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  1. Jim Marshall (not a doctor) said … One of the most important meetings of doctors for men with advanced prostate cancer is the ASCO (American Society of Clinical Oncology) meeting held each year. Yesterday at the ASCO meeting Dr Maha Hussain, on behalf of her team presented the initial results of the PROSPER clinical trial. That trial tested whether men with no metastases, but who had rapidly rising PSA, would do better with early Enzalutamide (Xtandi). This presentation is just the start of scientific reporting. Dr Hussain is presenting this study to hundreds of her colleagues so they can absorb and criticize it. Only if it stands up against criticism will doctors add it to their armament. Basically, if you had no visible metastases and your PSA was rapidly rising, starting Enzalutamide would delay the appearance of mets by 3 years (compared to about 1 year with no Enzalutamide). Your PSA on Enzalutamide would stay steady for 33 months (compared with 4 months). This report is just a progress report, so details of whether your life will be extended will have to wait (but the figures are looking hopeful). Eligible men had no identified mets, PSA doubling time of up to10 months and a PSA of 2 ng/mL or higher. (Thanks to member David Prestridge for spotting the pre-meeting reporting of this and alerting us to this.) ... end Jim The ASCO Post reported these key points yesterday: The median for the primary endpoint, metastasis-free survival, was 36.6 months for men who received enzalutamide compared to 14.7 months with ADT alone. Patients who received enzalutamide plus ADT had a 93% reduction in relative risk of PSA progression compared to patients who received ADT alone; enzalutamide plus ADT delayed the median time to PSA progression by 33.3 months vs 3.9 months with ADT alone. Enzalutamide plus ADT prolonged the median time to first use of new antineoplastic therapy by 21.9 months vs ADT alone (39.6 vs 17.7 months), a 79% relative risk reduction. [jm: antineoplastic therapy = next anti-cancer drug.] A link to an ASCO abstract. This link may not have a long life. PROSPER: A phase 3, randomized, double-blind, placebo (PBO)-controlled study of enzalutamide (ENZA) in men with nonmetastatic castration-resistant prostate cancer (M0 CRPC).
  2. Geoff Buttfield

    PSA (NOT) Testing

    One from the PCFA website, which unfortunately, I believe, will soon apply to us. "It is likely that men will develop more advanced prostate cancer before it is diagnosed and be less likely to be cured" http://www.prostate.org.au/research/research-news/relaxed-guidelines-on-psa-testing-might-miss-aggressive-tumors-study/
  3. A well researched article (pub. online 8 Jan. 2015) by Dr.Michael Kolodziej, MD, FACP in AJMC, (with free access via PubMed,) outlines the current treatment options, as well as those being investigated. http://www.ajmc.com/journals/supplement/2014/ACE021_Dec14_Prostate_CE/ACE021_Dec14_ProstateCE_Kolodziej/ Interestingly, although it covers some of the newer PSMA scanning technology (including C11 Choline) still no mention of the Gallium 68 PSMA scans now available in most? Australian capital cities. Perhaps we lead the USA in this regard?
  4. While the draft Testing guidelines may seem a step in the right direction, unfortunately, an important item in the 2013 Melbourne Consensus http://www.bjuinternational.com/bjui-blog/the-melbourne-consensus-statement-on-prostate-cancer-testing/ Consensus Statement 4: Baseline PSA testing for men in their 40s is useful for predicting the future risk of prostate cancer has not been included. This would have been the only way to stop younger men from being found too late. As it stands, GPs are advised to refuse testing to anyone under 45, and not to suggest testing before 50, an age which is too late for some (including me) The Draft Guidelines can be found here- http://wiki.cancer.org.au/australia/Guidelines:PSA_Testing I can only agree with this statement in the conclusion of the 2013 statement- As Dr Joseph Smith editorialized in the Journal of Urology following the publication of the ERSPC and PLCO trials, “treatment or non-treatment decisions can be made once a cancer is found, but not knowing about it in the first place surely burns bridges”
  5. Hi all My story is going on this post as a quick overview and account from the first diagnosis of Prostate cancer to the present In the hope that others may see similarities and possibly help others One good bit of advice is DONT PANIC just make a decision thats best suited for your stage, get a second opinion if needed and follow through It was December 2010, just at my 51st birthday my wife insisted I get a check up with the doctor I protested and made the point that I don't get sick, I don't take any prescribed medications, and in fact I haven't been to the doctor for about 12 years ( hence the title of my post ) Last time I visited the doctor was for a bone fracture in the hand. It's true I simply don't get sick, I have a physical job that keeps me fit and trim, I am 3/4 vegetarian, don't drink except a glass of beer on special occasions ect That equates to a healthy lifestyle by anyone's standards The physical or check up consisted of a blood test and a follow up appointment to evaluate the findings Dr said PSA level looks high Paul but I don't think it's an issue with you ? But just in case I better send you to a specialist Specialist appointment A poke up the rectum and the answer was - Paul just by the feel of it you have an 80% chance you have prostrate cancer but will need to do a biopsy Biopsy showed that I had a 3+4=7 - T2 on the Gleason scale and he gave me many options to consider Christmas was a few days away but I found it more comforting to tell the family over holding the news inside me I returned to the specialist with a list of what I wanted 1) I want to save my nerves if possible 2) I want a fall back if needed in the future 3) I want the procedure ( irrespective of pain ) that gives me the longest observed success rate 4 ) I don't like radiation if I can avoid it He advised me and referred me to a another specialist of the Robotic Prostatectomy procedure I did that and booked in the operation for January 2011 This is the funny bit, my operation was scheduled to be done and the Brisbane floods were in full swing. My operation had to be rescheduled for a week later due to The Wesley Hospital being cut off Procedure done on a Da Vinci robot with all my requests achieved, recovery was a fast but not completely pain free 6 weeks Lots of walking as therapy around the neighbourhood gave me a pleasant feeling of being alive And the reason for that was that I had a phone all from the specialist to inform me that the post operation biopsy came back as a 4+5=9 T3 on the Gleason Scale The next hurdle was to become continent again that took 2 years and only archiving 80% At this time on my last follow up with the specialist my PSA started to rise again and I was referred to a radiation specialist in prostrate oncology Advice was get a sling procedure to be 100% continent and return 4 months after the operation Also in the meantime I was prescribed 2 doses of a hormone therapy capsule that is inserted under ones skin and slow releases over 3 months I think it was Zoladex Sling procedure was booked in and done within 3 weeks with a successful and desired result achieved I am 100% dry hooray Last PSA test, only a few weeks ago has shown that its now 0.1 or negligible due to the hormone therapy another hooray That brings us to the present - This Thursday I am starting on a seven week radiation therapy programme to eradicate any stubborn cancer cells that refuse to give up Well the little buggers won't get a chance to regroup if I have anything to do with it Back soon with an update on the current treatment Be positive and in control - think like a general in the battlefield Regards Paul
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