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Minutes of Advanced Prostate Cancer phone-in meeting Friday 26 April 2013


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These Minutes of the Teleconference are general in nature and not meant as advice. You must consult with Health Professionals for advice.


Guest Speaker is Associate Professor Lisa Horvath, Head of the Department of Medical Oncology at the Sydney Cancer Centre (Royal Prince Alfred Hospital) and a Visiting Post-doctoral Scientist at the Garvan Institute of Medical Research. Dr Horvath is also a Clinical Associate Professor within the Central Clinical School of the University of Sydney. She has an active clinical practice and is involved with a large number of clinical trials in prostate, lung and colorectal cancers in addition to phase I trial work. 


Since returning to clinical practice, her research has focused on drug resistance in castrate-resistant prostate cancer. This work integrates clinical trial work and correlative biomarker studies using both standard and experimental anti-cancer treatments. While mainly a prostate cancer researcher, she has also applied this paradigm to lung and colorectal cancer research.


Chairman_Bruce welcomes and invites Dr Horvath to speak.


Dr Horvath What I am going to talk about today is some of the new treatments in advanced prostate cancer and then a little bit about the biomarkers research we are doing. Essentially, as a medical oncologist, I work in the area of castrate resistant prostate cancer. Basically that is when the hormone treatment that switches off testosterone is no longer controlling all of the cancer. There are two different types of castrate resistant disease. I frequently get patients with the different types I thought it would be worthwhile going over the different treatments for each category. 


So the first category of people that come to see me are guys who are extremely well. They have been on hormone therapy often for a number of years. Those hormone therapies are GnRH analog and include Zoladex, Eligard and Lucrin which you may have heard of and anti-androgens in the form of a tablet like Cosudex, Anandron, Nilutamide or Androcur. 


The next group are the non metastatic group and they come to me and their PSA is rising despite all of these treatments, however there is no evidence of cancer on a bone scan or a CT scan. So we know the cancer is growing but it is too small to see on any form of Imaging. Those gentlemen, I often refer to them as being in limbo land, because without any actual evidence of metastatic disease they may be perfectly well and their PSA may slowly go up, and I may be able to watch them for years. That initially can be somewhat distressing to them that I don’t want to do anything while the PSA is slowly rising they gradually gain confidence that nothing is going to change in a hurry. 


The second group, where we do most of the treatment, are those who have metastatic castrate resistant disease. This means they have hot spots on bone scans or they have spots in the lungs or the liver on a CT scan, so this is where most of the treatment goes on. 


The biggest breakthrough in this area of treatment was about ten years ago when for the first time in about twenty years of clinical trials a drug called Docetaxel (Taxotere) finally shifted the goal posts. It was the first drug that showed a survival advantage in metastatic castrate resistant prostate cancer. We had drugs that had been known to improve bone pain, so people would feel a bit better for a period of time, but never had a drug that helped them to live longer. This was exciting because I was in America the day they presented the data and there was a lot of feeling this was twenty years of hard work and finally getting a reward. 


Docetaxel (Taxotere) is a chemotherapy drug which is given through a drip in the hand every three weeks. It only works for about half of the people we give it to and it does have a number of side effects including hair loss, it can affect nerve endings and makes you moderately tired. However for the group of men for which it works it does make those men feel much better. This is because they can have bone pain before the treatment begins. This does not mean that they have lots of pain but they might not be able to get round and do things as easily as they would like. 


So when Docetaxel works it is fabulous because they will come back within a couple of months and say they can move around more easily and they are not wondering where the next ache is going to come from. So it can be a very successful treatment and for many years that is what be had. 


About three years ago there has been an explosion in the number of drugs and the first of those new drugs was Cabazitaxel (Jevtana). This is kind of like a younger cousin of Docetaxel. Cabazitaxel helps to overcome a resistance mechanism. A couple of years ago a study was presented where they showed if you gave men Cabazitaxel after they had developed progression of the cancer after initially having received Taxotere you could at least benefit half of the men to live longer. The Cabazitaxel is given a similar way as the Taxotere as it is still a chemotherapy drug given through a drip in the arm every three weeks with similar side effects as the Taxotere. It is a huge advance, after many years, to have a second line agent to use after either the Taxotere didn’t work or the Taxotere worked or after some time, as always happens, the cancer comes back at some point. So those were the first two big steps forward.


