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June 2007, newsletter
CANADIAN PROSTATE CANCER SUPPORT GROUP
Volume 14, Issue 4, December 15th, 2009
A support group that provides understanding,
hope and information to prostate cancer patients and their families
Make sure you come to our Christmas Meeting on
December 10th, 2009 (note date change, it's
the second Thursday this year).
At the Newmarket Seniors Meeting Place,
474 Davis Drive, Newmarket
Time: 7:00 pm to 9:00 pm
The Upper Canada Cordsmen will be back
for the seventh straight year to add their special
musical talents to our annual Christmas party,
Canadian Prostate Cancer Support Group,
Newmarket, Ontario. 905-830-0447
Doug Armstrong, Acting Chairman
a member of the
Jane & Frank Kennedy, Newsletter,
905-895-2263Pat & Ron Stevenson, Greeters,
Phil Harrison, Member at large
The Newmarket Prostate Cancer Support Group does not recommend products, treatmentmodalities, medications, or physicians. All information is, however, freely shared.
Tanya Giaquinto's November Notes on Diet and Cancer
will be in the January Newsletter
Side Effects of Hormone Therapy
Testosterone is the primary male hormone, and plays prostate cells. Although hormone therapy plays an important
an important role in establishing and maintaining the typical role in men with advancing prostate cancer, it is increasinglymale characteristics, such as body hair growth, muscle mass, being used before, during, or after local treatment as well.
sexual desire, and erectile function, and contributes to a host
The majority of cells in prostate cancer tumors respond
of other normal physiologic processes in the body.
to the removal of testosterone. But some cells grow indepen-
The list of potential effects of testosterone loss is long: dent of testosterone, and therefore remain unaffected by hor-
hot flashes, decreased sexual desire, erectile dysfunction, fa- mone therapy. As these hormone-independent cells continuetigue, osteoporosis, weight gain, decreased muscle mass, ane- to grow unchecked, over time, hormone therapies have lessmia, and memory loss. Most men who are on hormone therapy and less of an effect on the growth of the tumor.
experience at least some of these effects, but the degree to
Hormone therapy is therefore not a perfect strategy in
which any man will be affected by any one drug regimen is the fight against prostate cancer, and does not cure the dis-impossible to predict.
ease. But it remains an important step in the process of man-
Before beginning hormone therapy, every man should aging advancing disease, and will likely be a part of every
discuss the effects of testosterone loss with his doctors, so he man’s therapeutic regimen at some point during his fightcan alter his lifestyle to accommodate or head off the changes. against recurrent or advanced prostate cancer.
The most common types of hormone therapy are de-
Over the years, researchers have explored different scribed below. Although each of these therapeutic options is
ways to minimize the side effects of testosterone loss while effective at controlling prostate cancer growth, the loss ofmaximizing the therapeutic effect of hormone therapy. The testosterone confers significant side effects in nearly all men.
most commonly explored strategy is known as intermittent
Because about 90% of testosterone is produced by the
This strategy takes advantage of the fact that it takes a testicles, surgical removal of the testicles, or orchiectomy
while for testosterone to begin circulating again after LHRH an effective solution to blocking testosterone release. Thisagonists are removed. With intermittent hormone therapy, the approach has been used successfully since the 1940s, but be-LHRH agonist is used for six to twelve months, during which cause it’s a permanent and irreversible surgical solution, mosttime a low PSA level is maintained. The drug is stopped until men opt for drug therapy instead.
the PSA rises to a predetermined level, at which point the
For men who choose this option, the procedure is typi-
drug is restarted. The “drug holidays” in between cycles al- cally done on an outpatient basis in the urologist’s office. Re-low men to return to nearly normal levels of testosterone, covery tends to be rather quick and no further hormone therapypotentially enabling sexual function and other important qual- is needed, making orchiectomy a very attractive choice fority of life measures to return before the next cycle begins someone who prefers a low-cost, one-time procedure.
At this time, however, the true benefits of this approach
LHRH, or luteinizing-hormone releasing hormone, is
remain unclear, and large clinical trials are currently under- one of the key hormones released by the body before test-way to evaluate its use in men with advanced prostate cancer. osterone is produced. (Note that LHRH is sometimes calledIf the approach proves to be as effective as continuous therapy GnRH, or gonadotropin-releasing hormone.) Blocking thein suppressing tumor growth, intermittent therapy will likely release of LHRH through the use of LHRH agonists or LHRHbecome popular because of potential for an improved side analogues is one of the most common hormone therapies usedeffect profile.
