<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40"><head><meta http-equiv=Content-Type content="text/html; charset=us-ascii"><meta name=Generator content="Microsoft Word 12 (filtered medium)"><style><!--
/* Font Definitions */
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
@font-face
{font-family:Verdana;
panose-1:2 11 6 4 3 5 4 4 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0cm;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri","sans-serif";}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:blue;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:purple;
text-decoration:underline;}
span.EmailStyle17
{mso-style-type:personal;
font-family:"Verdana","sans-serif";
color:windowtext;}
span.EmailStyle19
{mso-style-type:personal-reply;
font-family:"Calibri","sans-serif";
color:#1F497D;}
.MsoChpDefault
{mso-style-type:export-only;
font-size:10.0pt;}
@page WordSection1
{size:612.0pt 792.0pt;
margin:72.0pt 72.0pt 72.0pt 72.0pt;}
div.WordSection1
{page:WordSection1;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]--></head><body lang=EN-CA link=blue vlink=purple><div class=WordSection1><p class=MsoNormal><span style='color:#1F497D'>Hi all:<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>See below for the PCCN Oakville/Mississauga newsletter with a “big bunch” of articles on Prostate Cancer & various treatments.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Take care,<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Glen<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0cm 0cm 0cm'><p class=MsoNormal><span lang=EN-US style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'><br><b>Subject:</b> PC Newsletter - October<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><b><span lang=EN-US style='font-family:"Verdana","sans-serif"'>Breakthrough: world's first precision prostate cancer treatment - </span></b><span lang=EN-US style='font-family:"Verdana","sans-serif"'>How’s that for a headline!<b><o:p></o:p></b></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><strong><span lang=EN-US style='font-family:"Verdana","sans-serif";color:black;border:none windowtext 1.0pt;padding:0cm;background:white;font-weight:normal'>Personalized medicine is the new buzz in cancer treatment, not just for PC. Personalized or Precision medicine is an approach to cancer care that uses information about the genetics of a man’s tumour to work out the best treatment for him.</span></strong><b><span lang=EN-US style='font-family:"Verdana","sans-serif";color:black;background:white'><o:p></o:p></span></b></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif";color:black;background:white'>In PC, the intent would be to move from a one-size-fits-all approach to treating advanced prostate cancer to a much more effective approach where drugs target the genetic drivers of an individual’s cancer. (try Googling “personalized prostate” for example)<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'>The attention-grabbing news this month is on the latest results on olaparib (Lynparza).<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif";color:black;background:white'>Olaparib is a type of drug known as a PARP inhibitor, which targets cancer cells' ability to repair damage to their DNA. Olaparib has been shown to be effective in men whose cancer has a mutation in one of 15 genes that are involved in repairing damage to DNA, including the </span><span lang=EN-US style='font-family:"Verdana","sans-serif";border:none windowtext 1.0pt;padding:0cm;background:white'>BRCA1, BRCA2</span><span lang=EN-US style='font-family:"Verdana","sans-serif";color:black;background:white'> and ATM genes.<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif";color:black;background:white'><o:p> </o:p></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif";color:black;background:white'>After all the hoopla, it might be a bit disappointing to read that it only delays cancer progression for about 4 months. But remember this is advanced PC where abiraterone and enzalutamide have stopped working. Also, this is just the beginning and the next decade may well produce what we would think of as true breakthroughs. Lots more to read here if you’d like more background<br></span><span lang=EN-US><a href="https://prostatecanceruk.org/about-us/news-and-views/2019/9/olaparib-trial-shows-evidence-of-worlds-first-precision-medicine-for-prostate-cancer">https://prostatecanceruk.org/about-us/news-and-views/2019/9/olaparib-trial-shows-evidence-of-worlds-first-precision-medicine-for-prostate-cancer</a><o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US><a href="https://www.pcf.org/news/new-precision-medicine-treatment-could-benefit-many-men-with-treatment-resistant-metastatic-prostate-cancer/">https://www.pcf.org/news/new-precision-medicine-treatment-could-benefit-many-men-with-treatment-resistant-metastatic-prostate-cancer/</a><o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US><o:p> </o:p></span></p><p class=MsoNormal><span lang=EN-US><o:p> </o:p></span></p><p class=MsoNormal><b><span lang=EN-US style='font-family:"Verdana","sans-serif"'>Survival Starts with a Doctor’s Appointment<o:p></o:p></span></b></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'>You wouldn’t want to hit your friends and relatives over the head with the complex article above, but you could do it with this one.