The next thing that happened in the last two to three years, even though I said castrate-resistant disease is really about when the Testosterone production has ceased and cells have grown without Testosterone what has been long known there is residual Testosterone, even when we think we have gotten rid of all, there is residual Testosterone and Androgen Receptor Activity going on. In order to use this two drugs have been developed. 


The first one is Zytiga (Abiraterone) which is a drug that effectively cuts out all steroid hormone production in the body, so it has to be given with Prednisone. This is because it gets rid of every bit of Testosterone in the body it gets rid of what is called Cortisol, which is what we all need to stand upright, so that drug Zytiga is given with a small dose of Prednisone to make sure the men having treatment function correctly. It, Zytiga, was used in a trial where patients had Taxotere and had either progressed on the Taxotere either at the first time of treatment or after treatment. So to researchers delight Zytiga worked extremely well after Docetaxel and again decreases pain, decreases symptoms but also has a survival advantage which helps people live longer. Unlike the chemotherapy drugs, Docetaxel and Cabazitaxel, Zytiga does not have as many side effects. Zytiga is not a chemotherapy, it is like a super Anti-Testosterone drug. It has some ankle swelling, can cause some problems with Potassium levels but those can be pretty well treated. Zytiga is a tablet so it is much more convenient and in general it is well tolerated. This drug has been given to men in their eighties and is usually well tolerated. 


Last year a new trial was published with Zytiga (Abiraterone) before chemotherapy and that showed it worked very well before Docetaxel and delayed the need for chemotherapy and again improved survival. We need to know what line of treatment is going to work the best in other words which treatment order works the best. So this showed Zytiga could be given before or after chemotherapy and seems to have very good benefit at either stage. Zytiga before chemotherapy delayed the need and the time for chemotherapy and again improved survival. So Zytiga could be given before chemotherapy or after chemotherapy and it seems to have good benefit at both stages.


The next new drug presented is Xtandi (Enzalutamide or MDV3100). Xtandi is unlike Zytiga which gets rid of testosterone production. Xtandi is a super anti-androgen more like Cosudex or Anandron and works in on the androgen receptor and is a much stronger inhibitor of androgen receptor. Just like Zytiga a similar study was done in patients that had had Taxotere. What was found in that study was that it helped symptoms and made men live longer. Unlike Zytiga you do not have to take Prednisone with Xtandi which is very useful because long term Prednisone treatment even in low doses can cause problems. The major side effect, apart from previous mentioned, is a very small increase incidence of seizures which is not completely understood. It is very, very slight but it is there. Trial of Xtandi before Taxotere is currently being done. 


In the last two to three years we have gone from just one drug, Taxotere, to three drugs that are commonly being used in Australia, Taxotere, Cabazitaxel and Zytiga, and Xtandi is going to enter the market very soon. So it has been a revolution in a very short period of time and although when you look at the studies the median survival benefit is three months or five months, what does this really mean, this does look like a very big benefit. However when you start to add up all those benefits from the various studies you start to get substantial changes not only in the quality of life of men with advanced prostate cancer but you also get substantial improvement in overall survival of prostate cancer. We don’t have the study that shows that at the moment. In Colorectal Cancer there was a boom in drugs happened about eight to ten years ago. Five years after that, we found once we started using all the new drugs and the same man may get three or four drugs instead of just one, the overall survival in the case of Colorectal Cancer was no longer a year it was being measured in two, three or four years. I believe we will see the same thing happen in prostate cancer because five years ago I was giving one drug and now I am giving three or four drugs which is a big step forward.


Where my research fits in is with all of these compounds they help about fifty to sixty percent of the men who have them. 


