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Found 30 results

  1. Abiraterone (Zytiga) is approved for supply on the Australian PBS under the following conditions: Authority Required Castration resistant metastatic carcinoma of the prostate Clinical criteria: • The treatment must be in combination with prednisone or prednisolone, AND • The treatment must not be used in combination with chemotherapy, AND • Patient must have failed treatment with docetaxel due to resistance or intolerance; OR • Patient must be unsuitable for docetaxel treatment on the basis of predicted intolerance to docetaxel, AND • Patient must have a WHO performance status of 2 or less, AND • Patient must not receive PBS-subsidised abiraterone if progressive disease develops while on abiraterone, AND • Patient must not have received prior treatment with enzalutamide; OR • Patient must have developed intolerance to enzalutamide of a severity necessitating permanent treatment withdrawal. (Current 7 June 2017. Check pbs.gov.au for the latest version.) So, for most men, only after treatment fails with the chemotherapy docetaxel. We can assume that the Australian supplier of abirateone (Janssen) will present the results of the latest STAMPEDE and LATITUDE trials to the government's expert committee (the PBAC) suggesting that abiraterone be made available to men on the PBS earlier in treatment. I am not a doctor, but these trial results are reported as being very strong. So it will come down to Janssen agreeing a pricing package with the government, if they can.
  2. Jim Marshall (not a doctor) said ... Earlier results When standard hormone therapy is no longer holding the cancer in check, adding abiraterone (always plus a steroid) delays progression of the cancer and extends life. These LATITUDE results Newly diagnosed metastatic men had: standard hormone therapy OR standard hormone therapy + abiraterone + a steroid The men who started abiraterone and hormone therapy at the same time took longer for their disease to progress, and survived longer. Standard hormone therapy Zoladex (Goserelin), Lupron (leuprorelin), Eligard (leuprolide), Lucrin (leuprorelin acetate), Suprefact/Suprecor (buserelin), Synarel (nafarelin), histrelin (Supprelin), Suprelorin/Ovuplant (deslorelin), Triptorelin (diphereline) and Firmagon (degarelix) ... end Jim N Engl J Med. 2017 Jun 4. doi: 10.1056/NEJMoa1704174. [Epub ahead of print] Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. Fizazi K1, Tran N1, Fein L1, Matsubara N1, Rodriguez-Antolin A1, Alekseev BY1, Özgüroğlu M1, Ye D1, Feyerabend S1, Protheroe A1, De Porre P1, Kheoh T1, Park YC1, Todd MB1, Chi KN1; LATITUDE Investigators. Author information Abstract Background Abiraterone acetate, a drug that blocks endogenous androgen synthesis, plus prednisone is indicated for metastatic castration-resistant prostate cancer. We evaluated the clinical benefit of abiraterone acetate plus prednisone with androgen-deprivation therapy in patients with newly diagnosed, metastatic, castration-sensitive prostate cancer. Methods In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned 1199 patients to receive either androgen-deprivation therapy plus abiraterone acetate (1000 mg daily, given once daily as four 250-mg tablets) plus prednisone (5 mg daily) (the abiraterone group) or androgen-deprivation therapy plus dual placebos (the placebo group). The two primary end points were overall survival and radiographic progression-free survival. Results After a median follow-up of 30.4 months at a planned interim analysis (after 406 patients had died), the median overall survival was significantly longer in the abiraterone group than in the placebo group (not reached vs. 34.7 months) (hazard ratio for death, 0.62; 95% confidence interval [CI], 0.51 to 0.76; P<0.001). The median length of radiographic progression-free survival was 33.0 months in the abiraterone group and 14.8 months in the placebo group (hazard ratio for disease progression or death, 0.47; 95% CI, 0.39 to 0.55; P<0.001). Significantly better outcomes in all secondary end points were observed in the abiraterone group, including the time until pain progression, next subsequent therapy for prostate cancer, initiation of chemotherapy, and prostate-specific antigen progression (P<0.001 for all comparisons), along with next symptomatic skeletal events (P=0.009). These findings led to the unanimous recommendation by the independent data and safety monitoring committee that the trial be unblinded and crossover be allowed for patients in the placebo group to receive abiraterone. Rates of grade 3 hypertension and hypokalemia were higher in the abiraterone group. Conclusions The addition of abiraterone acetate and prednisone to androgen-deprivation therapy significantly increased overall survival and radiographic progression-free survival in men with newly diagnosed, metastatic, castration-sensitive prostate cancer. (Funded by Janssen Research and Development; LATITUDE ClinicalTrials.gov number, NCT01715285 .). PMID: 28578607 This extract can be found on http://PubMed.com, and is in the public domain. On PubMed.com there will be a link to the full paper (often USD$30+, sometimes free). Any highlighting (except the title) is not by the author, but by Jim Marshall. Jim is not a doctor.
  3. Jim Marshall (not a doctor) said ... Earlier STAMPEDE results An earlier version of the STAMPEDE trial looked at men newly diagnosed with metastatic prostate cancer. One group of men was given hormone therapy, then chemotherapy when that was not enough to control their cancer. The other group started with hormone therapy plus chemotherapy. Men survived 22 months longer if they started with hormone therapy + chemotherapy. These STAMPEDE results Mostly newly diagnosed men who needed hormone therapy had: standard hormone therapy OR standard hormone therapy + abiraterone + prednisolone (Abiraterone is always given with a steroid. Prednisolone is a steroid.) The men who started abiraterone and hormone therapy at the same time took longer for their disease to progress, and survived longer. Standard hormone therapy Zoladex (Goserelin), Lupron (leuprorelin), Eligard (leuprolide), Lucrin (leuprorelin acetate), Suprefact/Suprecor (buserelin), Synarel (nafarelin), histrelin (Supprelin), Suprelorin/Ovuplant (deslorelin), Triptorelin (diphereline) and Firmagon (degarelix) ... end Jim N Engl J Med. 2017 Jun 3. doi: 10.1056/NEJMoa1702900. [Epub ahead of print] Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy. James ND1, de Bono JS1, Spears MR1, Clarke NW1, Mason MD1, Dearnaley DP1, Ritchie AWS1, Amos CL1, Gilson C1, Jones RJ1, Matheson D1, Millman R1, Attard G1, Chowdhury S1, Cross WR1, Gillessen S1, Parker CC1, Russell JM1, Berthold DR1, Brawley C1, Adab F1, Aung S1, Birtle AJ1, Bowen J1, Brock S1, Chakraborti P1, Ferguson C1, Gale J1, Gray E1, Hingorani M1, Hoskin PJ1, Lester JF1, Malik ZI1, McKinna F1, McPhail N1, Money-Kyrle J1, O'Sullivan J1, Parikh O1, Protheroe A1, Robinson A1, Srihari NN1, Thomas C1, Wagstaff J1, Wylie J1, Zarkar A1, Parmar MKB1, Sydes MR1; STAMPEDE Investigators. Author information Abstract Background Abiraterone acetate plus prednisolone improves survival in men with relapsed prostate cancer. We assessed the effect of this combination in men starting long-term androgen-deprivation therapy (ADT), using a multigroup, multistage trial design. Methods We randomly assigned patients in a 1:1 ratio to receive ADT alone or ADT plus abiraterone acetate (1000 mg daily) and prednisolone (5 mg daily) (combination therapy). Local radiotherapy was mandated for patients with