NEWSLETTER OF PROSTATE CANCER CANADA NETWORK OTTAWA
P.O. Box 23122, Ottawa, ON K2A 4E2 • (613) 828-0762 • [email protected]
Do You Really Need
a Biopsy? Two
and Sexual Issues
New Tests Help
It's the holy grail – a prostate cancer these tests and their proper role in
test that can, with complete accuracy,
the management of prostate cancer.
distinguish men who have prostate
Published studies are limited, and
cancer from those who are cancer
none of the tests has a long-term track
free and, when prostate cancer is
record in the real world where doctors
diagnosed, determine whether it's an
screen, counsel and treat patients.
aggressive form that requires prompt
It's also important to recognize that
treatment or a slow-growing tumor
prostate cancer tests can be marketed
that may only need close monitoring.
without proof of benefit and that
While no such diagnostic tool is on the
unsubstantiated claims abound for
A FREE engaging session by
near horizon, a number of companies
have introduced new tests that could
For now, the tests are intended to
Andrea Simone, RN, BScN, CURN,
push us closer to that goal. There's
augment – not replace – a doctor's
who will discuss successful
still a great deal to be learned about
clinical judgment and existing tests
techniques and treatments related
currently used to screen for and
to erectile dysfunction following
CRACKING OPEN THIS WALNUT
monitor prostate cancer. Whether the
prostate cancer treatments in a fun
Summer's been great.
new tests add information that will
and non-threatening environment.
We've had such a time.
significantly affect treatment decisions
We've read and relaxed
remains to be seen. Do you really need
Partners and spouses are welcome!
But my hamstring's not fine.
a biopsy? An elevated prostate-specific
Still, we forge on
antigen (PSA) level can indicate that
At 3:30 pm, Saturday,
a man has prostate cancer; however
September 20th, 2014
The back of my front
findings may also be elevated in men
Where that muscle affixes.
with other less serious conditions,
At the Chateau Laurier
But here's some new stuff
such as benign prostatic
Our reporters have found
Burgundy Room on level 2
enlargement (BPE). Yet most
‘Bout prostates and cancers,
men with elevated PSA levels
The news just abounds.
RSVP required as spaces are limited
See Biopsy? on page 4
RSVP: JOHN at [email protected]
THE WALNUT • SEPTEMBER 2014
A Look at Updated
This latest iteration represents the third
P.O. Box 23122, Ottawa, ON K2A 4E2
Prostate cancer experts at Johns
Hopkins have developed an
update of the data.
Email: [email protected] •
updated version of the Partin Tables,
The newly revised Partin Tables show
PCCN OTTAWA is a volunteer organization of prostate
a tool to help men diagnosed with
cancer survivors and caregivers. Our purpose is to
prostate cancer and their physicians
that certain categories of men who
support newly-diagnosed, current, and continuing
were previously not thought to have
patients and their caregivers. PCCN Ottawa is a
better assess their chance of a surgical
a good prognosis actually could be
member of the Prostate Cancer Canada Network.
cure. The refined tool, based on a study
of more than 5,600 men treated at The
cured with surgery. That's because
the researchers now have a better
Johns Hopkins Hospital from 2006
and Bill Dolan
understanding of intermediate risk
to 2011, was published in the British
and see that more men now fall into
Journal of Urology International.
that category, instead of the higher-
"The first thing most men want to
know when they learn they have
For example, men with a biopsy
prostate cancer is their prognosis and
Gleason score of 8 and above
whether they will be cured," says Alan
previously were not thought to be good
W. Partin, M.D., Ph.D., Professor
Outreach/Awareness John Arnold
and Director of the Brady Urological
candidates for surgery because of the
Volunteer Coordinator Bill Lee
Institute at Johns Hopkins and creator
likelihood that the prostate cancer had
Peer Support Director Knowlton Constance
spread. The new Partin Tables data
of the Partin Tables.
show a higher probability of a cure
The Partin Tables are a statistical
with surgery even if a man's Gleason
model to show the probability that
the prostate cancer is confined to the
prostate and therefore is likely to
Gleason scores of 9 and 10 are still
considered high risk, indicating that
be cured with surgery. The model is
the prostate cancer likely has spread.
