SBRT is a form of radiotherapy that is delivered at a higher radiation dose per day but over a shorter period of time, 4-6 sessions versus 20-45 sessions (conventional external beam radiation therapy). The radiation dose is precisely targeted to the area containing cancer in a small number of fractions (hypofractionation) thereby avoiding surrounding structures and reducing toxicity. In the initial session a team of ...

Active surveillance (AS) is an approach that uses a combination of PSA testing, prostate examinations, and prostate biopsies to monitor prostate cancer. Traditionally its has been advocated for those with localised very low risk and low risk stages of disease, but more recently .....

Numerous hypotheses have been tested to find the cause of prostate cancer. An abundance of research has focused on various nutrients and diets as a potential risk factor. This blog will provide a brief update on contemporary research findings, will touch on the concept of prehabilitation and conclude with integrative clinical models to improve diet and nutrition for patients on various stages of their cancer journey.

Pre-prostate biopsy MRI can yield a 27–49% reduction of patients undergoing transrectal ultrasound (TRUS)-guided biopsy. A meta-analysis of seven clinical trials with 2582 patients found that MRI with or without a targeted biopsy offered a 57% increase in clinically significant prostate cancer (csPCa) detection, a 33% decrease in the total number of biopsies, and a 77% reduction in cores per biopsy procedure¹. The PRECISION trial .......

Penile rehabilitation is a well-established concept and is thought to counter the effects of hypoxia (oxygen deprivation) in the penile tissue and cavernous nerve neuropraxia (damage to penile nerve supply) after a radical prostatectomy (RP) which leads to fibrosis (scarring) and atrophy (shrinkage) of the smooth muscle cells of the corpora cavernosum (erectile chambers) of the penis. The variations to tissue cause veno-occlusive dysfunction and lower the probability of long-term recovery of erectile function. Techniques utilised include .....

Despite recent research advances, metastatic castration-resistant prostate cancer continues to be fatal. Prostate-specific membrane antigen (PSMA) is highly expressed in metastatic castration-resistant prostate cancer. Lutetium-177 (177Lu)–PSMA-617 is a radioligand therapy that distributes beta-particle radiation to PSMA-expressing cells and the adjacent microenvironment. It is capable of

Metastatic prostate cancer is initially treated with androgen deprivation therapy (ADT) by inhibiting the cancer cells growth through blockade of testosterone (androgens). Despite a high initial response rate, most patients become castrate-resistant within 3 years from the start of treatment. As discussed in previous blogs castration resistance is not only due to ADT resistance. Despite the reduction of .....

Immunotherapies as a single agent have not been shown to be effective for treating advanced prostate cancer till now. In this research blog we will try find out why they are not effective and what the potential alternatives are. Numerous blogs in the past have addressed the concept of immunotherapy and the types available. The premise of immunotherapy is ...

Like the ageing woman develops menopause due to the waning levels of oestrogen so too does the ageing man develop andropause or testosterone deficiency. Some men remain symptom free despite this change while others develop significant symptoms. These symptoms may include mood changes (depression), memory and sleep disturbances and lower energy levels. This condition may result in osteoporosis (increased risk of fractures), anaemia, loss of libido, sexual dysfunction and increased risk of metabolic syndrome (diabetes, cardiovascular disease, stroke, high cholesterol). Many other conditions can cause......

A previous blog addressed the different focal therapies for prostate cancer and brachytherapy is classified as another treatment modality. It is the implantation of radioactive sources directly into the tumour, also known as interstitial brachytherapy. Brachytherapy is used to...........

Financial toxicity is an expansive term which refers to the economic ramifications and subjective burden brought on by a cancer diagnosis and treatment¹. Escalating costs include direct, or out of pocket (OOP) payments, as well as indirect costs associated with foregone earnings for both patient and caregiver, which amplify financial burden. The notion of financial toxicity arose from fears that escalating costs of anti-cancer medications coupled with insurers’ increased cost-sharing with patients may lead to undesirable outcomes similar to traditional toxicities associated with treatment, such as ......

For now PSA (prostate specific antigen) is the most widely used screening test (as discussed in previous blogs). But there is a large amount of research examining other ways to determine who gets screened and how they will be screened. Prostate cancer screening was very topical at the recent European Association of Urology (EAU) virtual meeting in July. Some new blood tests and formulas have been suggested along with imaging to guide algorithmic developments. This blog will focus on

Screening is a means of detecting potential conditions or risk markers for disease. These programs identify conditions which could turn into disease in the future. One could deduce that by doing this the disease can be detected and treated earlier, reducing morbidity and .....

Prostate specific antigen (PSA) is an enzyme produced only in the prostate and acts on a protein in semen called seminogelin to give the semen a more liquid consistency. PSA shows up in the blood when sampled. Prostate cancer can raise the level of PSA in the blood but so can age related prostate enlargement causing trouble with urination (benign prostatic hypertrophy); infections (prostatitis); surgical procedures (prostate biopsy, cystoscopy) and natural increase with age. The PSA level may be ........

The main goal of focal therapy is the targeted focal destruction of cancer tissue with the preservation of surrounding healthy prostate tissue. There have been conflicting opinions on the definition, but it seems the consensus is “ablation of the dominant or index lesion”1. The principle of targeted therapy has been applied to other cancers such as breast, liver, brain, and thyroid. It represents the middle ground between active surveillance and treatments such as radical prostatectomy and radiation therapy.......

This year’s meeting was held virtually from 8-12th July and in this weeks’ instalment we will highlight three major focus areas presented at the meeting:

• Novel treatment approaches for de novo Metastatic Castrate Sensitive Prostate Cancer (mCSPC)
• Future replacement of MRI by PSMA-PET/CT Scan for prostate cancer diagnosis
• New androgen deprivation therapy (ADT) options.......