My big problem is, I can quote the figures to men and say yes you have a fifty percent chance of the drugs working, the man sitting in front of me wants to know which fifty percent he is in. So the last few years my group have been collecting blood samples, mainly on men who have been having Taxotere chemotherapy, before they have chemotherapy and then again three weeks later just before their second cycle. We are now doing the same, collecting blood samples, with men having Cabazitaxel (Jevtana). What we are looking at is trying to find blood markers that can tell us whether a particular man is going to do well on this drug or he should get off it before he gets all the side effects and go to another drug that is more effective. We have found some really interesting things with a lot of the blood markers that seem to be associated with a poor response to chemotherapy seem to be related to the immune system. 


We thought we would be finding all this stuff about the tumour in the blood and in fact what we are finding is if your immune system starts to pick up and work overtime when we give chemotherapy that suggests this drug is not going to work for you at least in the setting of chemotherapy. Now this goes against most things we have been told with regards the immune system because the immune system is supposed to kill the cancer cells and a failure of the immune system is one of the reasons why people get prostate cancer. However if your immune system is in overdrive while you are having chemotherapy it clearly stops the chemotherapy from working. These are studies we have been doing over several years on small groups of men about sixty to a hundred men. We are now working with, and negotiating with, a large American group to take the signature that we have come up with and test it on a study of seven hundred men in the USA to see if it works in a group of men that we didn’t collect, we didn’t see and in a completely independent cohort.


 If it works in that cohort we are going to be, taking our signature, saying it is time to take this into the clinic so we can use it then to help men make decisions about their treatment. The classic situation I see this being useful in is a man comes back after the first cycle of Taxotere, he has not felt very well on the chemo, he has lost a couple of kilos, very tired and his bone pain is no better and the blood test says all of the immune markers have gone up. We can probably say not only do you not feel very well the blood test suggests this is not going to work let’s put you on something else that does work. The holy grail of all this research is to be able to say one day this drug is not going to work but this one will, but that is further away than I can currently see. 


So in concert with all these drugs we still need to know how to tailor them and make them personalised to an individual man sitting in front of the oncologist. That is really where my research is running trying to create that more personalised view of oncology treatment. 


Chairman_Bruce opened the conference to questions.


Man #16 you mentioned extreme tiredness as a side effect of chemo drugs, what do you call extreme tiredness? I have extreme tiredness from hormone therapy and I can sleep standing up practically. 


Dr Horvath I think that is a very much a personalised thing. The fatigue from the chemotherapy has to be compared to what is a man’s baseline especially for the first week or ten days after the chemotherapy. A man might have needed a nap for an hour in the afternoon might find that he may need two hours nap and he may also have less energy to get up and do things as everything feels a bit slower. Then in the second half of the three week period as the chemotherapy gets out of the system the energy levels tend to come back up. The other thing that can happen is, especially with men starting this treatment, some not only have pain but are quite tired from the cancer. So what can sometimes happen is if the chemotherapy is working men can feel better after the first two or three lots of the treatment then the fatigue from the chemotherapy kicks in because they have got rid of the fatigue of the cancer. 


Man #11 Could you comment, as an oncologist, on what you considered the point where the PSA is rising so rapidly when a man should be referred by his Doctor or Urologist to an Oncologist? Is the evidence of metastases is relevant for a referral to an oncologist? And your views on intermittent hormone therapy verses continuous hormone therapy? 


Dr Horvath So the first thing - when do you refer to an oncologist? That depends on the individual team. Most of us work within a Multidisciplinary Team every day with prostate cancer, the urologist, radiation oncologist and medical oncologist. Those teams may work in different ways, there are some urologists who will have a man on Zoladex or Lucrin or one of the other LHRH agonists and try one of the Anti-Androgens like Cosudex or Androcur and if the PSA is still going up then they will refer to an oncologist. There are other people who are more confident using multiple different Anti-Androgen treatments and they may refer later. There are no real absolute criteria and whether you have people tend to refer earlier men with metastatic disease than those with non-metastatic disease. This is where having your treatment with a doctor that is part of a Multidisciplinary Team becomes very important as the urologist can talk to the oncologist and he can say I think it is time you go and see that oncologist as well. There are no guidelines as such it is just the way different teams work. 


