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  1. MEN AND SEXUAL HEALTH-PROSTATE CANCER STUDY HOW HAS PROSTATE CANCER AFFECTED YOUR SEX LIFE? WHAT SUPPORT DO YOU NEED? Tell us your story. The Men and Sexual Health-Prostate Cancer study is recruiting men from around the world who have started or received treatment for prostate cancer to take part in a 30 minute online survey. The study examines how prostate cancer affects a man's sense of themselves (masculinity), their sexual concerns after treatment, and overall quality of life. Our aim is to develop better ways to support men with prostate cancer in the future. Help other men affected by prostate cancer by sharing your experience. Get the PDF with details by clicking here: Has prostate cancer changed your sex life Study.pdf (You may have to visit our website to download this. Click on the Go to this Topic button lower in this email.)
  2. Having incurable cancer has caused Larry Axmaker to adjust his definition of "quality of life". Click here to read about how Larry defines "quality of life"
  3. We are all familiar with the concept of intermittent ADT as opposed to continuous ADT. Now researchers are investigating the concept of intermittent chemotherapy as opposed to continuous chemotherapy. If certain criteria are met, there will a break in the chemotherapy treatment and the patient will have a “drug holiday”. In theory intermittent chemotherapy may serve 2 purposes. First, with less constant exposure to the drug, this may potentially delay the development of taxane-refractory disease. Second, breaks in therapy or “drug holidays” may improve the quality of life for patients, allowing them to recover from the cumulative toxicity of chemotherapy during these “drug holidays.” Resolution of drug side effects may also allow taxane therapy to be prolonged, which could also improve outcomes. It is interesting to see that one of the abstracts for the 2016 ASCO (American Society of Clinical Oncologists) meeting in Chicago next week is about “PRINCE: A phase III study comparing intermittent docetaxel therapy versus continuous docetaxel therapy in patients with castration-resistant prostate cancer”. PRINCE which was a study conducted by German researchers found that: “The intermittent docetaxel chemotherapy was non-inferior to a continuous therapy in one-year survival. It was well tolerated and may present a treatment option for patients with CRPC”. Reference: http://abstract.asco.org/176/AbstView_176_170886.html
  4. At its November meeting the Pharmaceutical Advisory Committee (PBAC) considered an application to extend the listing of enzalutamide (brand name Xtandi) to include treatment of metastatic castration-resistant prostate cancer (mCRPC) in patients who have not had prior docetaxel (chemotherapy). The PBAC has released its decision on the application. It is what the PBAC describes as a "1st time decision not to recommend". It's disappointing that the application was not successful but encouraging that the PBAC is asking Astellas to resubmit the application. Here is the full decision from the PBAC: "The PBAC decided not to recommend extending the PBS listing of enzalutamide to include treatment of metastatic castration-resistant prostate cancer (mCRPC) in patients who have not had prior docetaxel because the submission was focused on a claim of survival advantage, which was small and uncertain, rather than on outcomes that clinicians and patients considered to be of most value. The purpose of using enzalutamide earlier in the disease pathway would be: 1) to delay symptoms from developing and maintaining a better quality of life for longer in asymptomatic patients for whom placebo, or watchful waiting, is the appropriate comparator; and 2) delaying the toxicities of chemotherapy in symptomatic patients considered suitable for docetaxel. The PBAC noted the median time to initiation of cytotoxic chemotherapy in the PREVAIL trial was 28.0 months in the enzalutamide group versus 10.8 months in the placebo group, a median difference of 17.2 months, which was clinically meaningful. In contrast the overall survival gain of 4 months for enzalutamide in the same trial compared to enzalutamide in the post-docetaxel setting (4.8 months from the AFFIRM trial) highlighted the minimal impact of earlier enzalutamide treatment on overall survival. The PBAC therefore rejected the application because it did not appropriately reflect the value of early enzalutamide treatment. The PBAC encouraged a resubmission to evaluate the potential gains in quality of life based on the patient populations and outcomes described above". The Drug Company commented: "Astellas is disappointed not to have secured an extended PBS listing for patients with mCRPC who have not had prior docetaxel, but is grateful to the PBAC for their helpful feedback and advice."
