We men with prostate cancer have seen the struggle and suffered the anxiety in getting Abiraterone (Zytiga) approved by NICE for men who have metastatic prostate cancer and who had under gone a cycle of chemotherapy.

Even though the treatment did have significant quality of life benefits for some men at a time when they had none.

The main stumbling block in getting NICE approval was the cost of around £3k per month per man so it will not be an easy task to convince the Health Minister that the benefit compensates for the cost.

We should give the researchers the time they need to decide if there is a real benefit for men with high grade/localised prostate cancer?

I certainly believe it is one to watch for the future and if you are or know a man that fits the criteria then ask your consultant/doctor/CNS/ trials specialist if they think you would be suitable to take part in the trials whenever they start a selection process which may be some way off.

It has been thought for some time that abiraterone when used in conjunction with other treatments could be beneficial for men with earlier stage prostate cancer.

The phase I/II studies done involving men with localised high risk ( PSA > 20, Gleason 8 or above) and stage T3 (tumour confined to the prostate gland) so far have been on small numbers of men and whilst the results look promising we need to see more extensive trials.

Abiraterone (Zytiga) can block the production of testosterone and in a different way than the established hormone treatment.

At a recent PCF conference in England Professor Ken Muir talked about the exciting development that is genetic testing.

The known risk of prostate cancer (PCa) for those men with a family history of PCa but it is not known what are the exact things passed on.

Genes that are common in PCa known as SNPs (snips) add a score of 5 points.

These all added in to the Sunnybrook calculator which is used in Riskman.

He went on to say that PSA is being superceded and may not be necessary in future.

The risk calculator is already changing and will continue to do so. The 10 markers have now been increased to 60 from a study which Prof Ros Eeles from the Royal Marsden Hospital is involved in.

Any cell in the body contains a complete set of genes.

You are born pre-disposed to your genes which is changing the whole debate.

One third of all the genetic markers have been found.

This can reduce by 30% the number of men needing to be screened for prostate cancer.

There is no more data left for us to extract anymore markers (for at least the next 10 years).

Attitues to using genetic markers are the way forward with targeted screening.

Those younger men with a high genetic risk should go in to the screening programme.

Professor Muir believes there is a unique opportunity to design a proper screening programme and get it right!!!!!

A baby could be genetically screened at birth which would cost around  £1,200  about the same as for personalised screening.

He says this may be a difficult concept for the NHS and it is probably 10 years off happening.

From the red sock point of view it is new and exciting news offering something positive for the way forward in diagnosing prostate cancer.

Extract from Prostate Matters

Take 17 minutes out of your day to watch this video.

The link is http://www.youtube.com/watch?v=F-P4nFgh_P4&feature=player_embedded

I would be interested to hear any views others may have on this subject.

For me the highlights were.

“Detect as late as possible but whilst its still curable”

I think that’s a real challenge.

“Single PSA at 50 is important in deciding frequency of testing by measuring PSA and other indicators/diagnostics).”

My comment would be choose your GP and your consultant Urologist/Oncologist carefully.

“Use the kallikrein markers as part on the decision making when deciding who needs a biopsy”

“A biopsy should consist of 10-16 cores”

“Avoid testing older men (> 70), no data currently supports a benefit”

“Maybe we should lower the cut-off PSA score to 1.5/2″

There are the ones that some say will never cause a man to die and those cancer cells are commonly referred to as the “pussycats”

The ones that are thought by some to cause all the deaths in men from prostate cancer and those cancer cells are called the “tigers”

The researchers the Urologists and the Oncologists say that they cannot identify the “tigers”

So some say how can a cure ever be claimed unless EVERY “tiger” and every “pussycat” is either removed by surgery or treated by radiation or killed in some other way.

It may be that the man who is claimed to be cured didnt have any of the “tigers”.

So the real task that faces the prostate cancer researchers is in identifying these ”tigers” and having the equipment to kill them and stop them from being reformed.

Maybe the work of GWAS and COGS will reveal those men most at risk and identify those genes that are common in aggressive prostate cancer.

This must surely looks be the way forward by identifying the men most at risk.

It is said that almost all of the over and unnecessary treatment would be eliminated.

All the above comments are my own extracted from various medical journals.

As with any disease prostate cancer has the best chance of a cure when it is detected at an early stage.

ITS A FACT ACCEPTED BY EVERYONE

An early stage for prostate cancer is when the cancer is confined to the prostate gland.

ITS A FACT ACCEPTED BY EVERYONE.

Prostate cancer in its early stages is unlikely to show signs of any symptoms (see Prof Roger Kirbys book showing a  diagram of how the disease progresses).

ITS A FACT ACCEPTED BY EVERYONE.

A biopsy from which a Gleason score is given identifies aggressive cancer cells, it may miss the aggressive cells because it is only taking a number of needle head samples from the tumour and the aggressive cells are only identifiable under the ‘microscope’. Men with a Gleason score of 8, 9 or 10 who have organ confined prostate cancer have a chance of a cure if the prostate is removed.