based on a patient's prostate specific
antigen (PSA) level, Gleason score
The researchers also found that having
Members at Large
David Brittain, Lionel Burns,
a PSA level of 10 and above was a
John Dugan, Gerry Gilbert,
(a number from 2 to 10 that estimates
better cut-off for predicting the spread
Admin Support Team Mike Cassidy, Doug Payette,
the aggressiveness of tumors removed
Martin de Leeuw, Fil Young
during a biopsy based on their
of disease compared with lower levels.
appearance under a microscope) and
To access the updated Partin Tables,
clinical stage, which is the extent to
which a tumor can be felt during a
PCCN Ottawa does not assume responsibility or
digital rectal exam.
By inputting your PSA, the Gleason
liability for the contents or opinions expressed in this
newsletter. The views or opinions expressed are solely
Data for the Partin Tables, first
score, and the clinical stage results
for the information of our members and are not intended
published in 1993, have been
and clicking on "find results," you
for self-diagnosis or as an alternative to medical
advice and care.
based on the outcomes for more
can see the percentage chance that the
than 20,000 men who underwent
cancer is confined to the prostate, has
PCCN Ottawa Mission Statement
prostate removal (known as radical
migrated to the edge of the gland, has
We provide information on prostate cancer to
prostatectomy surgery) at Johns
invaded the seminal vesicles, or has
those in need, gathered from a variety of sources.
Hopkins over the past three decades.
spread to the lymph nodes.
We participate in events that provide a venue
for promoting awareness of prostate cancer
through our informed member interaction at public
gatherings or as speakers. We collaborate with local
organizations such as The Ottawa Hospital, the
Ottawa Regional Cancer Foundation, the Canadian
Cancer Society, urologists and oncologists for
Our Steering Committee did not steer itself into oblivion. Instead, it took a much-deserved
information and support.
summer break. A summary of the September meeting will be published in the October issue.
THE WALNUT • SEPTEMBER 2014
A Question About Kegel Exercises from johnshopkinshealthalerts.com
Here's an important question
continence, initially in women,
from a recent issue of the
Although men can be considered
and later, when the era of radical
Prostate Cancer Bulletin. "I am
good candidates for surgery up to
prostatectomy began, for men. After
68 years old and am scheduled for
the age of 70 and even beyond,
radical prostatectomy, patients can
prostate cancer surgery next month.
urinary continence is an important
exercise the pelvic floor muscles as
In a conversation with my urologist
consideration in my practice.
a means of interrupting the urinary
today, he told me that he wanted
stream. Kegel exercise is commonly
me to begin Kegel exercises daily to
The Kegel exercises were derived
recommended, although the ability to
strengthen my pelvic floor muscles.
from the work of Dr. Arnold Kegel,
interrupt the urinary stream doesn't
He said that these special exercises
a Los Angeles gynecologist who, in
guarantee that total urinary continence
would help speed up the return of
the 1940s, developed a method for
will be preserved.
urinary continence following the
rehabilitating the strength of the vaginal
surgery. I had never heard of these
muscles after childbirth. Dr. Kegel
Your urologist is correct in suggesting
exercises before and was even more
created these exercises to strengthen
that doing Kegel exercises before
surprised to hear that I may have
the muscles that travel from the front of
surgery will familiarize you with
problems with urination after the
the pelvis around the rectum. Actively
the kind of muscle contractions
surgery. What are your thoughts on
contracting these muscles shortens,
necessary to interrupt the urinary
the value of Kegel exercises before
tightens and rehabilitates the vaginal
stream. However, there's very little
and after prostate surgery?"
muscles. In men, they have the same
data to suggest that you will actually
effect on the muscles that control the
strengthen the sphincter muscle in any
Dr. Mostwin replies. At age 68, you
meaningful way. So start doing the
should definitely be concerned about
Kegel exercises now in preparation for
urinary continence after prostate
Kegel exercises have been
utilizing them after the operation, but
cancer surgery. Increased age is one
adopted over the years as part of a
understand that there are other factors
of the risk factors in developing
rehabilitation program for urinary
in regaining continence post-surgery.
