Newsletter

Guest Speaker Report

NOVEMBER NEWSLETTER

Following our October meeting concerning the 20th anniversary of the closure of the BHP Steelworks we now return to medical issues.

Well known Newcastle Urologist D. Paul Ainsworth returns (last visit 10/11/2015) to bring us up to date with Prostate Cancer issues from the Urology perspective.

Very much to discuss in a short time but we hope to hear about Robot Assisted versus Open Radical Prostatectomy, nerve sparing procedures and avoidance of continence issues following surgery. Dr Ainsworth may also discuss the use of artificial implants to correct incontinence and erectile dysfunction should this be necessary.

A hot topic at the moment is the preference for trans perineal biopsy over trans rectal biopsy where the former is said to result in lower rates of infection. Unfortunately, this is not available through the public system and our Support Group will be advocating for this to be made economically available to all patients and it will be interesting to hear about this from Dr Ainsworth.

Vaughan described his own experience of prostate cancer going back to his radical prostatectomy in 2009.

ABOVE: Vaughan Marten presenting to the group about the dismantling of BHP assets at 20 year anniversary.

Future Speakers:

There are no plans to have a Guest Speaker for our last meeting of the year on December 10th. This gives us the opportunity to reflect on the year to date and to tie up many of the loose ends in preparation for 2020. I am also pleased to report that our relatively new committee member Wayne Lennan has already begun preparations for Guest Speakers in 2020

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We will be able to give members a report on the Charity Golf Days organised by Ravensworth Coal Mine, our Group being the major beneficiary. Suggestions as to how best to use funds in aid of prostate cancer sufferers are still open.

Other issues such as Christmas Party location, your choice of Guest Speakers for 2020 and most importantly YOUR opportunity to have your say on what is good and not so good about the conduct of monthly meetings.

Vaughan Marten suggested a Lectern for the use of Guest Speakers could be a useful addition, David Binskin and Bela Sido are keen to have some advertising material placed inlocations where men would likely visit, John Leeks noted how important it is to maintain the attendance of the Specialist Nurses at our meetings and Terry Wheeler suggested we have Professor Jim Denham attend prior to his retirement, not as a Guest Speaker but more in a social and appreciation context.

Looking forward to your attendance

Mike Seddon     Guest Speaker Coordination

Mobile  0419 599 230

e mail    mikeandsheila@bigpond.com

Ravensworth Colliery Charity Golf Days An extremely successful two days have been arranged with proceeds going to our own local Hunter Prostate Cancer Support Group. Over $100,000 has been promised/raised as well as promoting the need for prostate checks and vigilance to the group of over 100 men lask week. Our sincere thanks to Ravesworth Colliery management and workers for this amazing opportunity to promote our cause. The last of the two golf days to be held Tuesday 29th October, 2019 before a final monetary figure will be tallied.

Below: L – R: Brad Scott, Nurses Nancy Consoli and Tracy Scott, Mike Seddon and PCFAs Kath Duggan at Ravensworth Colliery Inaugural Charity Golf Day.

A NEW TECHNOLOGY IS HELPING DOCTORS BETTER IDENTIFY AND TREAT PROSTATE CANCER IN MEN WITH ADVANCED DISEASE.

Search and destroy: How tiny molecules are making big changes in prostate cancer imaging and treatment

A new technology is helping doctors better identify and treat prostate cancer in men with advanced disease.

Richard Cook was 55 when he was first diagnosed with metastatic prostate cancer. “It really concentrates your mind” says Richard, a barrister and founder of an affordable residential college for university students in Melbourne. “Will I see next Christmas? Will I see that new skyscraper finished? You treasure every day”.

In the 13 years since diagnosis, Richard’s journey through prostate cancer has included treatment with brachytherapy, antiandrogen therapy and chemotherapy.

Eventually, all have failed.

“Having gone through all the other options, including the end of chemotherapy, there’s basically nothing else you can have”, Richard explains.

It’s for men like Richard who have exhausted all options, that PSMA – or Prostate-Specific

Membrane Antigen – offers a new hope

The search and destroy value of PSMA is the reason it’s now considered a ‘theranostic’: an agent that can be used both as a diagnostic tool (the searching part) and a therapy (the destroying part).

And while it’s hoped that it will be beneficial for those at all stages of the disease, it’s proving to be particularly useful for men like Richard with advanced prostate cancer. Richard finished his treatment early in 2017 and since then has been living a normal life with no significant cancer recurrence on follow-up scans.

Michael Hofman, Professor of Nuclear Medicine at the Peter MacCallum Cancer Centre in Melbourne, describes it as a bit like Where’s Wally.

PSMA offers another tool to find Wally. Using a radioactive substance, such as fluorine-18 or gallium-68, that attaches itself to PSMA, prostate cancer cells light up on PET scans.

For some men, like Richard Cook, the images are profound: “I’d had PSMA imaging done, and I lit up like a lighthouse.”

