7:00 PM - Program

Speaker:   Dr. Michael Hilz, Urologist, (New address) 300 N. Highland, Sherman

This meeting will be in the nature of a personal doctor's visit where Dr. Hilz will answer your specific questions about prostate cancer, therapy choices and their prognosis.  He will also answer your questions about therapy choices and their prognosis.  At the end he will take a few minutes  to discuss what prostate cancer treatments he sees coming down the pike.  He will remain afterwards to discuss your particular questions.  Members who have had radiation, brachiotomy, or radical prostatectomy will be on hand to discuss their outcomes with you.

Speaker: Dr. Hilz is board certified by the American Board of Urology.  He received his MD and did his Residency at UTMD-Galveston.   He is well qualified to discuss your options.

Old Business

None.

New Business

 None.

Program:  What forms of radiotherapy are available in Grayson County or elsewhere

Speaker:  Mary Hebert, M.D.

Dr. Mary Hebert, Board Certified Oncology Radiologist, is presently at the Texas Cancer Clinic and also has offices in Sherman and Denison.

Program:   Dr. Hebert made an excellent presentation using color slides.  She discussed the various prostate cancer radiation therapies available "locally" and also fielded 7our questions about brachiatherapy and external beam treatment. A number of our remembers also discussed their outcomes with those remaining after the talk.     

The meeting adjourned about 9 PM.

  Henri Plunkett, Program Chair/by the Editor

Advance prostate cancer recurrence --- Memorial Sloan Kettering Jan. '02 News
Watchful Waiting
The dreaded ultrasound biopsy
Prosthesis for urinary incontinence
Use of PET/CT Scanners in Oncology
Results from the recent American Urological Association Meeting
Ordering drugs from Canada
News you can use

Advanced prostate cancer recurrence
Memorial Sloan Kettering Jan. '02 News

Their researchers have found an explanation for why advanced CaP (prostate cancer) returns after hormonal therapy.  It was originally thought that blocking testosterone killed the cancer cells.  New work found that instead of dying, most cells go into a dormant state.  Eventually the dormant cells resume growth.  And this mechanism is the target of new research therapies.


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The following article summaries are from "Prostate Cancer Communication", V18, No 5, December 2002 -- R.B. McGowen's copy 

Watchful Waiting
Douglas Chinn, MD, Arcadia, CA
When one does watchful waiting under a physician's care, one watches for CaP spread.  The symptoms to watch for are: Urinary retention, kidney failure, weakness, rectal obstruction, or urinary bleeding.  When this happens,  hormone therapy is often instituted.  Radiation may be used for bone pain and obstructions may be removed surgically.  In severe cases, paralysis may be relieved by surgery.  The reasons for choosing this option are that you may not die from the cancer -- instead from something else.  Apparently with watchful waiting your life span will likely be 5 or 10 more years.  The reason you would choose watchful waiting is that you may not want to deal with the side effects of other therapies.  That is, all forms of cancer therapy have potential side effects.  Radiation side effects might include permanent effects of impotence and/or urinary and fecal incontinence.  Side effects of cryosurgery or a prostatectomy would include the first two.  Androgen blockade's side effects include impotence, weight gain, loss of muscle mass, male menopause, osteoporosis and anemia.  
However the risks of dying from watchful waiting are 50% higher than for a radical prostatectomy (a ten year randomized Swedish study).  Another study, the Kaplan Meier, found that after ten years, 57% of watchful waiters had died, 31% of radical prostectomey had died and 48% of external beam therapy users had died.  
Dr. Chinn's personal recommendation is to take the greater chance of being  cured by use of conventional therapies rather than waiting to die from cancer.


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The dreaded ultrasound biopsy

Fred Lee, Sr., MD, FACS, FACR, FICS, Commerce, MI.    