node-negative, nonmetastatic disease and encouraged for those with positive nodes. For patients with nonmetastatic disease with no radiotherapy planned and for patients with metastatic disease, treatment continued until radiologic, clinical, or prostate-specific antigen (PSA) progression; otherwise, treatment was to continue for 2 years or until any type of progression, whichever came first. The primary outcome measure was overall survival. The intermediate primary outcome was failure-free survival (treatment failure was defined as radiologic, clinical, or PSA progression or death from prostate cancer). Results A total of 1917 patients underwent randomization from November 2011 through January 2014. The median age was 67 years, and the median PSA level was 53 ng per milliliter. A total of 52% of the patients had metastatic disease, 20% had node-positive or node-indeterminate nonmetastatic disease, and 28% had node-negative, nonmetastatic disease; 95% had newly diagnosed disease. The median follow-up was 40 months. There were 184 deaths in the combination group as compared with 262 in the ADT-alone group (hazard ratio, 0.63; 95% confidence interval [CI], 0.52 to 0.76; P<0.001); the hazard ratio was 0.75 in patients with nonmetastatic disease and 0.61 in those with metastatic disease. There were 248 treatment-failure events in the combination group as compared with 535 in the ADT-alone group (hazard ratio, 0.29; 95% CI, 0.25 to 0.34; P<0.001); the hazard ratio was 0.21 in patients with nonmetastatic disease and 0.31 in those with metastatic disease. Grade 3 to 5 adverse events occurred in 47% of the patients in the combination group (with nine grade 5 events) and in 33% of the patients in the ADT-alone group (with three grade 5 events). Conclusions Among men with locally advanced or metastatic prostate cancer, ADT plus abiraterone and prednisolone was associated with significantly higher rates of overall and failure-free survival than ADT alone. (Funded by Cancer Research U.K. and others; STAMPEDE ClinicalTrials.gov number, NCT00268476 , and Current Controlled Trials number, ISRCTN78818544 .). PMID: 28578639 This extract can be found on http://PubMed.com, and is in the public domain. On PubMed.com there will be a link to the full paper (often USD$30+, sometimes free). Any highlighting (except the title) is not by the author, but by Jim Marshall. Jim is not a doctor.
  4. This video is about a treatment for men who already have prostate cancer. It is about adding an occasional testosterone boost to regular drug therapy to treat prostate cancer. Dr Sam Denmeade reports on encouraging trials of this approach. It is 56 minutes long and has Closed Captions (Cc) for the hard of hearing. Thanks to Rick Davis of the Answer Cancer Foundation for allowing us to post this video. Access the whole presentation, including introductions, questions and answers, at: https://www.ancan.org/bat-presentation The questions and answers begin at about 1hour 4minutes.
  5. Jim Marshall (not a doctor) said ... New agreement At the recent Prostate Cancer Research Institute (PCRI) conference I was fortunate to meet with Jan Manarite, Executive Vice President of Prostate Cancer International. The "New" Prostate Cancer Infolink is their corporate website. In the past we have republished individual articles from their site, with permission. Jan has been kind enough to now give us blanket permission to republish any article, with proper attribution. We are grateful to Jan and to Prostate Cancer International for this kindness. This article Men who were on hormone therapy (ADT) for 6 years took a long time to recover testosterone, if they did at all. ... end Jim From The "New" Prostate Cancer Infolink: After long-term ADT … recovery normal of hormonal function? Posted on September 22, 2016 by Sitemaster 2 Votes A group of Spanish clinical researchers have reported recent data from a small study designed to address an unanswered question about the recovery of (relatively) normal hormonal function after completion of androgen deprivation therapy (ADT). Planas et al., writing in the Scandanavian Journal of Urology, report data from a cohort of 40 patients who: • Were all treated with long-term ADT for locally advanced or metastatic prostate cancer • Had an average (mean) age of 71.5 years • Were treated with ADT for an average duration of 74.6 months (i.e., about 6 years) and then • Stopped their ADT therapy without any consequent rise in their PSA level The men were then followed for an average of another 36.5 months (about 3 years), and their serum testosterone (T) and serum luteinizing hormone (LH) levels were determined at 6-monthly intervals after cessation of the ADT. Here is what the research team reported: • At 18 months of follow-up, ◦ All patients had recovered normal levels of LH. ◦ 38 percent of patients still had castrate levels of serum T (< 50 ng/dl). • Based on a multivariate analysis ◦ Only time on ADT was correlated with recovery of serum T levels > 50 ng/ml (p = 0.031) ◦ Neither age nor clinical stage at start of ADT showed statistical correlation to recovery of serum T levels > 50 ng/ml • Average time for recovery of a serum T level of > 50 ng/ml was ◦ 14.5 months in men treated with ADT for < 60 months ◦ 29.3 months in men treated with ADT for > 60 months The authors conclude that: Age did not correlate with testosterone recovery in a group of elderly prostate cancer patients in whom ADT was stopped. Testosterone recovery after ADT cessation was significantly correlated with time under ADT treatment. So what this tells us is that a significant percentage of men on long-term ADT are probably never going to regain anything approaching normal serum T levels on their own after stopping ADT. We are aware of a small number of men who, after being on long-term ADT for several years, and stopping, then took testosterone replacement therapy (TRT) to regain normal serum T levels. That strategy clearly comes with a significant level of risk in men who were originally being treated with ADT for advanced or metastatic prostate cancer. Might that be an acceptable risk for some patients? Well, … probably only an individual patient could answer that question — and only with regard to himself. Original article on the "New" Prostate Cancer Infolink site https://prostatecancerinfolink.net/2016/09/22/after-long-term-adt-recovery-normal-of-hormonal-function/
  6. Treatment of metastatic prostate cancer has changed recently. In the past doctors used to use hormone therapy (ADT) at first, then wait until the disease was very progressed before giving chemotherapy with Taxotere (Docetaxel). The reason for the change? Professor Christopher Sweeney reported on a trial he led (CHAARTED). In CHAARTED, the researchers (an international team of medical oncologists) showed that starting BOTH chemotherapy and ADT at the beginning of treatment gave men a longer life. Yesterday (Sunday, 4 Sep 2016), members of your Executive Committee were invited to be the audience for an video interview of Christopher Sweeney and his Australian colleague, Professor Gavin Marx, by Anthony Lowe, PCFA CEO. Tony Maxwell, Alan Barlee and Nev Black and I were able to attend. (Paul Hobson had to miss out because of treatment.) Being able to question world leaders in advanced prostate cancer treatment was a privilege, and we were able to ask several questions men have raised with us in the past. I have been offered first cut of the video footage. I hope to be able to produce two YouTube videos - one the expert interview, the other on key questions men ask about chemo. Watch this space!
