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Advanced Prostate Cancer Teleconference 23/12/2012


Euan

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Many apologies were received and most with kind messages. One such message was “Please convey my apologies to the group and wish them and respective families including your good self a very merry Christmas and a safe prosperous 2012 along with improved health”.

Man #1 had a prostatectomy in Oct 2007. With a rising PSA he requested chemotherapy first being 9 doses of docetaxel (Taxotere®) and this brought his PSA down 4.5. He then had 24 weeks of androgen deprivation therapy (ADT) then 32 doses of radiation to the pelvic area which brought his PSA further down to 0.03. In June 2008 he had a blocked urethra from scarring. After many tests the specialist opened up his urethra and this fixed his ability to pee but at the expense of incontinence. After a lot of pelvic floor exercises he now only wears a small pad for the occasional drip. He had a penile implant in Feb 2011 and has had two infections in the past 12 months which were treated with antibiotics. His PSA is currently 0.05 and he feels fine.

Man #2 had a prostatectomy in 1996 PSA 5.7 and Gleason 2+2. At the time of his prostatectomy he was diagnosed with non Hodgkin lymphoma for which he had chemotherapy. This cancer has stayed in remission. He had Cabazitaxel back in July/August 2011 which wiped out all of his white cells and nearly killed him. His PSA is now 530 and he hopes to get on an abiraterone trial in 2012. He also experienced neuropathy (loss of touch) from his chemotherapy.

Man #3 was diagnosed in July 2005 at aged 51 with a PSA of 54 and Gleason 7. In Nov 2008 his PSA had risen to 13. After bone and CT scans a single small metastatic spot was identified in his pelvis. Through the Multi Disciplinary Team at the PAH he saw a radiation oncologist who suggested radiation to the spot when other radiation oncologists were more reticent. He received 3 gray per day for 13 days and had no side effects from it.

Man #4 mentioned that Snuffy Myers sometimes sends his patients to Sand Lake Imaging in Florida for a MRI scan using ferumoxytol (Feraheme®). Man #5 explained that when these nano-particles of iron are injected into the blood they are taken up in the lymph nodes but not in a metastasis. This shows on a scan as a lymph node with a hole in it.

Man #7 said that PET scanners use different agents and they cost about $1000 per scan. Could be useful if you then plan to irradiate the cancer spots. Some clinical trials exclude cancers found by PET scans in Australia. Man #5 thought that it might be because the spot is too small to measure. Man #7 said that he has investigated the use of MRI to find cancer but the response he gets from the diagnostic radiologists he has spoken to is that it is OK for looking at the gland but not for distinguishing cancer.

Man #7 said that urologists are good for administering short term ADT but for longer term you should be with a medical oncologist and even an endocrinologist to ensure that the side effects are treated. Man #5 said that once the ADT starts to fail you should be in touch with both a medical oncologist and a radiation oncologist and that there should be more multi disciplinary teams.

The group was asked about the spread of prostate cancer to soft tissue and bone. Man #5 said that years ago men used to present with prostate cancer having spread up to the bladder and down to the penis but seldom got into the lungs. So the organs in the pelvis and lymph nodes are the main soft tissue targets but bone especially in the pelvis and spine are where 80-90% of metastases will appear. It can then spread from the bone to the surrounding tissues.

Man #6 said that he had a radical back in 2003 PSA 5 Gleason 8 margins were clean but the PSA did not fall. Continuous Lucrin drove the PSA down to 0.05 but it slowly started rising again and by Feb 2010 it was back at 5 at which time Cosudex was added which drove the PSA down to 2.5 after 6 months and after a further 6 months rose to 3.9 when Avodart was added. In August 2011 his PSA was up to 5.7. Because some men get a benefit when coming off an anti-androgen he was taken off Cosudex. His PSA by Dec 2011 had risen to 10. CT and bone scans are still clean. He has just commenced on the drug nilutamide (Anandron®) which is another anti-androgen. Anandron is on the PBS for Locally advanced (equivalent to stage C) or metastatic (equivalent to stage D) prostatic carcinoma, in combination with GnRH (LH-RH) analogue therapy

Man #4 referred to the article on the website which covers Feraheme® and Sand Lake Imaging as well as the link to Snuffy Myers video on the subject. See http://advancedprost...ing-technology/

He also mentioned that he and another where going to work on an item to explain the various lifestyle and other changes we have made to slow down our cancer. After that we might put together some information on scans.

Man #6 said that he had given a brief presentation to Janssen-Cilag staff in Sydney who are launching abiraterone (Zytiga® ). Man #2 said that he was waiting to hear if he was accepted to go on an abiraterone trial. Man #6 said he was only aware of the phase 3 MDV3100 pre-chemo trial (PREVAIL) who are recruiting at the moment. To go on it you need a rising PSA and identified metastases. Man #2 said that he had had Taxotere® and handled it so well that his oncologist was a little disbelieving. Man #6 said that Provenge® which is a very expensive drug and is very unlikely to be launched here but find Australia a good place to run trials.

Man #5 next talked about how cancer spreads. Prostate cancer cells can burrow out of the prostate to surrounding tissue such as the bladder - this is local infiltration. In addition they can enter a lymphatic channel or venule within the prostate and hence spread throughout the body. A fourth method is for cancer cells to get into the space between a nerve and its surrounding sheath, call the perineural space, and spread slowly this way – usually into the tissues near the spine. Transmission by blood is the most common method.

Man #5 described radium-223 (Alpharadin®) is an alpha particle emitting isotope of radium and usually finds its way to bone where it can quieten down a cancer.

Man #2 mentioned that he has been on zoledronic acid (Zometa®) once a month for four years. Man #5 said to be cautious with Zometa® as you can get a painful condition known as necrosis (death of cells) of the jaw. Make sure you have any problems with your teeth seen to before you start on Zometa®.

Man #7 mentioned that he has compression of his spinal column caused a metastasis. It is causing terrible pain down his left leg and often wakes him at night. He takes oxycodone (OxyNorm®) capsules and patches for pain relief but he is like a zombie all day. It was suggested that he should perhaps talk to his doctor about the possibilities of seeing an orthopaedic surgeon to get support for his spine.

Being the last teleconference of the year the following people should be acknowledged: Jim Marshall our convenor who gathered all the material for the website and at his own expense developed the excellent website. He also gets the speakers and puts together each meetings agenda. Bruce Kynaston for chairing the teleconferences with a great deal of competence and common sense. Euan Perry our secretary who does the conference summaries, Daryl Hyland who was instrumental in starting the teleconferences and who continues to contribute as a committee member and Nev Black who has assisted with many website tasks.

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