Two problems are resolved through the use of TRUS (Trans Rectal Utrasound) biopsy:  The first solution is to aid the appropriate therapy for the tumor based on staging.  Your choice of therapy will be strongly determined by whether the tumor is confined to the prostate.  You and your doctor can now make more reasoned therapy choices.  The second solution is to avoid "over diagnosis" of CaP, that is; don't fix it, if it ain't broken.  The chief advantage of the TRUS is recognizing the size of the cancer.  Without my dwelling on the details, Dr. Lee uses ten diagnostic factors to determine the aggressiveness of the cancer and to prioritize treatment.
1.  Determine if you are in a high risk group.  First use the gland size to predict normal PSA and compare it to the measured.  Also use TRUS to localize a potential tumor.
2.  Determine the location of the cancer in the Transition Zone or in the outer gland where the cancer is more likely to be malignant.
3.& 4. Tumor size.  If the CaP has no dimension greater than 1 cm, Dr. Lee is of the opinion the cancer is likely confined.  (notice the more likely is a statistical term).  More extensive tumors are more likely to contact the capsule and extend outside.
5.  Degree of Doppler flow.  This test measures blood flow to the tumor.  If you are a Gleason 3+3, Dr. Lee will use the results to determine benign vs. malignant.
6. Pathology.  (explanation not clear to me. Ed.)
7.  Gleason score.  Usual approach
8. Estimate the extra capsule nerve invasion from capsule edge biopsy (if I follow Dr. Lee's description correctly. Ed)
9. Extra capsular extension. Where does the tumor protrude from the prostate.  Helps to avoid treatments the are very likely to fail.
10.  DNA Ploidy.  Watch out for diploid DNA (your guess is as good as mine).

Here are his treatment options:  Early confined CaP-->Watchful wait-->Androgen Ablation Therapy-->Seed Implant Alone-->Radical Prostatectomy-->Cryosurgery-->External Beam Radiation-Conformal-->Intense Modulated Radiation (IMRT)-->Proton /Neutron Beam plus IMRT

Dr. Lee defines Advanced CaP T2c - T3 as occurring after radical prostatectomy in the above flow chart.  You can see that the TRUS can help define therapy choices.  However, remember statistics work ONLY with large populations and that you are one individual in a large population.  If you recall the bell curve from High School (you know: the famous CURVE), you will also know that likely you are at the peak.  This means you will respond like most men who took that particular treatment.  Also remember, we didn't all make A's!!


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Prosthesis for urinary incontinence
American Medical Systems, Minnetonka, MN

For those of you who have severe urinary incontinence, continuously wear diapers, and don't wear light-colored pants, a urinary prosthesis might be a solution.  It is called the artificial urinary sphincter.  More than 50,000 people have received the device since 1972.  It works like the normal sphincter muscle with a saline-filled loop around the urethra; it is inflated to stop urination and deflated to allow it.  Patient satisfaction is reported by studies published in the Journal of Urology to be as high as 90% although the device may not be a perfect valve.  The implant is usually an outpatient procedure and is said to take less than an hour.


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Use of PET/CT in Oncology

 Scott Perlman, MD and Fred Lee, MD, U. WI, Madison, WI

They report that prostate cancer is one of the types that are not metabolic enough or are close to other highly metabolic structures to be consistently detectable with PET scanning (translation: PET mostly doesn't work for CaP).  They make no negative statements about CT, but one would suspect if it did work, they would.  Ask your doctor if you have further questions.


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Results from the recent American Urological Association meeting

From a summary by Mark Moyad, MPH

1)  Flomax or Proscar for chronic non-bacterial prostatitus.  Bottom line: these two drugs are commonly prescribed for benign prostate hyperplasia (BPH) but they may also help with chronic non-bacterial prostatitis.  (P. Narayan, et al, Abstract 97 p. 24, AUA Abstract Booklet, 2002 and  J. Downey, Abstract 104, p. 26)
2) Young male smokers have increased risk for more aggressive CaP, and the longer one smokes, the greater the risk.  WW Roberts, et al, Abstract 268, p. 268.


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Ordering drugs from Canada

Mediplan Pharmacy, 115 Main Street South, Minnedosa, Manitoba, CA R0J 1E0.
Phone: 1-888-773-2698 and FAX: 1-866-773-2696  Web site: www.rxnorth.com.

 1.  Do not write on your prescriptions: they will not be filled.  No transfers from your pharmacy, instead a new prescription from your doctor is required.  FAXED copies OK.
2.  Use the phone number above to get a quote, but there is a limit to the number over the phone (less than 6).  Instead use the web page for larger numbers.
3.  Allow 3 weeks for first time and new ones and 2 weeks for phoned in refills.  Usually FAX in your order and pay by credit card.  The numbers above are toll free.  If you need to pay by check, send your order by Global Priority Mail; otherwise allow 2 weeks to reach Canada.


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News You Can Use

You can find news you can use at the USToo International web site: http://www.ustoo.org/.  Check it out for the latest references.


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Jerry Bylander - Newsletter Editor