  7. At our phone-in meeting last Friday medical oncologist Professor Ken Ho and urologist Dr Ano Navaratnam spoke to us about their clinical trial looking to prevent and reverse the muscle wasting that occurs in men on hormone therapy (ADT). You will recall that the initial pilot phase of the trial is only available in Brisbane, Australia. Details Opportunity to Participate in World First Clinical Trial Are you a male who: • Has Prostate Cancer • On Androgen Deprivation (also known as “Hormones”) • Independent in your activities of daily living You may be eligible for our trial to prevent and reverse muscle wasting that occurs in men on “Hormones” Contact: Dr Irina Oleinikova Study Coordinator Princess Alexandra Hospital Irina.oleinikova@health.qld.gov.au Phone: 3176 2217 or 0402 159 586 Dr Ano Navaratnam Urology Fellow Princess Alexandra and Greenslopes Hospitals, navs_ano84@hotmail.com Supported by: Click here to download this as a PDF; Muscle wasting prevention clinical trial.pdf
  8. " In what seems to be a first, study researchers are saying that they might have uncovered a link between ADT and Alzheimer’s. Their study is small and preliminary and it does not prove a cause-and-effect relationship, but merely shows an association between ADT and Alzheimer’s disease." Click here to read more.
  9. Some men who are diagnosed with prostate cancer have metastases at the time of their diagnosis. Until recently the primary treatment for these men was Androgen Deprivation Therapy (ADT). Since the CHAARTED and STAMPEDE trials, ADT + Chemotherapy (Docetaxel) has become the standard of care for these men. What about ADT + Chemotherapy + Radiotherapy for these men? Maybe. Removal of the primary cancer has been used effectively in other cancers, either using radiation or surgery to increase cancer-specific survival time. "Whether radiotherapy or surgery is of any benefit after early chemotherapy is still very much an open question" for prostate cancer. Mike Scott and Allen Edel of the New Prostate Cancer Infolink suggest that it's something that a patient who is diagnosed at the outset with metatastes should discuss with their radiation oncologist. Click on this link to read the article.
  10. Jim was away in Sydney with a swag of other members representing our group at a meeting with Janssen, the suppliers of the drug Zytiga. As a result of this, Jim asked me to chair our phone in conference in his absence. We had no guest speaker at our gathering which made life a little easier for me as our talks would be based on a round table discussion among members. I had the feeling it might be a bit dull without a guest and members be reluctant to come forward and speak on issues. With this in mind I prepared some topics prior to the meeting just in case. I needn't have worried as right from the beginning we were off and running and I threw my cheat sheet into the bin. The meeting never ran out of steam and everyone contributed some great stuff for contemplation so much so that I decided to contribute this summary. I did not record any of our discussions so what I present here is from hurried notes and memory. It is subject to my interpretation and in some areas may be incomplete or inaccurate for which I apologise in advance. I received 8 apologies (most of which were from the members attending the Janssen meeting). There were 6 participants who took part in our meeting and I hope they were happy with the results of our gathering. The session began with a briefing by me as per my understanding of the meeting with Janssen being attended by the cream of our membership and with what little I knew of the nuts and bolts of that meeting I was only able to offer a broad assumption. Jim, I understand will be responding to members with a full report at some time in the future. Two men gave a report on exercise programs they were attending. One man is participating in a study at St Lucia University that includes dietary analysis and different exercise regimes. He intends to post a report on the program when he is able. However he stated that he might need assistance in getting the report ready for posting and has asked if any of the members would be able to assist. I can pass on contact details to any member willing to help out. The second man is on an exercise program at Deakin University Burwood Campus Melbourne that is oriented specifically to prostate cancer patients. In further talks on exercise programs and the relationship with the application of chemotherapy, the subject of a recent “Catalyst” program was raised. As can be seen in the Catalyst program there is a gym adjacent to the chemotherapy section where patients are encouraged to exercise straight after infusion of their chemo. This is believed to help increase blood flow to assist in the uptake of the chemotherapy drugs more effectively and improve the body's own immune system. Here is the link on Iview. this link It was also raised that jimjimjimjim had a guest speaker a couple of years ago during a phone in called Dr Prue Cormie. The minutes of that meeting can be found by clicking on this link. Also an interesting video talk by Dr Prue Cormie can be found by clicking on this link. [Edit - The Catalyst program featured Professor Rob Newton from Edith Cowan University in Perth. Dr Prue Cormie was previously at Edith Cowan but is now at the Australian Catholic University, Melbourne.] One man gave a report on his treatment involving a small trial using Lutetium 177 which is still ongoing. His initial thought was that about 10% patients have reported excellent results while he feels he has had moderate results with little side effects, mainly a sore throat and dry mouth as the radionuclide targets PSMA cells but also effects saliva glands. An interesting issue caught my ear in this discussion, regarding access to results while on a trial. If my memory serves me correctly, it appears that patients taking part in a blind trial are not given access to any pathology test results while on the trial. This is something I have not considered before, but I can see the point in keeping this information secret during a trial of this sort. However it is something to consider for those looking for trials to volunteer for. Perhaps other members may be able to confirm or deny my limited knowledge on this matter, as for Lutetium 177 more can be read by clicking on this link. A man gave a report on his experience with treatment using docetaxel and recommencement of ADT. His experiences were not good and included peripheral neuropathy particularly in legs ankles and feet, constipation, headaches, nausea and fatigue. This has taken 11 weeks to finally start to resolve since completing chemo. It has brought his PSA back down to an acceptable level though. A man also reported he was diagnosed with radiation cystitis some time ago and experienced bleeding and urine blockages, similar to my experience in 2014. He also was treated with hyperbaric oxygen treatment in a decompression chamber but in his case the treatment was successful. I congratulated him and passed the comment that thanks to his report I can consider a 50-50 success rate in this treatment. A bit unfair from me I know but it was written in jest and I include it here to present as a successful case in the use of this treatment for radiation cystitis. A man reported a rising PSA after intermittent ADT over the past 10 years since initial primary treatment. Recently he has been back on Lucrin but his PSA is doubling monthly. He was not looking forward to being advised to begin chemotherapy before being considered for enzalutimide or zytiga. After much discussion it was suggested that he should approach his GP, urologist or oncologist regarding this matter and perhaps a second or third opinion before any choice is made. The meeting concluded approx 1120 hrs. Lee Gallagher (Popeye)
  11. Help! - Hot flushes

    One of our members has just started ADT and complains "These hot flushes are still coming every 30 minutes 24/7. It's nearly 4am and just been woken up again covered in sweat!" What worked for you when you were battling with hot flushes?
  12. Increasingly men who are diagnosed with metastatic prostate cancer are being treated with a combination of early chemotherapy plus androgen deprivation therapy (ADT). Previously they would have been treated with only androgen deprivation therapy. There are still many men who are concerned about the side effects of chemotherapy. Some men take the "ABC" approach to treatment - Anything But Chemotherapy! Malecare has a report on a study of side effects of early chemotherapy presented at the recent 2016 ASCO GU Symposium (American Society of Clinical Oncologists Genitourinary Cancers Symposium). Click on this link to read the report.
  13. ADT carries with it a heightened risk of depression as well as cognitive effects. The cognitive impact, though, is neither well defined nor consistent. The data collectively suggest that the negative impact of ADT on patients directly (and on their intimate partners indirectly) are greater for younger than older men. Across the array of adverse effects, physical exercise appears to have the greatest potential to address the psychological effects of ADT, both in men who are receiving ADT and in their partners. Donovan KA, Walker LM, Wassersug RJ, Thompson LM, Robinson JW. 2015. Psychological effects of androgen-deprivation therapy on men with prostate cancer and their partners. Cancer [epub ahead of print] 15 September 2015. www.ncbi.nlm.nih.gov/pubmed/26372364 From Richard Wassersug's Life on ADT Blog
  14. ADT negatively affects mood

    Researchers asked prostate cancer patients to fill in an online questionnaire on their mood in relation to the prostate cancer treatments they had received. Their results showed that, compared to patients not on ADT, ADT does indeed negatively affect the mood of men, most notably increasing their sense of fatigue and decreasing their sense of vigor. The authors also asked partners of patients to rate the patients’ moods. The partners reported similar declines in the patient’s mood that the patients reported, but to a greater degree than the patients themselves. Often our partners know us better than we know ourselves. Van Dam D, Wassersug RJ, Hamilton LD. Androgen deprivation therapy’s impact on the mood of prostate cancer patients as perceived by patients and the partners of patients. Psycho-Oncology 2015; [epub ahead of print] 31 August 2015. www.ncbi.nlm.nih.gov/pubmed/26332203
  15. A retrospective study of nearly 17,000 patients has suggested that androgen-deprivation therapy (ADT) is associated with an increased risk for the future development of Alzheimer's disease in men with prostate cancer,. Click here to read a report in the New Prostate Cancer Infolink about the study. Researchers can’t prove a direct cause-and-effect link between ADT and Alzheimer’s in an observational study like this. Some other unknown variable might be influencing the results........ Given that it’s a first-time association in a retrospective analysis, this study helps inform future research but it’s not appropriate at this point to make treatment decisions off of it......... If your doctor has put you on this medication for your prostate cancer treatment, you should continue it. Consult with your physician, but don’t stop taking your medication based on a study like this....
  16. With increasing options to treat advanced prostate cancer, there is no clear agreement on the order in which these treatments should be given. I attach a chart prepared (following the STAMPEDE clinical trial which recommended early ADT and chemotherapy for certain patients) by an American oncologist setting out his view of what is currently best clinical practice in America. In Australia our options are more restricted: Abiraterone and Enzalutamide are only available on the Pharmaceutical Benefits Scheme after chemotherapy and Provenge is not available on the Pharmaceutical Benefits Scheme. Oldtimer's Disease - I can't remember which publication I found this table in. A prize for anyone who can tell me where it came from.
  17. A question for the experts - has anyone seen any information on the relative effectiveness of Lucrin verses Zolodex ?? I have been on intermittent Lucrin injections for 15 years, and its effectiveness seemed to be reducing recently, so we changed to Zolodex plus added Cosudex. I really dislike the Zolodex injections so we have changed back to Lucrin, but I do not want to compromise my treatment and will put up with the Zolodex if it is more effective. Any comments ?? [Moderator - This post has been moved. If you've got a new question, start a new discussion, rather than interrupting an existing discussion.]
  18. In short Jim had 4 years of continuous hormone therapy: 8 months before radiation; 4 months during radiation; and 3 years after the end of radiation. Hormone therapy is also called ADT (androgen deprivation therapy). After 3 years of undetectable PSA, Jim took a break from hormone therapy. This break lasted 2 years, but the PSA started rising again, so Jim is now on hormone therapy again. In detail Click on this sentence to see Jim's full story. If you know how to post on the website, why not post your own story? Or Click on this sentence to be helped to write your own story.
  19. Diabetes and ADT

    Does prostate cancer progress faster for advanced patients with diabetes on ADT? The good news is that diabetes doesn't affect the time to castrate-resistance or the time to death. However, diabetes may speed up the time to metastases Advanced patients on ADT who don't have diabetes may get diabetes as a side effect of ADT. Bottom line: patients on ADT should do whatever is necessary to avoid or control diabetes. From Richard Wassersug's Life on ADT Blog reporting on a recent study: click this link to read the blog article.
  20. Minutes of the dial-in meeting of 25 September 2015 - Part 2: Dr Olivia Wright Many thanks to member Janis Kinne for the preparation of these minutes. Chairman Bruce Kynaston: Welcomed Dr Olivia Wright and invited her to begin her talk. Olivia Wright: So I guess that was my way of introducing what I thought I would talk about today which is the Mediterranean diet and what we are using in our studies now. Our general overall dietary approaches to help enhance metabolic health to help prevent prostate cancer progression and also improve quality of life and reduce fatigue levels as well. That's another aspect we are looking into. We are also combining our dietary approaches with some exercise connections as well because we find that a combined approach is the best and there is actually very limited research and good quality studies that have been done into that. A Mediterranean diet is not a new concept as it's been around, or the thought of it has been around since the 1940s and Ancel Keys was the researcher who started looking at the dietary patterns of men on the island of Crete and also crossed them in other countries, the US, Japan, Italy and Greece, the Netherlands, Finland and what used to be Yugoslavia so he looked at a very large sample of men only. There were 13,000 of them and he looked at their general diet and chronic health issues and he found that the healthiest men were on what he called a ‘poor’ sort of diet which emphasised fruit, vegetables, grains, beans and fish so what we now know as a less refined diet. So no processed foods at all and all fresh and nutrient dense. So the other really important characteristics that this study was looking at was reduced risk of coronary risk which related to all the medical aspects I was talking about before. So the guys on the island of Crete back then walked everywhere so there was transport by donkey but lots of walking, lots of gardening and labouring in the land and the main meal was really in the middle of the day so included a lot of olive oil as well which is a really good metabolic mediator so really helps reduce inflammation throughout the body and can really reduce the risk of coronary heart disease and I guess where he’s gone with prostate cancer as well. We know that typically a lot of our guys are now living a lot longer and now need to sort of, stave off a lot of other conditions that can occur with general ageing and to try to help mediate that as well by looking into these metabolic aspects. So there is a medical diet pyramid and what it basically looks like is there is a lot of wholegrain breads and cereals so they are the biggest emphasis. The other thing that's really good to eat is legumes, so in Australia we eat hardly any legumes, broadbeans and chickpeas and things like that. Chick peas are actually really lovely, delicious, nutty flavour; really add well for salads. So with summer coming up it's really good to throw some baby spinach together with maybe some pumpkin - I can give you these recipes too if you are interested - and then throw some legumes in with that as well. Really generally healthy and including all of the nutrients we are trying to include now. There is open cereals, fruit and veg and then the next group is fish and seafood. There is a little bit of controversy in the literature about fish oil supplements in prostate cancer. So... ... 