NEXT MONTHLY MEETING
Thursday, Sept. 18
6:30 – 7:30 p.m.: Mentoring for newly diagnosed in the Shalom Room
7:00 p.m.: PCCN Ottawa business
7:30 p.m.: Melina Ladouceur, the Lead Cancer Coach at the Maplesoft Centre, will discuss
what the Centre can do for cancer patients. Ms. Ladouceur is a registered social
worker with a passion for health and wellness and a background in health system
navigation. She has received additional training in health coaching through Health
Change Australia and the National Association of Professional Cancer Coaches.
She also runs the Work and Cancer Survivorship group coaching program as well
as a program for children and teens who are coping with cancer in the family.
We meet the third Thursday of each month at St. Stephen's Anglican Church,
930 Watson Street. Follow the Queensway to the Pinecrest exit and proceed north, past
the traffic lights, to St. Stephen's Street on the left. Parking is at the rear of the church.
Please remember your contribution for the St. Stephen's food bank.
WARRIORS SUPPORT GROUP
Tuesday, Sept. 16
1:00 – 3:00 p.m.: Regularly scheduled meeting
Warriors meetings are held the Tuesday BEFORE the regular monthly meeting
at the Maplesoft Centre for Cancer Survivorship Care 1500 Alta Vista Drive
(at Industrial in Cancer Survivors Park, across from Canada Post)
THE WALNUT • SEPTEMBER 2014
Biopsy? from page 1
Prostate Cancer Detection Method
end up having an anxiety-provoking
biopsy to rule out prostate cancer.
Can Save Men Painful Examination
Two new tests appear to be able to
more accurately identify appropriate
Prostate Health Index. Commonly
known as the phi test, this assay
measures blood levels of PSA, free
PSA and a precursor (or early form)
of PSA, known as pro-PSA or p2PSA.
Research suggests that pro-PSA
levels are a better indicator of prostate
cancer than total or free PSA levels
and that men with elevated pro-PSA
levels are at high risk for having an
aggressive form of prostate cancer.
Using a mathematical equation, the
phi test combines all three variants
to better determine whether prostate
cancer is present. The test is indicated
for use in men age 50 and older whose
A new technique developed
of the PSA (prostate specific antigen)
at Eindhoven University of
value in the blood. If this is high,
Technology in the Netherlands can
physicians will usually remove
digital rectal exam showed no signs of
potentially show tumors with much
samples of prostate tissue through
cancer and who have a total PSA value
the anus at six to sixteen points for
between 4 ng/mL and 10 ng/mL – a
gray zone that could indicate prostate
Each year prostate tissue samples
cancer or a less serious condition such
are taken from over a million men
However, 70% of the subjects show no
as BPE. The phi test doesn't deliver a
around the world - in most cases using
signs of cancer. So does this mean the
definitive answer about whether or not
12 large biopsy needles - to check
high PSA level is a false alarm? Not
to have a biopsy. Instead, the phi test's
whether they have prostate cancer.
always: the biopsies may have been
results, which are scored from 0 to 55
This medical procedure, which was
taken at just the wrong places. Cancer
and above, reflect the probability that a
recently described by an American
is later found in 30% of the patients
biopsy will detect cancer. For example,
urology professor as ‘barbaric',
with negative results (no cancer).
a phi test score below 27 is associated
shows that 70% of the subjects do
Among the positive results (patients
with a 9.8 percent probability that
not have cancer. The examination is
with signs of cancer), doctors do not
prostate cancer is present, while
unnecessarily painful and involves
know the exact sizes of the tumor.
a score of 55 or more suggests a
risk for these patients, and it is also
In many cases, operations show that
likelihood of greater than 50 percent.
costly to carry out. A patient-friendly
the tumors are so small that surgery
Phi test results must be considered in
examination, which drastically reduces
was unnecessary. As well as that, the
light of a man's other risk factors.
the need for biopsies, and may even
examination leads to inflammations in
eliminate them altogether, has been
up to 5% of patients. Plus the fact that
4Kscore. This blood test measures
developed at Eindhoven University
each examination costs around USD
levels of three PSA variants (total
of Technology (TU/e), together
2500 to carry out.
