Prostate Cancer (Case Study)

Nov 26 2012

Having spent his working life dispensing medicines and good advice, pharmacist Vic Carroll had a healthy respect for his own wellbeing when he reached retirement.

Just as well …

In 2005 his regular-as-clockwork PSA checks began showing a steady increase and when the reading reached 6.6, Vic’s GP referred him to a urologist. A biopsy confirmed that further treatment was warranted.
 
“The ‘ray’ treatment went for seven weeks, five days a week, but I’d drive to Waratah, have my treatment and be home in an hour,” the Merewether resident said.

In addition to radiotherapy Vic received an androgen deprivation (AD) drug called Lucrin in a clinical trial known as RADAR (Randomised Androgen Deprivation and Radiotherapy). By inhibiting testosterone levels it shrinks the prostate and thus also shrinks the prostate cancer tissue.

Five years later, and now aged 73, Vic has annual appointments with Professor Jim Denham, a radiation oncologist at Calvary Mater Newcastle and a Conjoint Professor with the University of Newcastle, who directs the RADAR trial.

Vic gets regular DREs (Digital Rectal Examinations) and his PSA reading is currently 1.0. It’s a good result.
As Professor Denham explains, “After radiation, some of the normal healthy cells in the prostate survive and produce some PSA. The level will never be zero”.

Close to 3,300 men succumb to prostate cancer each year but through research and treatment they have a fighting chance.

In The Lancet Oncology published March 2011, Professor Denham reported that the use of six months of AD had reduced prostate cancer death rates 10 years after treatment from 22 per cent to 11.4 per cent in the RADAR trial’s predecessor (TROG 96.01).

As part of the RADAR trial, Vic also took a drug called Zometa that is commonly used for preventing osteoporosis but he stopped the medication after it flared up his gout.

“Zometa reverses the loss in bone density that Lucrin and similar drugs can cause, but this isn’t the whole reason for it being in the RADAR trial design,” Professor Denham says.

“Our major hope is that it will prevent the appearance of metastases (secondary cancerous spread) into the bones. We won’t know this until the main efficacy endpoints are analysed in early 2014.”

In another important milestone, toxicity and quality-of-life effects were studied in a cohort of 1000 men racross 23 cancer centres in Australia and New Zealand, with very promising results published in The Lancet Oncology in November 2012.

“We obviously want better treatment outcomes but not at the price of severe side effects. I am highly encouraged by the quality-of-life findings, which are considerably better than anticipated.”

Professor Denham said that androgen deprivation had been previously shown to destroy millions of cancer cells which otherwise would thrive on testosterone. The downside, however, was that men experienced temporary symptoms similar to menopause.

“In around one quarter of men side effects from androgen deprivation can be quite severe, with hot sweats, a reduction in libido and erectile dysfunction,” he said.

“Other repercussions caused by a year or more of hormone therapy include swelling of breasts, depression, loss of cognitive function, weakening of muscles, anaemia and bone fractures due to loss of mineral density.

“The side effects can be quite devastating for a man but we found that the additional 12 months of hormone therapy had little long-term impact compared to the standard treatment. The majority of men returned to normal once the therapy ceased.”

Today, Vic plays tennis three times a week, walks and gardens. Meanwhile, patient follow up in the RADAR trial is ongoing.