1 minute missing ... ... dairy is still there. Dairy really important for maintaining good bone health as well. And then up the top is red meat and sweets and things. And the other important one is wine in moderation in this diet as well.... ... dietary approach that we are looking to promote at the moment in our studies. We are going to be looking at very scientific measures and biomarkers and gene expression markers but they will be for a whole diet not just one particular nutrient. OK. Is that making sense so far? Jim Marshall: Yes indeed. Yes thanks. Olivia Wright: OK so I'll keep going. So there have been some studies of the Mediterranean diet for use in prostate cancer. The other really important factor of it is relaxation and eating with other people or eating with the family and not alone so the company and the quality of interactions can influence as well. And then they like to get a lot of sleep in the Mediterranean and that may influence their positive outcomes due to plenty of rest and relaxation. So there is a bit of mixed research. So some of the studies in the European Journal of Urology 2014 looked at a large cohort with a very long followup period and they used a questionnaire to measure your Mediterranean diet score so you can actually see how well you are adhering to that style of approach and I can send you out that if you are interested. ... There are other studies where it actually has shown specific reductions in prostate cancer mortality risk particularly looking at fat intake aspect overall as being extremely important and replacing as little as 10% of carbohydrate and animal fats with healthy vegetable fats such as olive oil, nuts, beans ... can cut your prostate cancer mortality risk. They achieved that by largely olive oil and improved nut intake. Just any sort of nuts are really good. A mixture is really good. A variety is always the way to go. So in order to improve your Mediterranean diet or if you want to start a Mediterranean diet you can add a bit of olive oil to your meals, to your cooking or even better extra virgin olive oil drizzled over salads. For the extra virgin types it is important to keep those cool. You don’t want to heat those because they can decompose very quickly. With the vegetables it is important to choose good quality ones. So we want a range of colours, particularly the dark greens, oranges, the reds, the purples. Nothing to change there - always say that. So it's really important to have those as much as possible. For fruit actually choose colours like the dark blues, reds, purples. They are the colours to ask after. Legumes which I have mentioned, so chick peas in particular are very nice and taste a bit nutty and also broad beans and other sorts of beans can add a lot of fibre and nutrition to dishes. Fish especially the oily ones you can add at least twice a week. Salmon, sardines and those type. Mix them up with walnut and almonds, are two of my favourites, as well as Brazil nuts which I'm sure you've heard me talk about before for they're good throwing in content as well as Hazel nuts or any other nuts you can have in there. The other main component of the diet is rich tomato sauces and garlic and onion based type condiments to go with meals. So you could make really nice pasta dishes. Make sure you have a lot of that in there. Tomato soup. Really good rich tomato soup. Just eating tomatoes is really helpful. So that is our lycopene. The lycopene I think is one of the really powerful nutrients to include in the diet. Watermelons as well but the biggest source is tomatoes and tomato paste. And then wine. It just depends on how much you... if you have cut back I certainly wouldn’t increase, but just the usual healthy intake of one to two standard drinks a day and one alcohol free day per week would be good. Well that is what it looks like and also reducing processed foods and packaged foods. So that was the summary of the Mediterranean diet and Ive got some recipes here that I can pass on to try and help you a little bit with that. Some really good salads you could make. You may see a little bit of weight loss when people change from a more to a less refined style of eating which can be beneficial and really help with metabolic health. And so where in our studies we are aiming for just some small amount of weight loss in our guys of 5 to 10% and just to keep things at bay and help with quality of life. So yeah we changed our approach substantially where we have still have the science in there but it's probably not quite as “sciencey” sounding on presentation, but that would certainly be part of the analysis looking at a lot of inflammatory markers, obviously all of the metabolic markers, cholesterol levels etc and potentially genes. But we are waiting on the gene analysis to see which genes are the most promising nearer the time when we are actually doing the analysis so we are constantly looking at the literature and seeing the new things that come out and we store our blood that we take and then we make sure we do the most up to date, looking at the mechanism part of it nearer the time. That was what I was planning to say specifically but I'm looking forward to hearing what you think. Bruce Kynaston: Yes well thank you very much Olivia. To use a mixed metaphor you have said a mouthful in a nutshell. Laughter Bruce Kynaston: Any questions please? Person #13: There is no mention there of sugars and carbs converting to sugars. Do you have a comment? Olivia Wright: Yes. I guess that comes with the less refined diet as well. We recommend that you minimise the added sugars and the consumption of the added sugars because that is very important to metabolic health I guess and also for weight management. So we certainly do... Yeah I actually have a slide here now that I'm looking at it. So that comes into it and we certainly recommend that people be aware of that and added sugars and things. But once they adopt this less refined dietary approach, that sort of follows suit with that. But obviously you want to have your treats every now and then, and we recommend that too. it's not meant to be... it's meant to improve quality of life and not meant to make you feel like you are on a diet as such. it's meant to be a lifestyle package that you can adhere to. And that's one of the studies we are looking to as well. Like can people adhere to this diet. How easy is it to follow? What are the difficulties associated with that? So that the real, what we like to call the translational aspects of our research, getting it out there and talking to people to actually do it rather than spending all of the time in the lab. Does that answer your question? Person #13: Yes, but should you also cut down on the carbs? Bread rolls and sliced bread from the bakery and all that sort of stuff? Olivia Wright: Oh yeah. So instead of the bread from the bakery, although whole grain is a very important factor so instead of the white highly processed breads and often the bread from the bakery has added fat in it to give it that really lovely bakery smell and taste. That's why it actually goes off quite quickly because they have added a bit of extra fat in there. I know that from a baker when I was doing a lifestyle programme once and thought aaaah, that's what happens. So certainly the really good whole grain bread you can buy in the supermarket is beneficial for you. it's good for fibre but you don’t want to be piling it in, so balancing that with the carbohydrate from really healthy vegetables and legumes would give you a better variety of nutrition. Person #13: Also what about coconut oil as a substitute for olive oil as an alternative? Olivia Wright: Very good question. It is a saturated fat. We have very little evidence in our population that is OK. They have studied it in some Asian populations and they found no adverse effects of it on cardiovascular health, however those populations have adapted to it and have been consuming it for the majority of their life. So I think the issue comes when we introduce something like that later on and we are not used to it. It does behave like a saturated fat as far as I am concerned so I would still prioritise olive oil over that. Definitely. Person #13: Thank you. Bruce Kynaston: I think an answer to one of the questions about bread rolls and so forth... I don’t think the Cretan gentlemen eat too many of those... Olivia Wright: No that's exactly right! Bruce Kynaston: They didn’t have money to splash around on fast foods. What we call luxuries they don’t have so if we stick to their lifestyle a little bit, exercise and not too much food. Just enough to allow you to work and you live longer. Olivia Wright: That's right. And I think their involvement in a lot of activities and around a lot of people contribute to that as well. So yeah. They were extremely active. Bruce Kynaston: Any more questions? Person #14: Dr Olivia I understood that you said earlier that you can use diet as a means of managing the side effects of ADT. Could you expand on that? Olivia Wright: That's right. The side effects of ADT that we are looking at include changes in cholesterol, a bit of weight gain, changes in body composition so we lose a bit of lean body mass and gain a bit of fat mass and also potentially insulin resistance, not diabetes but insulin resistance so the body isn’t quite as good at managing carbohydrates. So we really encourage this dietary approach to alleviate those side effects. it's been shown that it can alleviate those metabolic side effects so