PSA, free PSA and intact PSA), plus
with Academic Medical Center
an enzyme called human kallikrein
Research team leader Dr. Massimo
2 (hK2), which is elevated in men
Mischi at TU/e has developed a
with prostate cancer. Some scientists
According to statistics collected
method to investigate whether and
believe hK2 may promote the growth
and analyzed by Cancer Research
where men have prostate cancer using
and spread of prostate cancer. The
UK, an estimated 258,000 men died
existing ultrasound scanners, together
4Kscore also uses a mathematical
from prostate cancer (worldwide)
with the AMC Amsterdam. These
algorithm to calculate the risk of
in 2008. The standard procedure
devices create images of organs in the
prostate cancer in a man with an
used worldwide for prostate cancer
elevated PSA level.
examinations starts with measurement
See Detection Method on page 5
THE WALNUT • SEPTEMBER 2014
Detection Method from page 4
major comparative study will be held
in these hospitals next year between
body using sound waves, in the same
the old and new methods, to proof that
way as prenatal ultrasound scans. But
the new method is better. This will
these systems are usually unable to
involve the use of both methods on
show the difference between healthy
at least 250 men. If all goes well the
Prostatectomy and tumor tissue.
method will also be made available
from 2016 for other patients, a large
To make this visible, Dr. Mischi used
part of which will then no longer have
the fact that tumor tissue produces
to undergo the old and painful form
large numbers of small blood
of examination. The new method can
vessels to allow it to grow, with a
be introduced quite simply because
characteristic pattern. Patients are
no new equipment is required; the
given a single injection of a contrast
When is radiation the right choice
for men who have had a radical
existing ultrasound scanners which the
medium containing tiny bubbles,
prostatectomy? A panel of doctors
hospitals already have can continue
which are shown by the ultrasound
representing the American Urological
scanner right down to the smallest
Association (AUA) and the American
blood vessels. Using advanced image-
Society for Radiation Oncology
analysis techniques that can recognize
(ASTRO) have collaborated to answer
the characteristic blood vessel pattern
in tumors, the computer then generates
The resulting guidance, published
an image showing where the tumor
The Walnut Laureate
in 2013, is intended to help doctors
is. The examination only takes one
and their patients decide whether
minute, and the results are available
they should have adjuvant radiation
no more than a few minutes later.
(which is performed in conjunction
These examinations also save money,
with radical prostatectomy) or salvage
because costly biopsy analysis is no
radiation (which is administered in
response to evidence that cancer
The researchers were able to compare
the ‘tumor images' from 24 patients at
According to the panel, consideration
three hospitals in the Netherlands with
of adjuvant radiation should be the
the actual prostates after removal by
standard of care for any man who
operation. The images were found to
displays evidence of lingering cancer
give a good indication of the locations
by Glenn Kletke
following radical prostatectomy, such
and sizes of the tumors.
Every few months, you have a reservation.
as positive surgical margins. The panel
Figure it's time to eat at the old place again.
The use of the new method, which
also recommended that men with a
has been patented by TU/e, can avoid
The doctor's in the kitchen, he may pop out.
biochemical or local recurrence after
the need for biopsies to be taken from
Waiters walk efficiently around the room.
prostatectomy be offered salvage
millions of men around the world. The
No use looking at the menu. Not a hope in hell
radiation therapy if there is no
procedure will no longer be necessary
that you get to pick what you will be receiving.
evidence of distant metastatic disease.
for a large part of the 70% of men
Smiling men around you get served great plates
However, they stopped short of
from whom biopsies are currently
of undetectable, delectable dish you never tasted.
considering this the standard of care.
taken unnecessarily. And far fewer
For you it will be the usual salad of uncertainty.