ITS A FACT ACCEPTED BY EVERYONE.

So why are these HIGH risk men (family history of prostate cancer, men of African or Caribbean origin) not given the crucial information by their GPs that could save their lives ????????

Is the answer COST? or possibly lack of RESOURCES?

What price do we put on the lives of men who are mostly likely to die of the most prevalent cancer in men and second biggest killer of men??

Each morning for the last six years I have woken wondering
if this is the day the aggressive cancer cells within me become active again.

Then I put all those thoughts to the back of my mind and get
on with living a full and active life.

BUT I remember those early months of diagnosis and in
particular that very first day.

It was Thursday February 9th 2006 the day had started just
as most Thursdays but that was all about to change at 5.15pm I arrived in the
consulting rooms where I was given a coffee which I took into the consultant’s
office ready for my 5.30pm appointment.

There sat the Urologist I had no idea what one was but he
looked just like a normal bloke obviously he must have a high profile job as he
had his own office.

Why should I have be worried  as we exchanged pleasantries after all I am
very fit exercising every day, never smoked in my life, the occasional glass of
wine or two, in fact I had never ever been ill in my life (that I can remember),
doctors visits were for taking my children to when they were young not for me. I
was invincible I had had to be for my four children and running my own business
left no time to be ill.

Consultants weren’t they really important people?

What he said next was to change my life forever,
pleasantries over he said Keith I have looked at the report your GP has
prepared following your PSA/DRE  tests
and I am afraid it is almost certain that YOU HAVE CANCER!  I sat back motionless alone with this
stranger giving me news no one wants to hear, where are my family where are my
friends NOW I really need you. There I sat staring straight ahead the world
stopped briefly, I thought at last I am like normal people I have an illness,
that brief moment passed and my thoughts turned to CANCER, with my mind
reorganising itself to bring some equilibrium to the situation my next thought
well if its CANCER then I will have to have surgery for the first time in my
life but I will be fine after that, not quite the same but I will be okay.

After those few private thoughts the Urologist said Keith
this looks as if it is aggressive CANCER which could have spread to other parts
of your body. We need to do a series of tests that will show us how we can best
treat your CANCER.

I left the consulting room after shaking the hand of the man
who had just delivered a crushing blow putting my very existance into question.
The nurse/receptionist and I exchanged a smile at least her smile the coffee
were nice.

I got into my car to take the short drive to see my children
I knew three of them were at home the fourth was still in Cambridge Uni so it
would take a phone call to give him my news.

The journey was only
going to take 2 minutes so I had to think fast and drive slowly, I tried to
compose myself hands shaking head spinning working out how do I tell my
children their dad has CANCER  it was the
worst ever feeling. Then my thoughts turned to selfish me! Who will sort out my
garage!  Will I never see another
birthday, will my grandson not remember me, will I not be there to help and
guide my children that I have given life to they are my responsibility I am the
leader and now I have to explain that I am vulnerable how do I fight back
emotion I had only cried when my father died where was he now when I needed him
most?

I parked my car went into the house and got another coffee,
the three children were there so we all sat down in the lounge and I calmly
relayed the story of my visit to see the Urologist 30 minutes ago.

Emotion took over at that very private few minutes as we
hugged each other.

The day ended its official I HAVE AGGRESSIVE CANCER.

The scans and tests that I had that following week showed
that I had metastatic  grade 4 prostate
cancer that would one day spread to my bones and because my cancer was at an
advanced stage  my treatment would only
be palliative so at least I was to be spared the surgeon’s knife. They had said
that I may live for up to 18 months before the cancer became active again (or
more active). I know that I will die of prostate cancer and as the years pass
by I also know that the time is getting closer.

From all the research and visiting cancer hospitals around
the World I now know that my CANCER could have been cured if it had been
diagnosed earlier. The indication of prostate problems can be detected in most
men using the simple PSA blood test and the DRE physical examination which
takes less than a minute.

One man every hour dies of the most prevalent cancer in men
and each of those men’s cancer passed through a window of opportunity of a
cure! A cure that would have been possible with careful monitoring and timely
treatment as necessary.

March is prostate cancer awareness month and if you have men
in your life or know of men that are approaching 50 then urge them to have
their prostate checked it only takes seconds.

If the man in your life is of African or Caribbean origin he
is in the HIGH RISK group and should have the tests from the age of 40.

If the man in your life has a family history of prostate
cancer he too is in the HIGH RISK group and should have the tests from the age
of 40.

(The prostate gland remains relatively the same size until a
man is around 40 years old).

Don’t wait until you have symptoms because prostate cancer
in the early curable stages has NO SYMPTOMS so make an appointment today for
the man that you love it could save his life.

(You may have to fight to get the tests but remember you
don’t want your man to add to the statistic of
the 11,000 men in the UK who die of prostate cancer and most of them
were fit and healthy before being diagnosed).

Keith S. Cass