As for the intermittent hormone therapy verses continuous hormone therapy, there are two very different situations, there is the situation where the PSA rises after Radical Prostatectomy and it that situation the data is pretty clear you can use either intermittent hormone therapy or continuous hormone therapy and it does not make a huge difference. 


Then there is the man who has Metastatic Prostate Cancer and again there has been a study presented in America last year looking at intermittent hormone therapy verses continuous hormone Androgen Deprivation Treatment. The debate that went on after the presentation was spectacular. Arguments about whether they are equivalent or continuous may be a little bit better or intermittent maybe a little inferior. I have heard four different people all of whom I have known and trusted for a long time give different interpretations of the data. My feeling is it is probably given the facts it is probably a personal decision for each man. If there is a benefit for continuous it is probably a slight benefit. Side effects must be considered and I am not dogmatic about it. I tend to have the discussion. 


Man #27 In America they did a small trial with Taxotere, Avastin and Revlimid and it seemed to work very well. Then they did a much bigger trial with just Taxotere and Avastin which does not work anywhere near as well for prostate cancer although it does work for some other cancers. In the combinations of various drugs like Taxotere, Avastin and Revlimid do you know of any other combinations? 


Dr Horvath I heard a presentation where someone described Taxotere as the praying mantis of chemotherapy drugs where everything you give with it is eaten. So the problem with Taxotere is exactly what you said, that the phase two trials which is where you take fifty or eighty men and give them Taxotere and a new agent and that has looked very promising then there are six or eight trials with not only Avastin there is Atrasentan and all sorts of other drugs that fail in phase three trials. The problem is really that the phase two trials always end up taking the wellest men because of the nature of the entry criteria. So it is really the phase three data that tells us what is going on because that is where you take those well men and randomise them so you cannot introduce bias. Pretty much the anti blood vessel agents like Avastin are not going to work on prostate cancer. There has been millions of dollars spent and it simply does not work. 


There is a very interesting trial which will report in the next twelve months or so, which is a death receptor drug that finds the cells to die and then you give the patient Taxotere (Docetaxel). (The signal pathways activated by anticancer drugs are classified as death receptor). That looks the most promising one that is coming through. Someone put up a slide at one of the meetings last year of a graveyard of drugs that have not worked with Taxotere (Docetaxel) in prostate cancer. One of the thing that is also being discussed is how in the lab do we decide which drugs should go with Taxotere (Docetaxel). One of the things we have been looking at cell line models and mouse models of cell that we have made resistant to Taxotere (Docetaxel) and looking at new targets. It is a field that is moving forward and a lot of what we call Omics research which is Genomics and Proteomics and all of those sorts of things where we can look at lots of different things and lots of different pathways that are being affected and resistance that is going to help find better partners drugs for Taxotere (Docetaxel). 


Man #18 I have been through just about everything you have spoken about. At the moment I am on Zytiga (Abiraterone) which is a trial and it has worked very well but my PSA is rising. My last two readings a month apart were twenty one (21) and thirty four (34). I will be seeing my oncologist on Tuesday after another blood test to see how it is going then. I had twelve to fourteen months of Taxotere (Docetaxel) before I got onto the Zytiga (Abiraterone) trial. I was initially diagnosed seventeen years (17) ago so things have not been all that bad. 


Dr Horvath Seventeen years is certainly a good period of time with chronic prostate cancer. I always refer to it as a chronic disease. 


Man #18 when anybody says that to me ‘you are in your seventeenth year of survival you are doing well’ I say that is not what I want to hear I want to hear ‘that is nothing really I am in my thirtieth or fortieth year’. 


Dr Horvath I completely agree with you, however I cannot comment on your specific case. The good thing is though five years ago there would not have been Zytiga (Abiraterone) and you would not have had those sorts of options. The new options are certainly out there in real time and working.


Man #4 I would just like to ask about a trial going on, I think, at the MD Anderson Cancer Centre Houston combing Zytiga (Abiraterone) and Xtandi (Enzalutamide or MDV3100). Do you have any information on that trial? 


