Advanced Prostate Cancer Teleconference 28/10/11

[Euan]

Man #1 said that his PSA that was always low at around 1.2 which was the primary reason for his late diagnosis. At diagnosis PSA was 2.6, Gleason score 9 with asymmetrical bone metastases. Standard hormone therapy (androgen deprivation therapy or ADT) over 10 months has dropped his PSA down to 0.1 and much of his bone metastases cleared.

In March he received a very comprehensive report from the Multi Disciplinary Team at the Princess Alexandra Hospital (Brisbane). He also saw a psychologist at Cancer Council Queensland and both were at no charge and both were very helpful. At the UQ interprofessional clinic an exercise physiologist designed an exercise program for him. He also had consultations with a dietician.

Because of his low PSA he has a full body scan every 3 months. In June he had radiation to his spine and the pain disappeared. In September he discovered that his cancer had spread to his lymph nodes. A full body scan also found that the tumour had spread to his spinal canal. Radiation therapy to his spine has relieved him of almost all the pain.

Action: Man #1 said that he would start guidelines for disease management and also a guide on how to deal with specialists.

Man #2 told how he managed to get on to the MDV3100-3 “Prevail” trial through Dr Paul Mainwaring. Note: this is a strong anti-androgen. His PSA dropped from 44 to 3.6 but he is in zombie land most of the time. The other side effects are similar to ADT and varies greatly between men eg. muscle and bone loss, cognitive ability, weight gain, diabetes. His bone scans show that his metastases have cleared.

Man #3 explained that such trials typically compare the drug being tested with next best treatment. If the next best treatment fails then a cross over occurs and all participants are offered the new drug. Man #2 said that after 10 years of ADT off and on he now has stiff joints. Man #3 explained that arthritis is common but not likely caused by the ADT.

Kate Bolam is an exercise physiologist at the University of Queensland. Exercise can improve ones endurance, muscle strength, balance, anxiety, depression and fatigue. Going for a walk when fatigued can help reduce fatigue. Men with prostate cancer and especially androgen deprivation therapy (ADT) have more to gain from exercise.

Before starting exercise first do a 5 minute exercise such as a walk, also some stretches. Aerobic exercise (cardiovascular) is anything which gets your heart rate up to where you are slightly breathless but can still talk. Start slowly but work up to at least 20 minutes per session 3 to 5 times per week.

Resistance exercise (strength) is important because you are more able to do things and it increases your metabolism – good for weight loss and bone density. Suggested exercises are a leg press, seated row, chest press, shoulder press, sit to stand,. Therabands (rubber tubing) are cheap and portable. Sit to stand using only legs is good. Leave at least 48 hours between resistance exercise sessions. Lift the weight 10 to 12 times (muscle should now be exhausted) then a 30-60 second break and repeat. Note: for an excellent exercise booklet see http://www.cancerwa....cer-booklet.pdf. High impact exercise (jumping and landing with straight legs) can help bone density. Do not do this if you have artificial joints or already have osteoporosis.

Chronic Disease Management (CDM) (includes cancer) is covered by Medicare. Phone you doctor and ask if you are eligible for an Enhanced Primary Care plan (EPC) as not all doctors will do them and they can take 45 minutes. An EPC entitles you to 5 sessions per calendar year with a physiotherapist, exercise physiologist, dietician and many more. The doctor will decide which providers you will see. Veterans and their partners get a lot of free stuff so veterans should speak to the Department of Veterans’ Affairs. For those with type 2 diabetes there is an 8 week program which is fully rebatable see http://www.uqsport.com.au/diabetes. There is a free 7 week exercise program at UQ each May to June for men with prostate cancer. Kate can be contacted Ph: 07 3346 9710 or email k.bolamATuq.edu.au (replace the AT with the usual symbol).

Man #4 explained that after 3 years of complaining to GPs that he had serious difficulties passing water and PSAs around 4 and clear scans he finally was referred to a urologist who diagnosed aggressive (Gleason 5+4) prostate cancer with metastases in spine, both rib cages and a hip bone. In March 2011 he was put on ADT and is to see a radiation oncologist for his painful metastases. Because he has metastases and has not had chemo therapy he was advised that he was likely to be eligible for either MDV3100 or Abiraterone trials and that Dr Paul Mainwaring in Brisbane was the person he should contact (phone 3737 4730).

Man #5 had radical prostatectomy in 1996. He has previously had docetaxel with no ill effects, but when he managed to get on to a Cabazitaxel trial within 6 days he was in hospital in isolation with no white blood cells. Cabazitaxel caused his PSA to drop from 830 to 290. He will be discussing an Alpharadin trial with his oncologist. Man #3 indicated that Alpharadin was used for treating cancer in the bone. It uses the alpha particles from radium which do not travel far and hence do less damage to healthy cells.

Man # 6 had his prostate removed 2 years ago. He is currently on Zoladex and Cosudex and had been coping well but just in the last 6 weeks he has felt overwhelmed by the situation. He was advised to call 131120 (Cancer Council) and ask to speak to a Clinical Psychologist (free). He did say that he is on antidepressants. Man #3 said that he was aware that as men age and their testosterone declines that depression becomes more likely. Man #7 said that he had depression 5 years before prostate cancer and hormone therapy heightened the problem. He also added that he found exercise had really helped.

Man #8 was diagnosed 3 years ago with metastatic prostate cancer. He had his last Zoladex 13 months ago. In spite of this and regular exercise he still has a lot of lethargy. Man #1 said that he saw an exercise physiologist and her advise was to always make a start even if you are unable to complete the exercise. Man #9 found that he really had to force himself to exercise and after 3 or 4 minutes it became a lot easier. Man #10 also admitted that he has to force himself because he knows he needs to exercise. Another man concurred that once he got into a rhythm of exercise it became easier.

Man #9 wished to know about Zometa. Man #3 said that it was just for when the cancer had reached the bone. Man #5 said that he has been on Zometa since 2007 and that it was just for cancer in the bone.

Jim Marshall said that currently he has to send out emails manually. There is an automatic system on the online Community which he would prefer to use. To become a member of the Community go to www.jimjimjimjim.com and click on the blue ribbon. When asked about men who do not have a computer Jim said that at this time with the limited resources of Jim and a couple of others we were not able to do mail outs. Daryl Hyland mentioned that if we are going to grow than we will need to provide mail and he can arrange this through the PCFA office. Daryl also mentioned that additional staff at PCFA in Sydney may well become involved in the New Year.

David Abrahams commented that he was concerned about the cost of the teleconference and suggested that it be limited to bimonthly. Jim Marshall said that he would find out about the cost. The monthly or bimonthly teleconference was suggested as an agenda item for the next teleconference. Jim has now reported that because PCFA have a VoIP or internet phone system there is no additional cost born by PCFA. Bruce Kynaston suggested that for those that can to email any agenda items they wish to discuss.