April 2008 PCNG Newsletter Cincinnati

April 2008 Newsletter #85 (v. 9, 34
PCNG
Prostate Cancer Networking Group of Greater Cincinnati
PCNG (pcngcincinnati.org) is a chapter of USTOO (www.ustoo.com)
Founder: Bob Kanter - Convener: Tom Young – Newsletter: 450 copies this issue - Editor: Kees DeJong
Facilitators: Stan Moczydlowski: 8/’03; Steven Plymire: 9/’03; Jerry Glenn: 1/’04; Jack Ramsay: 5/’04;
Dick Fencl: 5/’05;: Jerry Bryan: 2/’07; Librarian: Stan Moczydlowski; Reviewers: Frits Roos, Daniel White

Telephone contacts:

751-6888 Kees DeJong: 1996 (56), PSA 24, GS 9; IAD; EBRT+Brachy, IAD, AD, ketoconazole+HC, Leukine, estradiol patches; Taxotere, carboplatin, Avastin, Emcyt	871-3844 Carol Cappiello	528-2769 Gordon Huntley:1999, PSA 4, GS 9; RP & Orchiectomy
272-1820 Dick Fencl: 2003, PSA 14, GS 6, EBRT+Brachy		733-5745 Bill Riggs: 1995, PSA 33, GS 6; RP, EBRT, AD
221-6736 John Hoffmann: 1997, PSA 5, GS 6; RP, EBRT		984-3343 Tom Young: 2002, PSA 7.8, GS 6; RP

19/20xx: year of diagnosis; PSA: Prostate Specific Antigen; GS: Gleason Score; RP: Radical Prostatectomy; EBRT: External Beam Radiation Therapy; Brachy: Brachytherapy ('seeds'), and AD: Hormonal Therapy: Androgen Deprivation
Carol Cappiello is a partner of a PC patient; she will be happy to answer any questions about PC,
in particular from other partners

Our 17th APC Meeting will be held before the Large Meeting
Men with Advanced Prostate Cancer, please, come!!
From 5.30 to 6.30 pm; bring your spouses/partners, some food will be served.

The next Large Group Meeting Will Be Held on Wednesday, April 30th
Women Are Very Much Welcome!!
6.30--7.00 p.m.: hospitality and networking
7.00--7.30 p.m.: new members and sharing
7.30 p.m.: To freeze or not to freeze?
Role of Cryotherapy in Prostate Cancer
Krishnanath Gaitonde, MD
Dr. Gaitonde is a Clinical Assistant Professor and Co-Director of the Minimally Invasive Urology Fellowship Program at the
Division of Urology of the Department of Surgery, Univ. of Cincinnati. He is specialized in the Treatment of Prostate Cancer

8.30--9.00 p.m.: hospitality and networking

A free, public event with the latest information on all types of cancer
Saturday, May 10, 2008 10 a.m. to 2 p.m.
University Pointe Medical Campus, West Chester
for more information: www.uccancereducationday.org (513) 584-9097

Community Cancer Education Day

Sponsored by the UC Barrett Cancer Center at University Hospital. This is an event for anyone whose life is touched by cancer: whether you are fighting a personal battle against the disease, providing care to a loved one or simply evaluating your risk.
            Free and open to the public, Community Cancer Education Day offers the latest information, possible causes, risk factors, screening recommendations, treatment options and outcomes for all cancer types. In addition to self-guided educational booths and materials, you can talk to physicians and researchers one-on-one.
            You will also hear from Henry T. Lynch, MD, who is recognized widely today as one of the fathers of cancer genetics. He will give a keynote address at Community Cancer Education Day at 10 a.m.
            The 2008 Community Cancer Education Day will be held at the University Pointe Medical Campus, located at 7700 University Court, West Chester. OH 45069. Free parking is available on site.   Directions: Take I-75, Tylersville Road Exit (#22). Turn East on Tylersville Road, then North on Cox Road. University Pointe is on the left.

HR Quality of Life after Treatment for Prostate Cancer

Health Related Quality of Life (HRQOL or HRQL) is an important issue for those diagnosed with prostate cancer: in the course of disease, choice of initial treatment, and process of recovery. A search in PubMed yielded 134 titles of articles published on HRQOL and prostate cancer, and 12 titles on HRQL and prostate cancer―54 were published in 2006-8.
We read some of the more recent abstracts, and scanned a few articles. Below is our report.

Karakiewicz PI et al: J Sex Med. 2008 Apr;5(4):919-27. The effect of comorbidity and socioeconomic status on sexual and urinary function and on general health-related quality of life in men treated with radical prostatectomy for localized prostate cancer. In Short: you will suffer more after prostate cancer treatment when poor (low socioeconomic status (SES)) than when middle-class (high SES).
“We sent a self-addressed mail survey… to 4,546 men treated with RP in Quebec between 1988 and 1996. … Survey responses from 2,415 participants demonstrated that comorbidity and SES are strongly related to sexual, urinary, and general HRQOL.”