The Movember Foundation might be considered an early adopter when it comes to this promising technology. Since 2011, the Movember Foundation has invested more than $3.2M across 11 global projects in supporting developmental work to help build the evidence around PSMA as an imaging agent.This includes support for the recently launched ProPSMA study – a randomised trial examining the diagnostic accuracy of PSMA PET scans being led by Professor Hofman – as well as the Global Action Plan (GAP2) Advanced Prostate Cancer Imaging Initiative, which uses global collaboration to harness the power of research teams from around the world.

This work is made possible through partnering with leading men’s health organisations around the world, including the Prostate Cancer Foundation, Prostate Cancer Foundation of Australia, Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Prostate Cancer Canada, and Prostate Cancer UK.

Help Prof Michael Hofman in his Movember campaign to raise $2000 and establish a research portfolio.

More information:

https://au.movember.com/mospace/14010555…

Results of the CARD trial:  Benefit for patients needing a third-line therapy option.

22nd October 2019

Metastatic castration-resistant prostate cancer (mCRPC) refers to prostate cancer that has spread outside the prostate and no longer responds to traditional androgen deprivation therapy (ADT). Patients have several different treatment options, including second-generation androgen-signaling-targeted inhibitors (ARTA) like abiraterone or enzalutamide, and chemotherapy drugs (docetaxel, cabazitaxel) . However, for patients whose disease progresses after treatment with one ARTA and with docetaxel, questions remain: Should the patient switch to the other ARTA? Should a chemotherapy drug be used?

The results of the CARD trial, an ambitious study presented at the 2019 European Society of Medical Oncology (ESMO) Congress, shed light on what the next step should be. Cabazitaxel, an FDA-approved drug, was shown to be more efficacious with similar toxicity as third-line treatment in patients who had received one ARTA and were progressive on this drug within 12 months, and had also received docetaxel.

Results showed that patients who received cabazitaxel experienced significantly better outcomes, including radiographic progression-free survival (no worsening of disease on scans; median of 8.0 months with cabazitaxel vs 3.7 months with the ARTA) which was the primary endpoint, reduction in PSA levels by at least 50% (35.7% vs 13.5% of patients), tumor shrinkage (36.5% vs. 11.5% of patients), and reduced pain than those who received the alternative ARTA (45.0% vs. 19.3% of patients). Additionally, toxicity from cabazitaxel seemed not worse vs the other study drug, (adverse events of Grade 3 or higher, 56.3% vs 52.4% of patients).

What does this mean for patients and physicians? The question of what is the optimal next line of treatment for patients fit for chemotherapy who have received docetaxel plus one line of ARTA and were progressing under the first ARTA within 12 months is answered with this trial. Gillessen notes that we need to resist “chemophobia.” Cabazitaxel is a new standard of care for third-line treatment in patients who have progressive disease after docetaxel and progressed within one year or less of abiraterone or enzalutamide and who are fit enough to tolerate chemotherapy.

“Before this trial, we knew from other trials that the response rates and duration of response, if any, to the alternate ARTA were low. This trial has shown very elegantly in a representative patient population, and in a randomized, prospective design, that cabazitaxel is superior in this setting. While only 13% of patients in this trial had docetaxel in the castration-sensitive setting and only one patient had abiraterone in the castration-sensitive setting, we will see these treatments being given in the castration-sensitive setting more frequently,” said Dr. Gillessen. “The question remains how to treat patients with a very good response to the first ARTA of longer than 12 months. One may also raise the question if 20mg/m2 of cabazitaxel would be sufficient (a lower dose than the 25mg/m2 dose given in the trial). So, in summary, the authors have for the first time demonstrated a survival benefit in a third-line setting in a randomized trial, and that is a big step in the right direction, but some questions remain still unanswered.”

Further reading:

Long-term study shows most prostate cancer patients don’t need aggressive treatment

By Karen Weintraub, 12th December 2018

Nearly 30 years after it began, a study of prostate cancer patients shows both that the disease will not cause harm to the majority of men who have it, and that aggressive treatment is warranted for men with an intermediate risk of spread.

The nuanced results come from a new update to a landmark study, published Wednesday in the New England Journal of Medicine, that has followed 695 Swedish men since they were diagnosed with localized prostate cancer between October 1989 and February 1999.

The study’s duration and insights into one of the most common forms of cancer make it “arguably one of the most important publications of the year,” said Dr. Adam Kibel, a professor of surgery at Harvard Medical School and chief of urology at Brigham and Women’s Hospital in Boston, who is not involved in the research.

Half of the men had their prostates removed to get rid of the cancer, and half were put on “watchful waiting,” a now-discredited approach that essentially amounted to doing nothing. Today, roughly 20 percent of the men are still alive, although prostate cancer is generally diagnosed late in life. Of those who died, 70 percent died of something other than prostate cancer, the study found.

In Sweden today, 80 percent of men with newly diagnosed prostate cancer are not treated, but “actively surveilled,” to make sure their tumor is not becoming more dangerous, Bill-Axelson said. Active surveillance includes regular checkups, whereas with “watchful waiting,” follow- ups were often deferred until a man had symptoms. “The majority who are diagnosed today are diagnosed so early from PSA detection and also have usually low-risk disease. They will very likely be overtreated if they are treated immediately.”

Further reading: