Radiation Therapy - Week THREE

DAY FOUR

Well ... today represented a milestone as far as my treatment is concerned. Today I arrived the '25% completed mark' i.e. Ten treatments now complete and ONLY thirty to go!


Makes You Wonder!

A strange thing happened today! Just prior to my treatment, I was looking around for something to casually read; you know, to take my mind off things. Suddenly I spied an interesting looking clipboard with certain information sheets on it - 'dumped' beside one of the visitors chairs and a pile of what looked like discarded papers ready for the shredder.

Hmm ... I wonder what that is?

Now with my curiousity piqued, I figured that a 'quick' look wouldn't be out of the question. And so, with the documents [on the clipboard] now clasped firmly in my hand, I noticed that the content was actually a summary of all patients who had died over the past several years!

Now, for some inane reason, I blurted out to my daughter who was my accomplice before the fact:

"I'll bet you that my name is on this list"!

Guess what? It was!

Now just in case you're interested; I 'John Purcell' died [of cancer] while still a patient of the hospital [in question] on 8th August 2005!

I of course, was simply hoping that this was not a 'predictive' list i.e. an estimate based on the current prognosis with a mistake made concerning the year! I'm not sure I'm in a hurry to see the 8th August this year - just in case!

Do the Right Thing!

Well ... yes I did do the responsible thing! I took the list to my friend 'Nurse Judy' and [hamming it up] stated:

"You've got the wrong date on this"!

Nurse Judy's response; once she read the document I handed over; was one of shock, disbelief and outrage!

As I left her office, having explained just how those documents came into my possession; I could hear her mumbling:

"Admin ... they got a lot to answer for! Just wait 'til I see ..."

Treatment

Yes, my treatment went well again today, thanks for asking!

Locally Advanced Disease (Stage T3–T4)

Locally advanced disease refers to prostate cancer that is no longer confined to the prostate and has started to invade nearby organs such as the seminal vesicles, but where there is no evidence of spread to distant sites such as the bone (T3–T4). This may also include those patients with biochemical failure following curative treatment, patients with N+ disease and those who are surgical margin positive after radical prostatectomy.

The aim of treatment for locally advanced disease is to reduce the risk of metastatic spread and tissue invasion and thereby prolong survival (Table 3.3). There are several possible treatment alternatives for patients with this early stage of prostate cancer. Some patients may be cured.


Radiotherapy + Hormonal Therapy

Neoadjuvant hormonal treatment prior to radiation therapy

Neoadjuvant hormonal therapy, used in combination with radiotherapy, is generally administered to reduce prostatic size/symptoms. The term neoadjuvant is used to describe a treatment is given before the primary treatment. Examples of neoadjuvant therapy may include hormone therapy commenced prior to radiation therapy.

EBRT (External beam radiotherapy) is often sufficient to suppress PSA levels to within normal ranges and delay disease progression. However, EBRT following neo-adjuvant hormonal therapy has been shown to produce better local control of disease and effect greater reductions in the risk of clinical or PSA relapse than EBRT alone.

The RTOG 86-10 trial investigated the use of MAB (goserelin – ZOLADEX plus flutamide) given for 4 months, starting 2 months before and continuing for 2 months during radiation therapy in T2–T4 disease. Disease free survival at 8 years was significantly improved (33%) in patients receiving neoadjuvant therapy compared to 21% in patients receiving radiation therapy alone.

Overall survival was improved in patients with a Gleason score of 2-6, although survival in all patients was not improved. In addition such neoadjuvant therapy reduces the number of patients requiring salvage therapy (Pilepich MV et al. Int J Radiat Oncol Biol Phys 2001; 50: 1243–52).

Figure 3.10. RTOG – 86-10 - Disease-free survival, all patients

Prostate cancer survival improved with whole-pelvic radiation plus hormone therapy

Abstract

Patients with localized prostate cancer who have a 15% estimated risk of lymph node involvement and an elevated prostate-specific antigen level are good candidates for whole-pelvic radiotherapy plus neoadjuvant and concurrent hormonal therapy.


Complete Article - 16 Jun 2003

These are the findings of a phase III study involving 1323 such patients reported by Dr. Mack Roach III of the University of California in San Francisco and colleagues in the May 15th issue of the Journal of Clinical Oncology.

"This trial tested the hypothesis that combined androgen suppression and whole-pelvic radiotherapy followed by a boost to the prostate improves progression-free survival by 10% compared with combined androgen suppression and prostate only prostate-only radiotherapy," they explain. "This trial also tested the hypothesis that neoadjuvant and concurrent hormonal therapy improves progression-free survival compared with adjuvant hormonal therapy adjuvant hormonal therapy by 10%," they further explain.

According to the team, whole-pelvic radiotherapy was associated with a 4-year progression-free survival of 54% compared with 47% for prostate-only radiotherapy (p = 0.022). Patients treated with neoadjuvant and concurrent hormonal therapy had a 4-year progression-free survival of 52% versus 49% for adjuvant hormonal therapy (p = 0.56).

Compared with the other treatment, the combination of whole-pelvic radiotherapy plus neoadjuvant and concurrent hormonal therapy was associated with the longest progression-free survival (60%).

"This study proves that there is a favorable biologic interaction between whole-pelvic radiotherapy and neoadjuvant and concurrent hormonal therapy, but no advantage to short-term neoadjuvant and concurrent hormonal therapy compared with short-term adjuvant hormonal therapy when only the prostate is irradiated," the investigators conclude.

The benefits of whole-pelvic radiotherapy plus neoadjuvant and concurrent hormonal therapy in the lymph nodes "should not be completely surprising," they add. "Occult lymph node involvement despite negative imaging is a well-recognized problem in patients with prostate cancer, and prophylactic nodal radiotherapy has been shown to prolong survival in women with breast cancer," they add.

(Source: J Clin Oncol 2003;21:1904-1911: Reuters Health: June 13, 2003: Oncolink)

Spirituality and Health in Hospital: perspectives of patients and visitors

Results of a spirituality and health survey conducted at Prince of Wales Hospital...

Do spirituality and religious beliefs affect health? Over 80% of people surveyed at Sydney's Prince of Wales Hospital think that health is affected by beliefs, and that these beliefs become more important when a person is ill. Whether it is “God's healing”, “inner strength”, “living right” or “a placebo effect”, respondents agreed that spirituality and religion has an impact on the way we view health, illness, loss and recovery.

Preliminary analysis of the hospital-wide survey of 228 patients and their family members, found that religious rituals and/or spiritual practices were observed by nearly 79% of respondents, and 74% felt them to be of moderate or strong importance. Of this group, 68% said they would want to continue them if/when they were in hospital for reasons such as “it's who I am”, “I need spiritual refreshment”, “to help the healing process”, “something familiar in an unfamiliar environment”, and “to help my family cope with my illness”.

Respondents identified different ways in which their beliefs affected their health. Many felt their attitude or emotional state was enhanced, eg “peace of mind”, “giving me hope”, “it brings comfort and strength”, “understanding”, “calming', “it reassures me I am not on my own”. Others described a direct impact on their general health or recovery from illness, eg “as a result of my faith I have remained healthy”, “helps the individual to heal faster”, “I'm getting better – God has answered my prayers”.

Some respondents talked about their beliefs having a preventive affect, eg. “it's protected me not to take alcohol, smoke, etc.”, and “I gave up smoking, drugs, premarital sex and other health hazards”. There was also feedback about the potential for beliefs to have a negative affect on health, eg “all my wrong-doings in life are reflected in my poor health”, “if I felt my illness was divine punishment it might make me worse”.

The survey attempted to disentangle the concepts of religion and spirituality. Patients and visitors were asked to define the concepts, and then state how they see themselves. This enabled respondents to identify their beliefs more flexibly than traditional surveys allow. The findings supported increasing national evidence that Australian society is becoming less religious, but more spiritual. (1) (see Figure 1 below)

Overall, the survey found that 74% of respondents had spiritual or religious beliefs of some kind, a figure that tallies with the 2001 census in which 74% of the population stated they had a religious affiliation (2). However, in the hospital survey, 1/3 of these (24% of all respondents) did not identify as religious, only spiritual. Twenty one percent of respondents selected more than one description from the list of major religions and spiritual beliefs. This supports growing evidence that, for many people, beliefs are not as rigidly defined and neatly categorised as previously thought. (3)

Over 70% of respondents felt it was helpful for hospital staff to know about their religious and/or spiritual beliefs, and said it was alright for staff to ask them. This contradicts the popular idea that patients find it intrusive to be asked about their beliefs (4). Nearly 40% of people who completed the survey said they would like to speak to a chaplain, “it's strengthening to be with people who share your beliefs”; while a further 17% thought they might like to see a chaplain, depending on their situation, “if I feel that I might need support and comfort”.

Diversity Health and the Chaplaincy Department at Prince of Wales are currently using survey data to develop education initiatives and resources designed to support staff in their understanding of, and response to, the diversity of people's religious and spiritual beliefs, practices and wishes.

For more information, contact Julieanne Hilbers, Diversity Health Coordinator, Prince of Wales Hospital, on (02) 9382 3306 or email: julieanne.hilbers@sesiahs.health.nsw.gov.au

___________________________________________________________

(1) Bouma, G. (2002). Globalization and recent changes in the demography of Australian religious groups:1947 to 2001. People and Places , 10(4), 17-23.

(2) Peach, H. (2003). Religion, spirituality and health: how should Australia's medical professionals respond? Medical Journal of Australia , 178, 86–88.

(3) Tacey, D. (2003). The Spirituality Revolution: the Emergence of Contemporary Spirituality Sydney: HarperCollins

(4) Post, S; Puchalski, C; Larson, D. (2000). Physicians and Patient Spirituality: Professional Boundaries, Competency, and Ethics. Annals of Internal Medicine , 132, 578-583

Latest Australian Cancer Statistics Released

Cancer in Australia: an overview, 2006 presents comprehensive national data on cancer incidence and mortality in Australia, and hospitalisation trend data from 2000-01 to 2004-05.

The report provides 2006 projections on incidence and 2003 data for cancers by site, age and sex, with summary data for each state and territory. Prostate cancer and cancer differentials for rural areas analysed.

The information in this report is supported by more detailed information in cancer incidence and mortality data cubes and workbooks on the AIHW's website. Cancer in Australia: an overview, 2006 is an important reference from the Cancer series for all those interested in the health of Australians. Authored by AIHW.

Full publication (1020KB PDF)

Preliminary material (180KB PDF)

• Half title and verso pages


• Title and verso pages


• Contents


• Contributors


• Summary

Sections

Introduction (96KB PDF)

• What is cancer?


• Cancer surveillance in Australia


• National Cancer Statistics Clearing House


• Cancer data on the AIHW website
  

Incidence and mortality (318KB PDF)

• Introduction Estimates of cancer incidence and mortality in 2006


• Incidence in 2003


• Incidence of lymphoid and haematopoietic neoplasms


• Cancer incidence in the states and territories, 1999-2003


• Incidence trends 1983-2003


• Mortality in 2003


• Mortality trends 1983-2003


• Cancers attributed to smoking and excessive alcohol consumption

Hospitalisation (158KB PDF)

• Introduction


• Main findings

Prostate cancer in profile (213KB PDF)

• Introduction


• Incidence and mortality


• Drivers of growth in new cases diagnosed


• Implications for projected incidence of prostate cancer


• International comparison


• Key statistics on prostate cancer
  

Regional cancer differentials (179KB PDF)

• Introduction


• Incidence differentials


• Mortality differentials

End matter (265KB PDF)

• Appendixes


• WHO classification of lymphoid and haematopoietic neoplasms

1. Methods


2. Population data


3. Cancer registration in Australia


4. Cancer registries contact list


5. Data sources

• Abbreviations and glossary


• References


• Related state and territory cancer registry publications


• List of tables


• List of figures

Latest Statistic

The latest statistics associated with the Prostate Cancer Institute suggests that there is a much greater awareness of prostate cancer in the community. As we move closer to the baby boomer era, there will certainly be a rise in the number of prostate cancer sufferers.

The Cancer Institute of NSW stated that prostate cancer made up 14% of new cancer cases detected in NSW in 2003 – a total of 4637. By 2011, the incidence of new cases is expected to be 5942, with prostate cancer the most common form of all cancers.

The attached graph displays the number of new patients with prostate cancer with the green section showing new patients under the age of 60 years.