Drugs in this class, including leuprolide (Eligard,
Prostate cancer cells are just like all other living or- Lupron, and Viadur), goserelin (Zoladex), and triptorelin
ganisms—they need fuel to grow and survive. Because the (Trelstar), are given in the form of regular shots: once a month,hormone testosterone serves as the main fuel for prostate can- once every three months, once every four months, or once per year.
cer cell growth, it is a common target for therapeutic inter-
vention in men with prostate cancer.
LHRH agonists cause what is known as a “flare” reac-
Hormone therapy, also known as androgen-depriva- tion because of an initial transient rise in testosterone. This
tion therapy or ADT, is designed to stop testosterone from can result in a variety of symptoms ranging from bone painbeing released or to prevent the hormone from acting on the to urinary frequency or difficulty.
Antiandrogens such as bicalutamide (Casodex),
the most important part of your cancer treatment—getting
flutamide (Eulexin), and nilutamide (Nilandron), help to block
the action of testosterone in prostate cancer cells. They are
) Prostate cancer cells that have spread beyond the
therefore often added to the LHRH agonist for at least the
prostate seem to prefer bone tissue and tend to migrate there
first 4 weeks of therapy when the flare reaction typically oc-
after escaping the pelvic region. Once the cells settle in, they’re
curs. In this setting, antiandrogens can be helpful in prevent-
known as prostate cancer bone metastases. Unlike bone can-
cer, which originates in the bone, prostate cancer bone me-
Although the sexual side effects of the antiandrogens
tastases are actually collections of prostate cancer cells that
when given alone are typically far fewer compared with the
happen to be sitting within the bones.
LHRH agonists, antiandrogens might not be as effective as
) When prostate cancer cells settle in the bones, they
orchiectomy or LHRH agonists and are not the optimal choice
interact with the bone cells, causing new bone cells to grow
for men with documented metastatic prostate cancer.
and causing the bone tissue to break down. The dye-like ma-terial that’s injected during a bone scan highlights areas of
What to Consider When Your PSA is Rising
bone metabolism or activity—areas where bone tissue is
During Hormone Therapy
changing more rapidly than it normally would in a healthy
This section summarizes key points to consider when
your PSA is rising while undergoing hormone therapy. The
) Men who experience pain from a bone metastasis
list is by no means exhaustive, and there might be other points
will often be treated with radiation targeted directly to the
that you want to think about as well. The goal is to help you
metastasis or with radiation-emitting drugs that settle in the
focus on what you need to know about each stage of disease
metastasis after being injected through a vein. The radiation
so you can hold meaningful, regular dialogues with all mem-
will kill the prostate cancer cells in the metastasis and thereby
bers of your health care team as you find the treatment path
) Bisphosphonates are drugs that are designed to help
) A rising PSA during hormone therapy doesn’t mean
reset the balance in the bone between bone growth and bone
you’re out of options—it means you need to consider the use
destruction which is disrupted by the prostate cancer bone
of other systemic therapies such as chemotherapy or agents
metastases. Zoledronic acid (Zometa) is a bisphosphonate
that target prostate cancer bone metastases.
given intravenously that can delay the onset of complications
) The primary goal of chemotherapy is to stop the
associated with prostate cancer bone metastases and relieve
cancer cells from dividing and the cancer cells from grow-
pain. It is typically given once every three weeks as a 15-
ing. But when we look at whether a drug is working, there
are generally two levels of effectiveness—whether a drug is
) As the bones in the spine weaken, they can col-
palliative, meaning whether it can alleviate symptoms, and
lapse one on top of the other, compressing the spinal cord
whether it can affect the cancer cell growth significantly
and the nerves that run out from it. Cord compression associ-
ated with metastatic prostate cancer can cause serious prob-
) The benefits of chemotherapy in prostate cancer were
lems if not managed immediately, so be sure to tell your doc-
only first realized recently: mitoxantrone (Novantrone) was
tors about any new pain, weakness, or changes in bowel hab-
approved by the FDA in 1996 when it was shown to provide
its, any of which can result from spinal cord compression.
palliative benefit to men with advanced prostate cancer;
) Cancer can be painful, and there’s no benefit in
docetaxel (Taxotere) was approved in 2004 when it was shown
acting stoic and pretending it doesn’t affect you. There are
to prolong the lives of the men who took it and relieved symp-
plenty of very effective pain medications available, and us-
ing them will allow you to feel better and stay stronger.
