Thursday, October 9, 2014

Prostate cancer webinar

Dr. Anthony Joshua: genital urinary malignancy and melanoma Princess Margaret, Toronto.
Many men die of other things than prostate cancer as it is very slow growing.
Specialist in radiation and chemotherapy.

Including riding a bike.

Can tend to spread to bones.
Bone pain is a symptom.

Gleason 1 - 5
At Gleason 7+ you don't know how will behave. 

Pioneered by Canadians: treatments
Over the last decade: safe treatment options.

Hormone treatment:
cancer lives on testosterone, add hormone therapy.
if you add radiation on top of better cure rates.

Take away testosterone which cancer feeds on. Chemo can also work when therapy doesn't work anymore.
Watchful waiting vs. active treatment.

They won Nobel prize for this.
When Hormone Therapy doesn't work any more, cancer cells make their own testosterone and feeds off of it.
Strategy: block effect of testosterone. Live longer and live better with these drugs.
Drugs work in two diff. ways: Abiraterone stops DHEA from being made into DHT,
Enzalutamide Doc. stops it from working.

Not done lightly, due to side effects.

Chemo Canadian, Dr. Tannic. Pioneer.
Radium 223 - for those too sick for previous
Tested on elderly men, balance age
Treatment may be nothing, to test quality of life.

Phase 1 - early on in trials: works in a mouse, want to test on humans. Test on 5.
Phase 2 - perhaps 50 people.
Phase 3 - compare new and old treatment.

Q. 2; can you have surgery after radiation?
       Yes - not often done.   Salvage prostatectomy.
Q. 3; using an exercise bike affects PSA results, does it matter if prostate is removed?
     A: No. Sitting on bike squishes prostate and releases extra PSA. If the prostate is removed, it won't affect the test scores.
Q. 4; Can cordisone treatments for arthritis interfere with hormone. Prednisone.
Q. 5; What is the success rate of chemo?
     A: Success: live longer, bringing down PSA, when hormones no longer work.
It is effective, the degree of success cannot be guarnteed, more often than not achieve results, longer life. Better quality of life.
Q. 6; Do you have any knowledge Galitilone.
     Works well with the other drugs, recently finished a clinical trial. Have ideas about best patients for response. It is coming. May be effective for certain types of prostate cancer.
Q. 7; How long does radiation treatments.
     Weeks: type of radiation: looking at up to 6 weeks of treatment.
Q. 8; If experiencing pain: feels like muscle pain and lower abdomen.
     A: generally prostate cancer goes to the bones.
     Very late in the stage: boney ache, sharp shooting pain, sciatic pain,
Q. 9; Is there any evidence that biopsies spread prostate cancer.
Q. 10; Is there any evidence HPV virus causes prostate cancer.
Q. 11; Why colein 11 test not used in Canada to detect location of prostate cancer.
     A: Still in trials. Under investigation in some clinical trials in the US, not done in Canada.
Q. 12; Why is proton beam radiation not used in Canada?
     A: Too $$ in Canada, can do a lot more, not clear it achieves better results than radiation. We are very advanced in Canada, leading techniques, leading machines, not based in efficacy demonstrated.

Enzalutimide helps lengthen life. Bicalutimide doesn't help live longer.

Only in bones, hormone treatment, not strong enough to have radiation, not strong enough to have chemo: Radium 223 helps. Only a small proportion of men die of prostate cancer (US data: 3.5%), despite being diagnosed with cancer.

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