Dr Horvath No. I am sorry I do not have any information on that. However it is a logical. One of the big issues is how, given that we have single agent studies on all of these, now how do they all mix in and are there benefits? That sort of a trial would be attacking the top and the bottom end of cancer growth.


Man #4 It struck me that like the same logic as Zoladex and Cosudex but the new agents are more effective. 


Dr Horvath In a month’s time I am going to Chicago to the American Society of Clinical Oncology in Chicago 31 May 2013 to 4 June 2013. This is where a lot of trials get updated, so I suspect that is the sort of trial I might be hearing about. 


Man #2 Have you had any experience with Taxotere (Docetaxel) and Zometa having a reaction. 


Dr Horvath Not particularly. Do you mean in terms of muscle aches and pains and bones? 


Man #2 Basically, very bad fatigue.


 Dr Horvath I have had that experience with patients on Taxotere alone. I have not noticed that Zometa makes it worse. Zometa tends to make muscle aches and pains worse for a few days sometimes although it tends to get better as time goes after the second or third dose. 


Man #2 Have you heard anymore about Zytiga (Abiraterone) being listed on the Pharmaceutical Benefits Scheme (PBS)? 


Dr Horvath My understanding it has been approved by the Pharmaceutical Benefits Advisory Committee (PBAC) and it is sitting with Cabinet. The company has put together a subsidised access programme which means it will pay for half of the drug essentially. The patient pays for the first month and the company pays for the second month and then they alternate it and do a cost share arrangement. It is still very expensive but hopefully it will get through Cabinet shortly and that will make a big difference. 


Man #10 You said chemotherapy treatment Taxotere (Docetaxel) works for about fifty per cent of men. Say then they get onto Zytiga (Abiraterone)and that works for fifty percent of men. Is that fifty percent of the fifty percent? 


Dr Horvath No. Zytiga (Abiraterone) and all of the second line drugs Cabazitaxel (Jevtana), Xtandi (Enzalutamide or MDV3100), they can all work even if Taxotere (Docetaxel) has not worked. Each time it is the whole population I am talking about. There is a slight attrition as not everyone who has been on Taxotere (Docetaxel) does well enough to go onto the next series of treatment but for the most part I am talking the whole population.


 Man #27 One of our men had a lot of trouble with his finger nails when he was on chemotherapy. How often is that a problem and how is the best way to overcome that issue? 


Dr Horvath That is a problem for about twenty percent of people but it is only very severe in about ten percent. The nails can all go black and lift and become quite uncomfortable. There is no real solution to it except it does grow out and get better once the chemotherapy is finished. Some will use iced gloves on patients having Taxotere (Docetaxel) and the iced gloves reduce the blood flow to the nail bed and that may stop the Taxotere (Docetaxel) getting out there. It depends on who you talk to about how effective this is. I am told it is unpleasant to have your hand in the gloves for half an hour or so. 


Jim Marshall To answer the question you started with, I think you have pitched your talk exactly correctly, you have made everything very clear and I am sure all the men who have heard it or read it in our minutes will understand all of what you said much better than they may have before. Thank you very much.


 Dr Horvath Thank you. I am glad to hear that it has helped. 


The men all agreed with Jim Marshall with their thanks to Dr Horvath 


Man #13 Asked if there was anyone on the treatment he is on at the moment. I am Metastatic with a couple of spots on my spine top and bottom, I also have some spots on my ribs. The treatment my doctor is looking at is to Radiate the spots I have and to treat the whole of the prostate. The question is has anybody had Radiation to the Prostate and Metastatic spots at the same time. 


Man #16 I had my prostate Radiated and my right shoulder. I cannot have any more Radiotherapy because of the dosages I have had. Now with secondaries in my spine and ribs they cannot treat them with radiotherapy. 


Man #13 I had about ten days of radiotherapy on the tumours on the shoulder and the spine. I am starting in two weeks time to have my thirty seven Fractions of radiotherapy to the Prostate where the gold seeds have been embedded. Hopefully it will be a good result but I am pretty sick at the moment from the radiation on the tumours but I was told to expect that. I am getting a bit of blood in the urine and bowel and the windpipe is very sore. They hit me pretty hard and now I have three weeks break before they start on the prostate.