<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'>Just get tested! </span><span lang=EN-US><a href="https://www.healthinsight.ca/advocacy/prostate-cancer-survival-starts-with-a-doctors-appointment/">https://www.healthinsight.ca/advocacy/prostate-cancer-survival-starts-with-a-doctors-appointment/</a><o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US><o:p> </o:p></span></p><p class=MsoNormal><b><span lang=EN-US style='font-family:"Verdana","sans-serif"'>Surgery or Radiation??<o:p></o:p></span></b></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'>We all have our biases and maybe this guy does too but he makes some good points about radiation – most of which you will have heard if you have been a regular attender at our meetings over the past year or so. Great advances are being made in radiation vs surgery.<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:12.0pt'><span lang=EN-US style='font-size:12.0pt;font-family:"Times New Roman","serif"'><a href="https://m.youtube.com/watch?v=Pya8N78bR7s&feature=youtu.be&fbclid=IwAR2DsJFeEvktgh60bYWBATMfFPGCaA0nK_0jIfBJcMdDZgnywtHGpxSd9ZM">https://m.youtube.com/watch?v=Pya8N78bR7s&feature=youtu.be&fbclid=IwAR2DsJFeEvktgh60bYWBATMfFPGCaA0nK_0jIfBJcMdDZgnywtHGpxSd9ZM</a><o:p></o:p></span></p><p class=MsoNormal><b><span lang=EN-US style='font-family:"Verdana","sans-serif"'>Robotic or Open Surgery?<o:p></o:p></span></b></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'>Reviews to-date have not shown any long term benefit for robotic surgery in survival, recurrence, ED or incontinence. However, here is a new study which claims robotic may have an advantage in that tricky area of ‘salvage surgery’ after radiation. <br></span><span lang=EN-US><a href="https://www.auajournals.org/doi/abs/10.1097/JU.0000000000000327">https://www.auajournals.org/doi/abs/10.1097/JU.0000000000000327</a><o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US><o:p> </o:p></span></p><p class=MsoNormal><b><span lang=EN-US style='font-family:"Verdana","sans-serif"'>New Approaches to External Radiation<o:p></o:p></span></b></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'>It’s easy to get confused with all the new descriptions of radiation and the number of treatments (fractions) required. Here is a useful primer from a recent article:<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'> Conventionally fractionated RT e.g. 78Gy in 39 fractions over 7-8 weeks (i.e. 2 Gy per treatment fraction). <o:p></o:p></span></p><p class=MsoNormal style='text-indent:36.0pt'><span lang=EN-US style='font-family:"Verdana","sans-serif"'>Moderately hypofractionated RT e.g. 62 Gy in 20 fractions over 4 weeks (or something similar at more than 2 Gy per fraction) <br> Stereotactic body RT (SBRT) e.g. 36 Gy in 5 fractions over 1-2 weeks (or something similar at more than 5 Gy per fraction)<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'>The Gray (Gy) is a measure of the amount of absorbed energy.<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'>The challenge in radiation is to increase the dose per treatment without significantly increasing the toxicity (gastrointestinal or genitourinary) of the treatment. This has become possible through technical advances in radiation which permit more precise and conformal delivery of escalated doses of radiation to the prostate. There are benefits to both patient and hospital from a shorter course of treatment so the cancer control result doesn’t have to be better, just not any worse (’non inferior’ as they say in the studies).<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US style='font-family:"Verdana","sans-serif"'>Here is one of many articles touting the benefits of SBRT:<o:p></o:p></span></p><p class=MsoNormal><span lang=EN-US><a href="https://www.astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2018/Men-with-low-and-intermediate-risk-prostate-cancer">https://www.astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2018/Men-with-low-and-intermediate-risk-prostate-cancer</a></span><span lang=EN-US style='font-family:"Verdana","sans-serif"'><o:p></o:p></span></p><p class=MsoNormal><b><span lang=EN-US style='font-family:"Verdana","sans-serif"'><o:p> </o:p></span></b></p></div></body></html>