Bellizzi KM et al: Urology. 2008 Mar 14 [Epub ahead of print] Fear of Recurrence, Symptom Burden, and Health-Related Quality of Life in Men with Prostate Cancer. In Short: Fear of recurrence has an impact on the HRQOL. This fear of the cancer retruning may get less as time progresses but is not unrealistic: 39% of the 2,091 men operated by Dr. Walsh (urologist numero uno in the USA) had recurrence after 15 years (Han M, 2003).
“To examine the contributions of fear of recurrence …to the HRQOL of men treated for localized prostate cancer … a total of 730 men with localized disease were identified from CaPSURE*).”

Sadetsky N et al: BJU Int. 2008 Mar;101(6):691-7. Insurance and quality of life in men with prostate cancer: data from the Cancer of the Prostate Strategic Urological Research Endeavor. In Short: Insurance makes a difference!
“Men who were newly diagnosed at entry to CaPSURE*) and completed one questionnaire before treatment, and one or more afterwards, were included. … Of 2258 men who met the study criteria, 1259 were younger and 999 were older than 65 years. More than half of the younger patients belonged to an HMO or PPO (42.2% and 32.5%, respectively), with the remainder distributed between Medicare, FFS [Fee For Service] and VA.”

The figure to the left shows one of four physical HRQOL parameters used in RAND studies: RP = limitation because of physical problems. Baseline is before therapy. No patients <65 y in Medicare, no patients >65 y in VA.

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*) CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) patients are recruited from 40 community-based, academic and Veterans Affairs (VA) urology practices across the USA [none of them in OKI] by participating urologists who report clinical data and follow-up information on diagnostic tests and treatments;80% of patients are drawn from community-based practices in 25 states, ensuring a broad representation of geographically diverse community patients. Created in 1995, the CaPSURE database has enrolled, as of June 2007, 13,124 patients, providing one of the most extensive sets of data available today on prostate cancer. Physicians provide comprehensive clinical assessment of their prostate cancer patients over the course of their treatment, including method of diagnosis, pathological staging, medications and the results of all procedures and lab tests such as biopsies, imaging and blood tests.
Reports based on the CaPSURE database might be more representative than reports from a series at a single academic center.
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Mols F et al: Cancer. 2006 Nov 1;107(9):2186-96. Long-term quality of life among Dutch prostate cancer survivors: results of a population-based study. In Short: see last line of abstract. But are the better Mental Health scores indicating that prostate cancer sharpens the brain?
“Nine hundred sixty-four patients [registered in the population-based Eindhoven Cancer Registry] received questionnaires and 780 of 964 patients responded (81%). … long-term prostate cancer survivors reported comparable HRQL scores but worse General Health Perceptions and better Mental Health scores than an age-matched, normative population. Patients who underwent radical prostatectomy had the highest physical HRQL, followed by patients who received 'watchful waiting,' and patients who received radiotherapy. Patients who received hormone treatment, in general, had the lowest physical HRQL. … Because baseline differences between treatment groups cannot be excluded as part of the explanation for these differences, the current findings need to be verified in longitudinal studies.

The figure to the left shows on the vertical axis (ranging from 0 to 1.0) the proportion of patients and on the horizontal axis (0-24 months) the time after therapy. All patients were at 1.0 on the vertical axis before treatment. The solid line is for RP (Radical Prostatectomy); the dashed line for Brachytherapy, and the stippled line for EBRT (External Beam Radiation Therapy) patients.
General HRQOL (A and B in the figure) is not affected by the treatment of prostate cancer! Sexual function (E) is more affected than urinary (D) or bowel function (F).

The figure to the right shows on the vertical axis the mean score of patients before and after treatment for prostate cancer. Nerve-sparing RP patients are shown with the solid line, and non-nerve-sparing RP patients with dashes and points, beneath the solid line.

Ferrer M et al: Int J Radiat Oncol Biol Phys. 2008 Mar 4 [Epub ahead of print]. Health-Related Quality of Life 2 Years After Treatment with Radical Prostatectomy, Prostate Brachytherapy, or External Beam Radiotherapy in Patients with Clinically Localized Prostate Cancer.

“This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). … RESULTS: In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. … compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary [see figure to the left ― dotted line: brachytherapy, grey line: EBRT, and solid line: RP; notice that sexual performance was not optimal at pre-treatment!] and urinary incontinence scores …, and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores…. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel functioning, and brachytherapy caused moderate urinary irritation.”

No randomized clinical trial has proven the superiority of one treatment of localized prostate cancer, and choices can be made on the treatment’s side-effects, the HQOL. The articles on HQOL present some obvious and some surprising results, and demonstrate that one figure can be more powerful than 1000 words!