 Man #2 Sounds like a plus to me. It looks if someone is proactive trying something new in some ways. While the gold seeds are now new, having radiotherapy to other areas as well as the prostate at the same time is not that common. 


Man #13 That is correct the gold seeds are not new but they have used the seeds because they are using the IMRT (Intensity-Modulated Radiation Therapy) to Radiate and the seeds are a target. The new part to my knowledge is having Metastasis and having the prostate radiated at the same time. I had not heard of that happening before. I am on Zoladex and Cosudex.


Man #14 That seems like a reasonable think to do. I have been managing advanced prostate cancer now for ten years and I had a radical prostatectomy at the beginning which obliviously did not get rid of all the cancer. I have not been involved with radiation at all. 


Man #4 I spoke to Radiation Oncologist, at the Royal Prince Alfred Hospital (RPA)Melbourne, recently. My question was for the possibility of various tactics for highly targeted radiation to lymph nodes which is not quite the same as IMRT radiating the whole prostate gland. The oncologist tells me they are able to apply what they call Gating. If the gland moves or any other part moves, because of bladder filling as an example, the gold seed gives a highly precise radiation without affecting the bowel or nearby vulnerable organs. The idea of doing it after getting the palliative effect of radiating bone is to reduce tumour burden and to set the disease back as a whole, substantially, to allow other treatments such as Zoladex and Cosudex to be effective. 


Man #13 That was explained to me this way, once they get rid of the prostate, the Zoladex and Cosudex have a good chance of doing multiple times better treatment on the tumours. 


Man #4 I think the treatment on the bone metastases would be regarded as palliative to take care of pain. It does not guarantee you will not encounter new ones but the timing of that will be set back by not having cancer in the prostate itself.


 Jim Marshall I just want to explain to everyone the reason why the schedule was changed and the new man has been pushed back is if we have quite ill men on we always try to give them the forum when they arrive. 


Man #13 Thanked to group for hearing him and signed out as he was not feeling well. 


Chairman_Bruce introduces Man #9 


 I am seventy two years old, I live in Sydney and came to Australia thirty years ago. My story with prostate cancer started in June 2009 when my PSA result was 5.7 and the biopsy results were not very promising. My Gleason Score was five plus four. Five weeks after the biopsy I was on the operating table in Sydney. The PSA had by now risen to nine point seven. After a week in hospital just before I was to go home my condition rapidly deteriorated. I got internal bleeding and had to have another operation. One week after the second operation I didn’t feel very well but I was tired and I wanted to go home but after twelve hours the ambulance took me back to hospital. More internal bleeding, a third operation and after three weeks in hospital I was finally back at home. The report was very bad as the Gleason Score was ten with positive margins. After some time the PSA was 0.07 followed by 0.77 and the one. It was then I found I had metastatic prostate cancer. I had radiotherapy, fifty six gray (56Gy). I also went onto hormone therapy with Zoladex. After nine months of treatment my PAS had dropped to 0.001 that is unusual because I had the test in Poland and they have equipment that is not available in Australia. This low result encouraged me to cease hormone therapy. After nine months my PSA had risen to 0.2 I came back to the hormone therapy. The PSA again went down to 0.1 since then my PSA has stayed less than 0.03 and my doctor advised me to stop the hormone therapy again. My next test is in May. I would also like to tell you about the Polish Forum where I am one of the Administrators and one of the Advisers. Our forum is bigger than this forum as we have around twelve hundred members. We not only supply the knowledge how to treat cancer we give advice to people in writing. We have a team of very knowledgeable people including a doctor. We are giving advice to people with prostate cancer who come to the forum with little no knowledge we help them as to what to do next. That is want I wanted to tell you about our forum. 


Man #4 That is a great success story Man #9 to be Gleason ten and be as responsive to treatment as you have been is fantastic. 


Chairman_Bruce asks Man #9 Are your members worldwide or local. 