blood glucose levels go back to normal, cholesterol levels fall and start becoming more stable and appropriate. There's other things we can suggest as well to fix things. We might suggest plant sterol margarine and things like that to absorb the cholesterol and excrete it. But, yeah, those side effects of ADT, the hormonal related ones, can be quite substantial. Also the fatigue levels. So this diet - we are not sure we are testing - can help with that combined with an exercise regime as well so we can maintain lean body mass whilst on ADT to reduce the loss of it. it's really good to keep in with some regular exercise patterns. They trialled resistance training here at UQ and found that to be very successful in maintaining lean body mass. And we are looking at quite a high intensity exercise extension for a few weeks on top of a diet intervention to see what we can do. So as far as the exact results we get from our particular diet patterns from ADT we are yet to find out but certainly the theory and the science behind it should help with those cardiovascular and diabetes insulin type resistance effects you can get. Person #10: This trial you are doing with men on ADT on a diet. How long have these men been on ADT for? Olivia Wright: At least 3 months. We like them to have been on it for at least 3 months at any time. So it doesn’t have to be a criterion for inclusion for that. So it's one of my PhD students conducting that trial so we are... yeah, you don’t have to be still on it now it's just that if you've ever been on it for 3 months at any stage we are interested in seeing if we can help. Person #10: Ive been on it for years intermittently and I don’t have any special diet but I just exercise regularly with resistance training and hydrotherapy and I seem to be managing OK. Ive also been told though that with most nutrition and diets you get better results if you start them before the cancer comes. Would you like to comment on that? Olivia Wright: Yeah, obviously prevention is advantageous but that's not always possible and for certain reasons unknown to us and in our genetics and other factors we could have a wonderful diet and still develop cancer. So there is a lot of things we don’t understand about it but certainly following a diet like the Cretan men for the entire of our lives should prevent a lot of conditions as well as cancer. But it doesn’t always so... yes. From that point of view that is true but I guess the evidence today from the Cretan diet is that with prostate cancer it can reduce the overall mortality so even at that point in time you can still have a really positive effect from following that diet as well. But if you are interested in our studies drop me a line and we can have a chat later on. Person #10: Yep, OK thanks. Olivia Wright: You would certainly be eligible for it if you wanted to. Person #10: Yep, OK thankyou. Olivia Wright: Thanks. Person #8: A couple of technical ones for you Olivia. One is a while back some of the prostate cancer gurus were strongly supporting the concept behind reducing cellular inflammation a la Barry Sears anti inflammation zone for example. I'm just wondering how much evidence there is for that and if there is what are the useful markers that might be used to track it? Olivia Wright: OK, very good question. Inflammation is really important and we know that from the science that it is linked to a progression of a range of chronic diseases through the inflammatory markers so it can cause the cells to do silly things, to continue to progress. Certainly there is a range of anti inflammatory markers that we look at so we've got quite a few prostate cancer, well not prostate cancer specific ones. We are looking at the interleukins now. I need to double check exactly what we are looking at. I'll try to get a file up. Certainly IL 2, IL 6, IL 10 that we are looking at. We look at insulin related binding proteins 3, certainly IGF1, insulin-like growth factor 1 we do a lot of work with in colorectal cancer as well as prostate cancer because their markers are related to insulin could also be related to inflammation as well. So there is a number of ones. I think PSA is related to it as well. It can be indicated but there are some quite technical ones. Once I find my list of exactly what we are looking at I can show it to you. There is another one, C-reactive protein. The C-reactive protein is probably one you would be able to get more standardly from your standard blood type analysis. So some of the other ones I mentioned you may not be able to get. I'm not sure. Person #8: What was that last one? Olivia Wright: C-reactive protein Person #8: Oh the CRP blood test - yep. Olivia Wright: CRP, yeah. So we in our research we look at a high sensitivity version of that but the standard test is just CRP and that just shows a broad scale systemic inflammation. So it's not going to tell you there is inflammation in this particular tissue or that particular tissue. it's often associated with if there is a cardiac event as well it tends to go up. Or any kind of Illness or anything... it's positivity phase proteins that means it goes up when there is Illness or infection or whatever as well. So it's not definitive but that's generally used as the inflammatory marker in general day to day life, but we are looking at a lot of other ones. So many that I cant remember them all. But interleukins are a big part of it. But yeah the anti-inflammatory nutrients are indeed being touted as being important over time and certainly if you take a vitamin D supplement then I encourage that for maintaining bone health and we study more vitamin D supplementation for inflammatory reductions happening are quite mixed but we cant seem to get a vitamin D clinical trial to give us any sort of more consistent information in the literature because there are so many genetic issues in vitamin D and the way it operates in the body so until we sort that out we will continue to get all this mixed data. Person #8: From what Ive read DHA, one of the important components of fish oil... ... used to be fairly closely linked... Olivia Wright: Yeah that's right Person #8: I did a test on myself where I was measuring serum DHA, I cant remember the other component, but certainly I was able to track the... by changing diet I was able to track the change in the serum response but whether that was confirmed causing an improvement in my prostate cancer I have no idea. Olivia Wright: Yeah well certainly omega 3’s are very anti inflammatory, and omega 6's are pro inflammatory... Person #8: Yeah I think it was a DHA total Omega... Olivia Wright: Yeah, that's Omega 3... Person #8: Omega 6 I think was the ratio I was looking at... Olivia Wright: Yeah, so we want to get more Omega 3 in the diet we just need the ratio to be at least 3 to 1, Omega3 to Omega 6 to get that on the right side of things, so that's the other main anti inflammatory and we recommend that as an anti inflammatory for any condition that is associated with inflammation so Omega3’s and the DHA. Person #8: OK. Thankyou. Olivia Wright: No worries. Bruce Kynaston: Any more questions or are we done? Gentlemen...? Person #8: I'll ask another one if none else is speaking up. The LDL cholesterol and cholesterol generally is a precursor to testosterone and how it is synthesised in the body so low cholesterol and LDL in particular seems to be logically connected to better PSA that comes if you try and minimise testosterone in the body. Is that a proposition you would agree with or not? Olivia Wright: Yeah, absolutely. Yeah, so definitely cholesterol is a precursor to our fatty hormones and our sex hormones so yeah, absolutely we want to keep that down but yeah also just for general cardiac and metabolic health as well we are really interested in keeping it down. Also which would then feed back on testosterone which also increases risk on cardio vascular issues as well. So it's all related in a big flow chart circle. We just want to catalyse change across as many systems as we can and have a very broad approach now instead of just giving supplements for various things and seeing what they do, because we cant adequately see what they do basically, with the tests we have available at the moment. So it's better to take a broader, what we call translation approach. Person #8: Mmm. And finally a comment on red meat? Olivia Wright: Oh, you want me to expand on that? Person #8: Yes, just a little if you can. Olivia Wright: Yes, so... Certainly the Cretan guys didn’t have much of that so probably around once or twice a week they maybe had some red meat, that's how they fitted all of the other good things into their diet and certainly the Australian Dietary Guidelines cut down the amount of red meat they recommend. Now that's because of environmental sustainability purposes, not necessarily nutritional. There is no real strong evidence to suggest that nicely cooked, trimmed fat nice piece of steak, not burnt obviously, on a BBQ is going to do you any harm. The real concern we have with meat is the highly processed, canned, yeah... any highly processed meat that has gone through that procedure with the cancerous chemicals, and strange sausages where your not quite sure what's in there. So when you are going to have meat I would buy the most high quality, whatever your most favourite cut of meat is. Cook it, make sure you don’t burn it and enjoy it and not worry about having it but certainly try and fit all of these other things into your diet as well and keep off the ham and other really highly processed... Person #8: I'll bet that most of the people listening don’t have any red meat at all. Olivia Wright: No... Person #8: That's been the folklore around prostate cancer. Olivia Wright: Yeah... And that's because I think of why the fatty acids in there that they are thinking they have an effect, but I haven’t seen any particular evidence for that and I guess from our point of view we want you to keep your iron levels good as well and... But if you want to avoid it and you're getting a lot of iron from vegetables and other means and fish etc then that's totally ok. You don’t have to eat red meat by any means and they certainly only had it once or twice a week. Person #8: Is the availability of iron from vegetable sources sufficient? Olivia Wright: it's not as good as from animal sources but seafood is quite rich in it as well and so long as you have the vegetable source with some vitamin C. So have an orange when you have your... or some orange juice or something like that when you have your green veggie source as it helps absorb it a lot better because it makes things a lot more acidic and it activates more absorption processes so that's what we recommend. Person #8: Thankyou. Bruce Kynaston: Olivia, Bruce. On the matter of not eating meat, consider the brumbies and how they eat vegetarian and how they maintain excellent health I'm not too sure but all the animals who eat grass and so forth is a wonder nutritionally. Olivia Wright: That's right Bruce Kynaston: It just goes to show that you don’t need it. But my red meat source is turkey meat because it's inexpensive and it seems to be the unwanted part when they prepare turkey breasts for a market and I make use of that in small quantities. Olivia Wright: Yes and turkey meat is great as it's got one of the precursors of seratonin in it which can help with mood as well but quite high in the amino acids. Bruce Kynaston: Low fat and... Olivia Wright: Yeah... very good. That's a very good recommendation for the meat sources. Bruce Kynaston: Another question? Person #14: Just going back to the subject of diet to manage the side effects of ADT. Dr Olivia would you have any do’s or dont’s in regard to that? Olivia Wright: Er, don’t eat too much and do eat like a Cretan. So certainly cut back on all of the processed foods. So cakes, chips, takeaways... If you want to get a takeaway get something you really like so that once a week. Cut back on the alcohol if that's important... But yeah a general overall healthy diet and as far as the dont’s I guess it's all to do with helping to maintain weight or lose a bit of weight if needed and not to eat too much I guess is the simple part of it. I think as a country as a whole we eat far too much food and our portion sizes are ridiculously large and much bigger than they need to be and of course we have adapted to that over time and that's our biggest problem and I don’t know how that is going to change. it's quite simple advice but there is nothing that is really specific that I could give that is a scientific way at the moment. Obviously getting the functional nutrients in so a really good variety of fruit and vegetables emphasising the rainbow of colours particularly the blues and the reds and the dark greens and a good intake of fish for the anti inflammatory properties or fish oil if you choose fish oil if you don’t like fish. But yeah that would be... I don’t really have anything else that would be more definitive than that at the moment. We were doing a study in Brazil nuts. We were going to give guys Brazil nuts and a selenium content. Just a small amount in different doses etc, but that project hasn’t continued because the students stopped doing that. we've got a little bit of data to show that the selenium levels increased a little bit, probably because we were only looking at healthy diets to start with, so young guys to see what effect it would have. Does that answer your question or does that...? Person #14: Thanks for your comment. Person #13: I was recommended I should have apple cider vinegar before each meal. What are your thoughts on apple cider vinegar? Like taking a glass. Olivia Wright: So what was that for? Was there any particular reason for that? Person #13: It was the doctor, the nutritionist who recommended I do that. She put me on the Mediterranean diet and said take that 10 minutes before each meal because I do suffer gastric reflux. Olivia Wright: OK. Well that's quite acidic as well so... Person #13: I know it's counter intuitive as well but... Olivia Wright: Yeah... Do you find it helps you? Person #13: Well I don’t know because I'm also on tablets for my gastric reflux anyway. Bruce Kynaston: Vinegar with its acetic acid is nutrition to the good bacteria in our gut. Olivia Wright: Yeah... That's the only thing I can think of, that it can be certainly beneficial to reducing harmful bacteria that may be in the stomach as well. Certainly is something that we are becoming more interested in as well and the bacteria in the micro bio and things. I haven’t seen any particular science or evidence about apple cider vinegar nut it certainly wouldn’t do any harm or have any problem causing properties I would think. But I am sure it would become acetic acid as well and that may help the beneficial bacteria. I'm just looking up some evidence here. I cant find any scientific studies but they are certainly mentioning in some of the natural health web sites promotion of good bacteria throughout the body so stomach as well as intestines. Jim Marshall: Hi again. Vinegar has been used to stop the glucose high from becoming too high, so if you eat a bread roll you can counter that by adding some nuts or almonds. Vinegar will also lower the high so that is perhaps what the doctor was thinking about. Olivia Wright: Maybe. And certainly there we know that it can slow the absorption of things so that could be right. Acid added to anything can be used to reduce digestive times. I'm reading something here that says vinegar might activate some of the digestive enzymes to break down carbohydrates so it will stop them being absorbed as much. I'll have to look into that. it's given me something to do. Laughter Olivia Wright: Hey it's good. Person #13: Mind you that advice came from a beautiful young Russian doctor. Olivia Wright: Right. Just because there is no evidence doesn’t mean it doesn’t work. That's the other fallacy not to fall into, but I'll look into it. But certainly adding fat or adding acid, yeah, they're the main two does slow the gastric dose. So lemon juice might work just as well I'm sure. Person #8: Just one final question. On glucose, because cancer cells require a fair bit of glucose for their own metabolism, the less of it that is floating around in the blood the better. So that and a lean body mass are supposed to be helpful. Do you have any comment there? Olivia Wright: Yes I certainly agree with that and that is why we are focussed on helping with the metabolic side effects as well because with ADT people can become a bit insulin resistant so they are going to have a higher blood glucose levels. So we can really improve that and impact that by changing diet and increasing exercise. Yeah so definitely we want to cut the metabolism of those cancer cells. Definitely . Person #8: So presumably low GI glucose, or low GI carbs I should say would be better than otherwise. For that reason yeah? Olivia Wright: Absolutely, yeah. And they're the less highly refined ones, the ones rich in grains and fibre. All the brown ones. Yep. Unknown: What about rye bread? Olivia Wright: Rye bread? Yeah it's a good one. it's quite... as long as it's not quite highly refined rye bread. Yeah if you really like that. That's good. it's a whole grain as well. You can look for whole grain labelling these days. So make sure that it's whole grain and it should be fine. it's a heavier bread so you probably don’t need as much of that. You would probably have less of that than if you had other breads just for the carbohydrate content. it's a lot denser. Other than that it's low GI and a good one as well. Unknown: Could I ask one more question? Olivia Wright: Sure. Unknown: And that relates to unpasteurised milk. Is that better for your bone density or not? Olivia Wright: No. I would say not. I wouldn’t suggest anyone drink unpasteurised milk at all. There are other dreadful risks like food poisoning and yeah... Unknown: I grew up on that as children. Olivia Wright: Yeah that's true. it's one of the fads going around at the moment that we hear quite a lot of and there is no reason it should be any better for the bones than the pasteurised milk. Olivia Wright: Even better get one with vitamin C added into it as well as that can be even more beneficial if you want to make the most of the milk if you don’t drink a lot of it, if you want to get the best out of it that's possible. Unknown: I'll get it from my own cow. Olivia Wright: Yeah well that's it. If you're totally in control of the non pasteurisation process then that's, yeah, then obviously less refined is better, maybe if you're confident in the safety of it, but we certainly don’t recommend that across the board. No. Bruce Kynaston: Do we have other questions? If not it would be an appropriate time... Well Jim would you like to thank our guest? Jim Marshall: Indeed, indeed. Olivia, by coincidence before you came on we were talking about getting a drug called Enzalutamide made available before chemotherapy in Australia. That drug being available before chemotherapy will reduce the risk of death by 29% Olivia Wright: Wow. Jim Marshall: If you want to have that now before the PBS pays for it, it's between five and six thousand dollars a month. I notice the paper you quoted, quoted a 30% risk reduction from dying... Olivia Wright: Yes. Jim Marshall: ...of prostate cancer... Olivia Wright: That's right. Jim Marshall: ... a lot more cheaply and also reducing your risk of dying of heart disease, stroke and many other things. Olivia Wright: It was actually 29. I rounded it up... Laughter Olivia Wright: Yeah I like to round things up. My notes actually say 29% for prostate cancer mortality. So there you have it. So that's good. Jim Marshall: So you've given us advice worth roughly five to six thousand dollars a month! Olivia Wright: Oh. I am so pleased. Jim Marshall: So you will probably be speaking to more people who are taking ADT than you will ever speak to at any one time. Almost all of your audience here is currently on ADT and anyone who is not on ADT is probably on a break from it. Olivia Wright: Sure. Jim Marshall: So we all have prostate cancer and we all eat so it's been very valuable to everybody. And I'm sure most of us will live at least a bit longer and more healthily because of your wonderful advice. Thank you very much. Olivia Wright: Oh thanks Jim. I really hope so. We really love helping you out. Call upon us at any time. Myself or any of my students here at EQU and we are really looking to help you all as much as we possibly can with these quite simple strategies, nothing overly complicated because it doesn’t need to be I guess. We do the complicated science stuff at the other end. Yeah, so wonderful to talk as always and I wish you all the very best and good health and happiness. Repeated thanks from the audience. Olivia Wright: Bye Bye Bruce Kynaston: OK Bruce back on the air
  21. A good video by the Prostate Cancer Canada Network Calgary. Psychologists from the Tom Baker Cancer Centre in Calgary Canada, Lauren M. Walker and John W. Robinson, share a talk the context of when Androgen Deprivation Therapy, or ADT, is used for treatment. They also talk about the studies and work they've done on the treatment, the side effects and ways to deal with them.
  22. In today's teleconference it was suggested that Megace might be useful to reduce hot flushes. I notice that Chuck Maack recently referred in a US forum to a warning by top Medical Oncologist Stephen Strum against men on androgen deprivation therapy using Megace for hot flushes. Strum warns: "I am not a user of Megace in this setting since it is metabolized to DHEA and then to androstenedione and then to testosterone. When the PSA is in good control and the testosterone is low, I use Depo Provera intramuscular injection 400mg ONCE and that usually eliminates hot flashes forever. The emphasis on "usually" added since there are rare cases wherein the hot flashes are not reduced/eliminated. Therefore, a 400mg Depo Provera intramuscular injection just once would be what I would have done were I experiencing hot flashes. Make sure the prescribing/administering physician is providing Depo Provera and at the recommended dose, and not Provera. Though both are Medroxyprogesterone, the difference is that Depo Provera is an addition of acetate. There are physicians not familiar with that difference who prescribe Provera when the requirement is, specifically, Depo Provera. HOWEVER, IMPORTANT TO NOTE: Depo Provera has also been known to cause gastrointestinal bleeding and a low HCT percentage can also be attributed to loss of blood. If you are experiencing fatigue and shortness of breath subsequent to Depo Provera, you may be experiencing a blood loss with this gastrointestinal bleeding and don't know it. Be sure your physician keeps an eye on red blood counts (RBC) as well as HGB and HCT levels". You should not start any treatment for hot flushes unless you have first discussed it with your doctor.
  23. ADT affects the brain

    Cognitive impairment can occur in cancer patients who are treated with a variety of therapies, including radiation therapy, hormone therapy, and chemotherapy. After chemotherapy treatment it is commonly called "chemo brain." Signs of cognitive impairment include forgetfulness, inability to concentrate, problems recalling information, trouble multi-tasking and becoming slower at processing information. The number of people who experience cognitive problems following cancer therapy is broad, with an estimated range of 15 to 70 percent. There have been several studies analyzing this side effect in breast cancer patients, but few have investigated cognitive impairment following androgen deprivation therapy (ADT) for men being treated prostate cancer. A new Moffitt Cancer Center study indicated that men who are on ADT have greater odds of experiencing impaired cognitive function. In this study, researchers used formal tests to compare the cognitive ability of 58 prostate cancer patients on ADT to 84 prostate cancer patients not on ADT, and to 88 men without cancer. The researchers also reported for the first time a possible genetic link among those individuals who experience cognitive impairment whilst on ADT. They found that patients who have a particular version of a gene called GNB3 were 14 times more likely to suffer from cognitive problems on ADT. The researchers suggested that doctors: before starting ADT, should discuss the risk of changes in cognitive functioning with their patients; and after starting ADT, should also ask their patients if they suffered cognitive impairment with a view to referring them for assessment and treatment as needed. I wrote to one of the researchers and asked what treatment was available for prostate cancer patients on ADT who suffered cognitive impairment as a side effect. This was his reply: “Unfortunately little research has been done on ways to improve cancer treatment-related cognitive impairment. But some recent studies have suggested that "brain training" may improve cognitive function...and [there is] some preliminary evidence suggesting benefits to cancer survivors who had cognitive impairment. There are also medications that could be helpful, such as stimulants (e.g., methylphenidate, modafinil). It is also recommended that other issues that could contribute to cognitive decline be adequately addressed. For example, depression or sleep problems could easily worsen cognitive functioning and are usually treatable. Exercise has also been shown to be very important for cognitive function. I would recommend first addressing the issue with your oncologist or perhaps requesting a referral to a neuropsychologist or another provider who may be able to make recommendations tailored to your situation.” Brian D. Gonzalez et al Course and Predictors of Cognitive Function in Patients with Prostate Cancer Receiving Androgen-Deprivation Therapy: A Controlled Comparison http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2014.60.1963
  24. 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?
  25. Not having a sex change just yet

    Dr Snuffy Myers suggests that small doses of oestrogen may minimise some of the side effects of Androgen Deprivation Therapy, including, amongst others, cognitive side effects. There were also a few small clinical trials around 2005-2007 which looked at the effect of oestrogen on memory (well-known researcher Tomasz Beer did a couple of these). For some time I've been trying to find someone willing to prescribe me oestrogen for this purpose. Until now, most doctors have been reluctant because of the increased risk of cardiac side effects, particularly deep vein thrombosis. My new endocrinologist was willing to prescribe it. The drug that he prescribed is normally used for transgender patients undergoing a sex change. This led to a very interesting conversation at the chemist when the pharmacist asked me had I used the drug before.
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