Advanced Prostate Cancer Teleconference 25/11/2011

[Euan]

The teleconference began with Chair acknowledging the passing away of a member of the Toowoomba group. “Today, on behalf of all members of the group I would like to extend our condolences to David Abrahams and his colleagues in Toowoomba for the loss of their friend Charles Dolding. Charles was not quite a member of this group. David – our thoughts are with you and your colleagues.”

Man #1 explained that he has recurrent cancer and had spoken to several doctors some recommending chemo and others recommending radiation. He decided to have the radiation and after 2 weeks has bad diarrhea. He will continue with the remaining 3 weeks of radiation. Some doctors said the radiation might be all he needs but others want him to start on chemo 28 days after the radiation. Man #2 said that he had a break of a month to give his body some recovery. Man #3 suggested that our speaker today, Dr Oleinikova, who will be speaking about the multi-disciplinary team at the PA Hospital, might be able to provide good advise for him.

Man #4 spoke of his rising PSA following a radical prostatectomy. Eligard now has his PSA undetectable and he wants to hear what others suggest between intermittent and continuous androgen deprivation therapy (ADT). A number of men mentioned that they were on intermittent ADT, some for several years, and over time the off time gets smaller and the PSA rises faster. Man #5 suggested that the higher the PSA and more aggressive the cancer then be more cautious about coming off. Man #3 suggested that a difference might also be if you have proven metastasis or not. Man #2 mentioned that he was diagnosed with bone metastases and had 14 months off with no repercussions. Man #1 said that his initial PSA was 300 and Gleason 4+5 and has been on Zoladex with an anti-androgen for 10 years. Man #6 said that a person’s cancer never stays the same and overtime usually becomes more aggressive. He was also unaware of any reason why a man with bone metastasis could not go on intermittent ADT. Man #7 mentioned that if you have erectile dysfunction and this is causing a problem with your relationship you should always mention this to your doctor.

Man #5 spoke of the clinical trial “PREVAIL” which is with the drug MDV3100 for men with metastasised Castration Resistant Prostate Cancer (mCRPC) who have not had chemotherapy. He also believes that there is also an Abiraterone trial for pre chemotherapy as well. For prostate cancer trials see http://www.prostate.org.au/articleLive/pages/Clinical-Trials.html

Man #2 mentioned that the reason for demonstrable metastases is that it can be measured whereas PSA is only a marker. Man #8 asked why Man #5 was seeing an Oncologist and did not stay with his Urologist. Man #2 said that if you have advanced cancer an Oncologist is a person to become familiar with as this is their area of expertise. Man #5 said that not only does he see an Oncologist to manage his cancer he also sees and Endocrinologist to manage the side effects of his ADT.

Dr Irena Oleinikova is the Clinical Trials Manager and also a member of the Multi-Disciplinary Team (MDT) for prostate cancer at the Princess Alexandra Hospital (PAH). MDT specialists are from urology, radiation oncology, medical oncology, palliative care physicians, psychologists, research scientists, dieticians, cancer care nurses and clinical support staff. The MDT assess the mans quality of life and mental health status, anxiety or depression. Anyone with prostate cancer who wishes to attend should first get a referral. This will generate further collection of documentation such as medical history including prostate cancer, current medications and previous treatment. The patient is asked to complete a questionnaire on his functioning and quality of life. The treating physician is encouraged to attend MDT meetings. If possible patients should attend an initial interview but if because of distance or health reasons then a telephone interview with the patient can be done. Patient involvement is very important for understanding of medical procedures and terms and lifestyle changes and emotional wellbeing. After evaluation of the patient an MDT meeting will usually result in a treatment recommendation including treatment at the PAH if appropriate.

The MDT are also involved with some clinical trials for which patients would be considered. They commence in 2012 for men with mCRPC. One is called PROSTVAC and is vaccination over 5 months intended to produce an immune response. The other is called the Tocotrienol trial and there is no placebo group with this trial. Tocotrienol is a constituent of vitamin E.

To contact the Multidisciplinary Team call Coordinator Linda Crook, Ph: 07 3176 3228 or email: MDT_ProstateCancerAThealth.qld.gov.au (replace the AT with the usual symbol). For more information see:

http://www.australianprostatecentre.org/clinical-trials/for-patients

Man #4 saw a Snuffy Myers video which mentioned curcumin and wanted to know what others thought. See: http://askdrmyers.wordpress.com/2010/09/29/curcumin-prostate-cancer/ Man #3 said that he was taking curcumin which is the main ingredient of turmeric and which gives the yellow colour to mustard and curries but is poorly absorbed this way. Adding black pepper does help with absorption. He imports it from Life Extension and cost about 60 cents per day. See: http://www.lef.org/magazine/mag2007/oct2007_report_curcumin_02.htm?source=search&key=curcumin Man #6 reading from the Wikipedia article on curcumin said that it is known to inhibit blood clotting and is not used in conjunction with blood thinners such as warfarin and Plavix. It is also known to aggravate gallstone problems. In vitro (in a petrie dish) and animal studies have proven that curcumin has antitumor, antioxidant, antiarthritic, antiamyloid, anti-ischemic and anti-inflammatory properties. Its potential anticancer effects stem from its ability to induce apoptosis in cancer cells without cytotoxic effects on healthy cells.

Jim Marshall our convenor and web master informed us that the daily digest of new items is temporarily broken until the next program update. To overcome this you need to login regularly then select the upper right menu item “View New Content”. For a better but more complex solution you can go to the web site and on top right just to the left of your login name is the small notifications icon. Click on this and then options. Then change your “Notification Preferences” from “Daily Digest” to “Immediate”.

Man #8 suggested that we add as a topic supplements that men are taking. Man #2 suggested men giving progress reports. Man #3 thought that that might be a good item for every teleconference. When asked about the 5 suggestions on the agenda there was no dissent only agreement. The question of family members participating was well received with no objections just a concern over numbers. No one had an objection to wives listening in. Having a one day special when family members are encouraged to join in to try it so that no one is caught by surprise seemed acceptable to all.

Man #9 said that the drug Cabazitaxel was turned down for listing on the PBS in July but has been resubmitted for November. Abiraterone has applied for listing in November. When outcomes are known an item will be added to the APC Community.

Man #7 asked about Prostascint scans. Man #5 said that it had been replaced by Combidex which is also no longer available and has been replaced by Feraheme. He is trying to find out what is available in Australia.

Man #10 asked about Alpharadin and the use of radium 223. Man #6 explained that the radium isotope was bone seeking and then put out alpha particles which travelled for just a few millimetres and therefore does not bother the marrow. It is still experimental and not available in Australia.

Man #10 also asked about Abiraterone and Man #6 said that he would send him an email. Man #9 explained that Abiraterone was basically a form of ADT as it lowers your testosterone. It does this by blocking the creation of DHEA and another androgen which later get converted to testosterone. It has been shown to extend life by about 4 months. MDV3100 which is an antiandrogen has had its phrase 3 trial stopped because it was so successful. It extends life by 4.8 months. Man #5 said that it was the post chemo trial that was called off and there is a pre-chemo trial currently underway.

The chat session now started and Man #3 spoke of his high blood pressure when measured by an electronic machine but normal pressure when measured with a stethoscope and also 15 minute recordings over 24 hours. The lesson here would seem to be to have your blood pressure checked occasionally with the more accurate old fashioned stethoscope method. Other men indicated that they have had similar experiences.

Man #11 said that his PSA in 8 months has gone from 0.9 to 15. He also said that he was currently receiving no treatment. He was advised that he needed to see his Urologist as soon as he is able and depending on his general health may be put on hormone therapy.