[Hopespringpcsg] FW: PC Newsletter - October X1

[Glen Tolhurst]

Hi all:

See below for the PCCN Oakville/Mississauga newsletter with a "big bunch" of
articles on Prostate Cancer & various treatments.

Take care,

Glen

 


Subject: PC Newsletter - October

 

Breakthrough: world's first precision prostate cancer treatment - How's that
for a headline!

 

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.

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)

 

The attention-grabbing news this month is on the latest results on olaparib
(Lynparza).

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 BRCA1, BRCA2 and ATM
genes.

 

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
https://prostatecanceruk.org/about-us/news-and-views/2019/9/olaparib-trial-s
hows-evidence-of-worlds-first-precision-medicine-for-prostate-cancer

https://www.pcf.org/news/new-precision-medicine-treatment-could-benefit-many
-men-with-treatment-resistant-metastatic-prostate-cancer/

 

 

Survival Starts with a Doctor's Appointment

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.

Just get tested!
https://www.healthinsight.ca/advocacy/prostate-cancer-survival-starts-with-a
-doctors-appointment/

 

Surgery or Radiation??

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.

https://m.youtube.com/watch?v=Pya8N78bR7s
<https://m.youtube.com/watch?v=Pya8N78bR7s&feature=youtu.be&fbclid=IwAR2DsJF
eEvktgh60bYWBATMfFPGCaA0nK_0jIfBJcMdDZgnywtHGpxSd9ZM>
&feature=youtu.be&fbclid=IwAR2DsJFeEvktgh60bYWBATMfFPGCaA0nK_0jIfBJcMdDZgnyw
tHGpxSd9ZM

Robotic or Open Surgery?

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. 
https://www.auajournals.org/doi/abs/10.1097/JU.0000000000000327

 

New Approaches to External Radiation

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:

          Conventionally fractionated RT           e.g. 78Gy in 39 fractions
over 7-8 weeks (i.e. 2 Gy per treatment fraction).                      

Moderately hypofractionated RT         e.g. 62 Gy in 20 fractions over 4
weeks (or something similar at more than 2 Gy per fraction)         
          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)

The Gray (Gy) is a measure of the amount of absorbed energy.

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).

Here is one of many articles touting the benefits of SBRT:

https://www.astro.org/News-and-Publications/News-and-Media-Center/News-Relea
ses/2018/Men-with-low-and-intermediate-risk-prostate-cancer

 

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