Man #9 They are around the globe. We have five people in Australia however three of our advisers are Australian. Our website can be found by wlobo135 in your search engine or the link http://www.gladiator-olsztyn.pl/viewtopic.php?pid=10480#p10480


Chairman_Bruce It was very interesting to hear your story and about your group. We wish you well. 


Man #20 I would like to ask the panel about Zometa Treatment as my cancer has spread to my ribs ect and the oncologist suggested I have Zometa to help slow down the cancer. I would like to know, one, if that is correct, and two, if I go onto it do I have to go on it forever? I have heard from other men I don’t have to so can anyone help me please? 


Man #28 If you have any of your own teeth and they require dental care it is best to get it done before you start on Zometa (is a Bisphosphonate that contains Zoledronic acid and administrated by IV Infusion). Zometa is associated with a very painful condition in some people called Osteonecrosis of the jaw (ONJ). Similar to a dry socket when teeth are removed and become very painful but settles down, this one does not settle down and just about defies treatment. Zometa is usually administered every three weeks. It does not take the cancer out, it is not a chemotherapy drug it is a Bisphosphonate and it is used to help with Osteoporosis. 


 Man #14 I have been on hormone therapy ten years and in the early stages of that after checking my bone density, which has never been bad, I was given three infusions of Zometa in 2004 or 2005. I had some dental issues a year or so later after the Zometa and my Endocrinologist did a lot of checks. Going to a specialist dental surgeon rather than a normal dentist I had three teeth out and I didn’t have any problems. So as everyone has said, you should have your teeth checked before Zometa but there may be a mechanism for some people if you are very careful. 


Man #44 I have been on Zometa since 2010.I was told when I first went on Zometa there was a suggestion it may help with the cancer, in reality it has not done that, but it does provide some protection and delay of Osteoporosis. My doctor told me if I was to need dental work I could go off the Zometa for a couple of months and then go back onto it.


 Man #7 The research is not in yet on Zometa and prostate cancer on shrinking the tumours. However in breast cancer it does shrink tumours and that research was done quite some time ago. Other research suggests it may enhance chemotherapy results.


 Man #18 I have been having Zometa since October 2007 and I have bone scans every year or so and my bone scans are better than they used to be. I have had dental work done but I have not had any extractions, but fillings yes.


Man #44 I was told to take a calcium supplement as Zometa is designed to take the calcium from the blood stream. 


David Abrahams I have posted an item in the Lounge Forum. I have been asked to give a 20 min Presentation on Palliative Care from a consumers view point on the 18 May 2013 down on the Gold Coast and I would really appreciate your input. Some of you have responded via the website and some by email directly. 


David Abrahams would greatly appreciative if you could take the couple of minutes to complete his short questionnaire. (your secretary completed the questionnaire via a private email ) If you need further information please contact the secretary@jimjimjimjim.com 


(1) Do currently see a Palliative Care Consultant? (2) Do you know where your nearest Palliative Care Consultant is located? (3) Has your GP mentioned Palliative Care to you? (4) When diagnosed with AMPC or APC did your medical specialist mention seeing a Palliative Care Consultant? (5) As part of Allied Health Support that you may have been offered was Palliative Care Mentioned? (6) When do you think you should see a Palliative Care Consultant? (7) Prior to joining the APC Forum where you aware of Palliative Care and its purpose?(8) Do you think your community would benefit if there was a Palliative Care Consultant in your district?


Jim Marshall We were hoping to have our American member Charles (Chuck) Maack join us today. We tested the technology today joining several phones together it worked but when we tried to do it with the teleconference it wouldn’t work. So I rang Chuck in America and apologised and we will do our best to find some way to have him on in the future. He asked that his contact details be published in the minutes, as he is prepared to help men any time. His email address is maack1@cox.net and his website is http://www.theprostateadvocate.com 


The Teleconference closed at ten fifty five am. 


The Next Telephone Conference will be on the Friday 24 May 2013.

 These Minutes of the Teleconference are general in nature and not meant as advice. You must consult with Health Professionals for advice.

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