They also recommended that
biopsies will need to be taken from the
The same stale overcooked PSA on your plate.
biochemical recurrence be defined
remaining 30% because the location
Main course of rising or almost-the-same or
as a detectable or rising PSA value
of the tumor is already clear. Once
a big heap of something's going on in there.
of 0.2 ng/mL or higher after surgery
the new method has been sufficiently
The bill. Relax. Your health card will cover it.
and that it be confirmed by a second
proven in clinical practice, the need to
Don't forget to make your next reservation.
measurement showing a rise of 0.2 ng/
do biopsies may even be eliminated
mL or higher.
Glenn Kletke's poetry has most recently
appeared in "Whistle for Jellyfish" published
The complete guideline is available at
The research is being carried out
by Booklands Press
together with the AMC Amsterdam
and two other Dutch hospitals. A
THE WALNUT • SEPTEMBER 2014
HEAR YE! HEAR YE! HEAR YE!
Viagra To Have Generic Name
and Available in Liquid Form
All drugs have two names, a trade name and generic name.
For example, the trade name is Tylenol and it's generic
name is Acetaminophen. Aleve is also called Naproxen.
Amoxil is also called Amoxicillin and Advil is also
called Ibuprofen. The FDA has been looking for a generic name for Viagra.
After careful consideration by a team of government experts,
it recently announced that it has settled on the generic
WHEREAS, prostate cancer is the most common
name of Mycoxafloppin. Also considered were Mycoxafailin,
cancer to affect Canadian men; and
Mydixadrupin, Mydixarizin, Dixafix, and of course, Ibepokin.
WHEREAS, 1 in 7 Canadian men will be diagnosed with
As well, Pfizer Corp. recently announced that Viagra will
the disease in his lifetime; and
soon be available in liquid form and will be marketed by
Pepsi Cola as a power beverage suitable for use as a mixer.
WHEREAS, an estimated 23,600 Canadian men will be
It will now be possible for a man to literally pour himself
diagnosed with prostate cancer this year; and
WHEREAS, 90% of prostate cancer cases are curable if
Obviously we can no longer call this a soft drink and it gives
detected and treated in their earliest stages; and
new meaning to the names of ‘cocktails', ‘highballs' and just
a good old-fashioned ‘stiff drink'. Pepsi will market the new
WHEREAS, Prostate Cancer Canada encourages men
concoction by the name of: MOUNT & DO.
over the age of 40, as part of their annual checkup,
to initiate a conversation with their doctor about early
detection of prostate cancer, which may include
prostate-specific antigen (PSA) testing and a digital
THEREFORE, I, Jim Watson, Mayor of the City of
Ottawa do hereby proclaim September 2014 Prostate
Cancer Awareness Month in Ottawa.
Here are some of the PCCN Ottawa participants in the
Father's Day Ultimate Run for Men's Cancers last June 15.
Our organization sponsors Team Don Hampton (in blue).
Don, who died of prostate cancer, was a member. Each
year his extended family takes part in the event. Also in the
photo, wearing the distinctive yellow Prostate Gurus shirts,
are Wilf Gilchrist (#88 - NOT his age!), Ron Marsden beside
him and team captain Fred Nadeau ((#89) on the far right.
Not in the photo, because he was still slogging through the
15 k event, is Richard Bercuson.
THE WALNUT • SEPTEMBER 2014
4th Quarter 2012 INSIDE THIS ISSUE: The following is Part 1 of a Series of 4 articles that we are including in the FWEA West Coast Chapter newsletters. °USF Career Roundtable Your First Date: A Successful Career Path for Life °New Luncheon Rates by Rachel Cantor, President, RC Associates
Differential response to a selective cannabinoid receptorantagonist (SR141716: rimonabant) in female mice from linesselectively bred for high voluntary wheel-running behaviourBrooke K. Keeneya, David A. Raichlenb, Thomas H. Meeka,Rashmi S. Wijeratnea, Kevin M. Middletona,*, Gregory L. Gerdemanb,wand Theodore Garland Jra Exercise is a naturally rewarding behaviour in human