For the latest statistics on prostate cancer, please visit the Cancer Institute NSW's website here", with a link to:

http://www.statistics.cancerinstitute.org.au/

Prostate Cancer Related Statistics

The following is excerpt from the Prostate Cancer Foundation's website. I have reproduced the information here, but encourage all readers to visit the above website.

What Chance have I Got?

The likelihood for a diagnosis of prostate cancer among men in Australia today can be categorised by age as shown below:

# For a man in his 40's there is a 1 in 1000 chance of
prostate cancer.

# For a man in his 50' s there is a 12 in 1000 chance
of prostate cancer.

# For a man in his 60' s there is a 45 in 1000
chance of prostate cancer.

# For a man in his 70's there is a 80 in 1000
chance of prostate cancer.

Further Statistics:

1. Each year in Australia, close to 3000 men die of prostate cancer - equal to the number of women who die from breast cancer annually. Around 18,700 new cases are diagnosed in Australia every year.

2. Each day about 32 men learn news that they have prostate cancer - tragically one man every three hours will lose his battle against this insidious disease.

3. One in 9 men in Australia will develop prostate cancer in their lifetime.

4. Prostate cancer is the most common cancer in Australian men and is the second most common cause of cancer deaths in men.

5. As many men die from prostate cancer as women die from breast cancer but... a national survey by PCFA in 2002 showed that while 78% of women felt well informed about breast cancer – only 52% of men felt informed about prostate cancer.

The chance of developing prostate cancer increases:

a) As men get older.

b) If there is a family history of prostate cancer eg a man with a father or brother diagnosed with prostate cancer.

NOTE:

* Early, curable prostate cancer may not have symptoms. While younger men are less likely to be diagnosed with it, they are more likely to die prematurely from it.

* Simple testing by a GP can indicate prostate cancer.

* Early detection can be achieved with PSA (Prostate Specific Antigen) blood test or DRE (Digital Rectal Examination) testing. Our research in 2002 shows that only 10% of men surveyed between the ages of 50 and 70 had taken these tests in the previous year.

Some groups are at greater risk of prostate cancer ... for example,

i) for every 100 men who dies of prostate cancer in a metropolitan area of Australia (such as Melbourne or Sydney) 121 men will die in rural Australia.
Various factors may include lack of awareness and education about prostate
cancer, distance from testing and treatment, poor GP awareness and limited
access to specialists (such as urologists).

(ii) The Vietnam Veterans Association of Australia states that veterans have a 53% higher mortality rate from prostate cancer than the average population.

(iii) A recently published international study showed that firefighters have a 28% higher risk of prostate cancer.

About Prostate Cancer

Each year in Australia, close to 3000 men die of prostate cancer - equal to the number of women who die from breast cancer annually. Around 18,700 new cases are diagnosed in Australian every year.

Prostate cancer can be cured if detected and treated while still confined to the prostate gland. The tests for prostate cancer are the prostate specific antigen (PSA) blood test and the digital rectal examination (DRE). These tests do not give a conclusive diagnosis of cancer but can indicate the presence of prostate cancer.

While prostate cancer is most common in men over the age of 50, younger men with a history of prostate cancer in their family are at greater risk. What is complicated with prostate cancer is that some cancers grow very slowly and don’t threaten life, whilst others grow more rapidly and do.

It is as a result of this dilemma that it is recommended you take an active role in your decision on testing, and if you develop cancer, how you choose to be treated. It is your choice.

Prostate cancer facts and figures

• Prostate cancer affects 1 in 10 men.
  
  
• The World Health Organisation estimates that over 540,000 new cases of prostate cancer were diagnosed worldwide in 2000.
  
  
• In Western countries, prostate cancer is the most commonly diagnosed cancer affecting men after middle age.
  
  
• Prostate cancer is common in the male population of the US and Northwest Europe but in contrast the incidence is much lower in Asia and South America.
  
  
• Historically, prostate cancer was considered a disease of old age but its prevalence is increasing in younger men.
  
  
• Compared with other types of cancer it is relatively slow growing
  
  
• A man with prostate cancer may live for many years without ever having the cancer discovered.
  
  
• In fact many men with prostate cancer will not die from it, but with it.

The likelihood of surviving prostate cancer 5 years after diagnosis is good compared to other types of cancer