  5. 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.
  6. The results of a large, randomized clinical trial of the use of zoledronic acid (Zometa) were presented at the recent annual meeting of the American Society of Clinical Oncology (ASCO). In this trial the researchers set out to test whether giving zoledronic acid every 3 months would be just as effective (i.e., “non-inferior”) at reducing bone pain and skeletal-related events (SREs) in patients with bone metastases as giving it according to the standard recommended regimen (once a month) specified in the product’s prescribing information. They found that zoledronic acid administered every 3 months was just as effective to zoledronic acid administered monthly for 24 months in breast cancer, prostate cancer and multiple myeloma patients. Dr Jeffrey J. Kirshner identified this trial as one of the 10 practice-changing presentations from this year's ASCO annual meeting and said this less frequent dosing of zoledronic acid “will be less expensive and result in fewer visits for our patients and probably an improved quality of life.” References (click on the link to read) Article in the “New” Prostate Cancer Infolink Abstract of the trial presented at ASCO Comments by Dr Kirshner
  7. The Annual General Meeting of the American Society of Clinical Oncologists (ASCO) is an important event where lots of new developments in oncology are announced and discussed. This year’s meeting will be held from 29 May 2015 to 2 June 2015. Ahead of the meeting, a number of abstracts (summaries of scientific articles) have been released. One of these abstracts was a study by researchers led by Professor Daniel Galvao of Edith Cowan University in Perth. The benefits of exercise for prostate cancer survivors is well established. Professor Galvao and his colleagues studied 463 Australian prostate cancer survivors to see how many of the men were getting sufficient exercise. The participants in the study were also tested for psychological distress, unmet supportive care needs, and quality of life. Current exercise guidelines for cancer survivors recommend 150 minutes of moderate intensity or 75 minutes of strenuous exercise per week and twice weekly resistance exercise. Only 12.3% of the men got sufficient exercise in accordance with the guidelines. 40.2% of the men did some exercise. 47.5% of the men were inactive. The study found that lack of physical activity contributed to poorer quality of life and greater psychological distress. However, doing some exercise was better than doing none at all. The men who did some exercise had less psychological distress and anxiety than the men who didn’t exercise. 2015 ASCO Annual Meeting Abstract No: e16089 Australian prostate cancer survivors’ compliance to contemporary aerobic and resistance exercise oncology guidelines and associations with psychological distress, unmet supportive care needs and quality of life.
  8. Patients with castration-resistant prostate cancer and bone metastases may experience debilitating pain that impacts daily functioning and diminishes the quality of life. Previous results from a phase III trial demonstrated superiority of Denosumab (brand name Xgeva) to Zoledronic Acid (brand name Zometa) in delaying or preventing skeletal-related events (pathological fracture, radiation or surgery to the bone, spinal cord compression) in castration-resistant prostate cancer patients with bone metastases. Participants in this trial regularly completed Pain Inventory and Quality of Life questionaiires. Researchers did an ad hoc analysis of this trial which focused on the subgroup of men with no or mild pain at the start of the trial. This analysis showed that that Denosumab therapy significantly delayed the time to worsening of pain interference and maintained a higher overall cancer specific quality of life compared to Zoledronic Acid in castration-resistant prostate cancer patients with bone metastases. Should you be having Denosumab instead of Zoledronic Acid? I agree with Joel Nowak that you should "Speak with your doctor about this question.” Previous posts about Denosumab v Zoledronic Acid are at http://forums.jimjimjimjim.com/index.php?/topic/534-denosumab-or-zometa-for-protection-of-bones-in-prostate-cancer/ http://forums.jimjimjimjim.com/index.php?/topic/535-denosumab-or-zometa-for-protection-of-bones-in-breast-cancer/?hl=zometa
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