) Although all chemotherapy drugs are designed to
) Don’t assume that you can’t get pain relief unless
slow or stop the growth of cancer cells, each one tends to
you’re completely doped up. Some very simple and easy to
work in a slightly different way, and using two or more to-
take oral medications might be enough to ease your pain.
gether or one after another in a row can often be more effec-
) Don’t worry about becoming addicted to pain medi-
tive than just using one drug alone.
cation. Taking pain medications so that you can spend your
) Pay close attention to your reactions to the different
days feeling healthier and stronger is the opposite of addic-
chemotherapy drugs. You’re the only one who really knows
tive behavior. However, both physical dependence and toler-
your own body, so you’re the only one who can know whether
ance are possible as your body starts to get used to the drugs,
you are able to tolerate a particular treatment regimen.
so you and your doctors should take them into consideration
) Don’t be too tough or “macho.” There are plenty of
as you start and stop different pain medications.
drugs available to help ward off or treat the different side
) Consider enrolling in a clinical trial of an experi-
mental new treatment or regimen. Clinical trials are the only
) Focus on yourself. It doesn’t matter what you do, as
way that new and better treatments will be developed and
long as it can help you relieve stress and can help you with
The importance of healthy bones as we grow older
We all think that our skeletal system is pretty stable,
Drugs deliver double punch
supporting our body but not changing much over the years.
Patients who have bone marrow transplants and take
Not so. The skeleton is always changing and that's important,
immunosuppressive drugs, such as glucocorticoids, face two
too. The skeleton is the body’s source of calcium; without it
problems. High doses of these drugs, meant to decrease the
the brain couldn’t function. Bone health should be a concern
risk of the body rejecting the transplant, may increase the rate
for everyone, especially cancer patients. Your cancer, treat-
of bone breakdown and decrease the rate of bone formation
ment may lead to increased bone loss.
Cancer patients often have decreased appetites, and if
they receive chemotherapy they may be nauseated as well.
As a result, they may not eat well, which may cause a cal-
cium deficiency. If we don’t take in enough calcium in our
diet, our body will withdraw it from the skeleton. If unchecked,
Certain cancers, such as multiple myeloma, stimulate bone
Vitamin D is crucial
loss and inhibit formation of new bone.
Many patients also have vitamin D deficiencies, either
Early menopause robs bones
because they do not get enough in their diet, or they have
Chemotherapy for breast cancer often induces early
liver or kidney failure so their body does not make it. Vita-
menopause (the end of a woman’s menstrual cycles). Meno-
min D enables the body to absorb calcium from foods and
pause leads to a deficiency in estrogen, which may cause bone
supplements. While the minimum daily requirement is set at
loss. Many breast-cancer patients develop bone loss at a
400 to 600 IUs (international units), many researchers sug-
younger-than-normal age, which increases their risk of os-
gest it should be much higher. Over fifty percent of the popu-
teoporosis. If we don’t do something to prevent bone loss at
lation in the United States and Canada are vitamin D defi-
the beginning of treatment, a 45-year-old woman might be-
cient. This means that, even if they are getting the daily rec-
gin to have bone fractures in 20 years.
ommended amount of calcium, they are absorbing only about
Men are affected also
Testosterone in men helps protect bone, much like es-
Bone up on health
trogen does for women. Although several therapies are avail-
Take your bone health seriously. You may be able to
able to treat prostate cancer, they all lower testosterone lev-
prevent serious problems down the road if you add calcium-
els. In most cases, men begin with higher bone density than
rich foods to your diet and Exercise regularly. You should
women, so it takes longer for them to reach levels of bone
speak to your doctor about any bone health concerns. Ask if
loss that might lead to fractures. However, the problem should
you should take calcium supplements, have your vitamin D
level checked and have a bone density test.
NEW MEDICINE FOR MEN
With Viagra such a great medical success for increasing men’s sexual prowess, Pfizer is bringing forth a whole line of
drugs oriented towards improving the performance of men in today’s society. Here are a few of the new ones:
- a dose of this drug given to men before leaving on car trips caused 72 percent of them to stop and ask
directions when they got lost, compared to a control group of 0.2 percent.
- Men given this experimental new drug were far more likely to actually finish a household repair
project before starting a new one.
- In clinical trials, 82 percent of middle-aged men administered this drug noticed that their wives
had a new hairstyle. Currently being tested to see if its effects extend to noticing new clothing.
- Has the exact opposite effect of Viagra. Currently undergoing clinical trials on sitting U.S. presi-
- This drug had the strange effect of making men want to turn off televised sports and actually
converse with other family members.
- This drug causes men to be less than truthful when being asked about their sexual affairs. Will be avail-
able in Regular, Grand Jury and Presidential Strength versions
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Warfarin and Other Medication This fact sheet is intended to help those aﬀ ected by atrial ﬁ brillation (AF) understand warfarin and the eﬀ ects other medications • Dexamethadone oral steroid medicationMany people with atrial ﬁ brillation may ﬁnd that farin and Other Medication - P warfarin therapy is recommended to thin the blood and reduce their risk of stroke. Warfar