One of the treatment options for locally advanced non-metastatic prostate cancer is external beam radiation therapy in conjunction with androgen deprivation (testosterone blocking) therapy. If there are no lymph nodes (glands) that are obviously involved, then radiation would be confined to the prostatic bed. However, within the radiation oncology fraternity there has .....

Kerry Santoro, Prostate Cancer Specialist Nurse (Southern Adelaide Local Health Network) says that around 200 prostate cancer patients are diagnosed within her local health network each year, and that generally they remain in contact for a period of three years, meaning that at any one time Kerry is managing up to 600 patients on a rolling basis, consulting with .......

The focus on this year’s meeting was on advanced cancer. Two types of cancer were presented: those that would respond to anti-androgen therapy (Castrate sensitive prostate cancer – CSPC) and those who have had anti-androgen therapy and developed resistance to treatment (Castrate resistant prostate cancer- CRPC) .......

With many parts of the country back in lockdown, medical care and support for cancer patients has reverted to the online space. This includes telehealth consultations, virtual support groups and the use of social media for peer-based support.

Despite the availability of this technology some of the emotional and mental well-being needs of these patients remain underexplored and underreported. Many have tried to address the void by .....

Dr Nathalie Bock and her team from the Queensland University of Technology have developed and validated a highly reproducible microtissue-engineered human construct in the lab that comprises osteocytic and osteoblastic cells (the cells responsible for the breakdown and formation of bone), with relevant protein expression and mineral content. The mature mineralized engineered tissue are cultured for up to 12 weeks. They then add metastatic prostate cancer cells to the mineralized microtissue. This model reproduces some of the cellular alterations seen ......

In observing NAIDOC Week, (4-11th July 2021), it seems fitting as a point of departure to acknowledge the impediments Indigenous Australians may encounter in engaging with treatment and receiving optimal health care in general (and cancer care in particular). Some of these factors include: difficulties communicating with health professionals; a lack of patient navigators; lower health literacy; lack of access to support from an Indigenous care provider; logistical barriers; and inadequate linkages with .........

In medicine we often speak of prevention over cure. Professor Manish Patel at the University of Sydney found physiotherapist guided-pelvic floor muscle therapy (PG-PFMT) commenced 4 weeks before surgery may have a beneficial effect in reducing the duration and severity of incontinence². Six weeks after prostatectomy, the intervention was associated with a lower degree of incontinence, with a significantly shorter duration to one and zero pad usage². A meta-analysis which pools the results of several studies showed there is a 36% reduction of incontinence risk at 3 months after surgery if preoperative PFMT was performed³. Best outcome is achieved by .....

The two major interventions for prostate cancer treatment are radiation and surgery (radical prostatectomy). Radiation very rarely results in leakage of urine, but may irritate the bladder and cause the urgent desire to urinate or the need to urinate with increased frequency. Surgery to remove the prostate most certainly can put one at risk of developing stress urinary incontinence. But what do we mean by stress? It does not mean incontinence brought on by a stressful incident. By stress we mean that any rise in the pressure inside the abdomen (such as during coughing, sneezing, defecating, positional shifts or exercise) may press down on the bladder and cause urine to leak. In rare instances, it may continuously leak on its own........

In many of our research blogs we have highlighted the psychological and beneficial effects of exercise. It has been shown that lack of strength and/or muscle power has been associated with poor survival¹. During this Men’s Health Week² (14-20 June 2021) the Prostate Cancer Foundation of Australian (PCFA) is encouraging everyone to do 45 sit-ups a day for one week (and hopefully long-term) to stay fit but to also start a conversation. But why 45? That’s because, “45 men are diagnosed each day, and over 3000 will die this year,” according to CEO of the PCFA, Professor Jeff Dunn (AO). He goes on to add that this is “currently the most prevalent cancer in Australia and by 2040, an estimated 372,000 men will be living with or beyond prostate cancer, a 60 per cent increase from around 230,000 today.”

At the COVID-19 pandemic’s peak or during one of it’s waves when there are many active cases in the community, the management of viral cases is given precedence over less acute cancer cases. In such circumstances a triage system is established in order to prioritise cancers according to stage and type....

A recent study by Paschalis et al from the Institute of Cancer Research at the Royal Marsden Hospital London examined the sampled tissue of 74 participants in an effort to search for a new potential therapeutic target site for metastatic castrate resistant prostate cancer.

The last stop for erectile dysfunction treatment By Kalli Spencer

At this juncture in one’s prostate cancer journey, spirits may be down, frustration levels high and all hope for a more fulfilling sex life might seem lost. As per last week’s blog various erectile dysfunction medications, mechanical devices and self-injections may have been attempted and either deemed ineffective or failed.

There is one final option in the third tier of the treatment strategy and that is the insertion of a penile prosthetic or inflatable balloon placed within the penis. This procedure eliminates the need for any further medication and an erection depends on a device to occur.

For more information on sexual issues following prostate cancer treatment click the following link to access the PCFA resource - "Understanding Sexual Issues"

The purpose of this discussion is to explore the next level of medical treatment available. Assuming all medication based options (and even mechanical ones, such as vacuum erection devices) have failed: what’s next?

Current imaging trends for prostate cancer

New imaging technology, using prostate specific membrane antigen (PSMA) PET combined with computerised tomography (PET/CT), has proven highly useful for staging prostate cancer in both the newly diagnosed and recurrent setting (disease that has returned after primary treatment). Benefits include greater utility in making treatment decisions and lower radiation doses.