Prostate cancer is the most common cancer diagnosed on the Mid North Coast, but there looks to be new hope for those men who have recurring symptoms! Associate Professor Tom Shakespeare from the Mid North Coast Cancer Institute sheds some light on this topic …
Hi Professor Shakespeare. What’s your role with the Mid North Coast Cancer Institute (MNCCI)?
I am the Director of Cancer Services with the Mid North Coast Cancer Institute and a senior Radiation Oncologist. I have special interests in prostate and breast cancer, as well as research and teaching.
You’ve been busy working with the Royal Australian and New Zealand College of Radiologists (RANZCR) to develop some new international guidelines for the treatment of prostate cancer patients in recent times. What was the impetus behind this association, and what were you hoping to achieve through this working relationship with RANZCR?
I am on the Council of the RANZCR and an executive member of the Faculty of Radiation Oncology Genitourinary Group (FROGG). We in FROGG identified a lack of consistency among cancer specialists and surgeons around the world when it came to the treatment of patients whose prostate cancer had come back after surgery or radiation.
We convened a conference and had more than a hundred cancer specialists and surgeons attend (from Australia and New Zealand, and as far away as the USA). We went through recent research that had been published, collated the new evidence, and obtained consensus among the specialists at the conference as to the recommended treatment for this group of men.
We have just published these endorsed guidelines, with the aim of ensuring that patients whose prostate cancer has recurred are referred to radiation oncologists, to be evaluated for potentially curative radiation therapy.
The new international guidelines outline how radiation therapy can be of benefit in those patients with recurring prostate cancer. How were patients with this issue generally treated in the past?
Up until now, there wasn’t really a consistent approach. Many patients had recurrences observed with no treatment at all. Some patients were just managed by family doctors, with others referred to cancer specialists or surgeons. Some patients may have been offered treatments that were unable to cure the cancer, and up until recently many patients were not offered curative treatments at all.
How does radiation therapy actually assist these patients?
Radiation can help a variety of these patients, including patients whose cancer has returned after surgery (with cancer coming back where the prostate used to be), and cancer that has returned in lymph glands or even the bone.
Our guidelines recommend patients with a rising PSA (prostate specific antigen blood test) after surgery or radiation should be referred to a radiation doctor for review. Even cancer that has spread to lymph glands can potentially be cured with radiation therapy, and cancer that has spread to the bone can also be successfully treated.
How many people (roughly) have been treated utilising these guidelines in the Mid North Coast area, and what have been the results so far?
Development of the guidelines has been a rigorous and time consuming process. Since the conference around 18 months ago, I have treated more than 100 patients using the guidelines. So far, I would say around 90 per cent of these patients are in remission (i.e. there is no detectable prostate cancer on blood tests or scans). There has been little in the way of side-effects for the vast majority of these patients.
The new guidelines have been in development for some time (nearly two years). Have they been published as yet – and where can interested people gain access to a copy?
The national consensus guidelines were published in November 2018 in the international journal, Radiotherapy & Oncology. Unfortunately, journals do not release free copies; however, interested patients can ask their family practitioners, cancer specialist or prostate surgeon for a copy.
If someone with prostate cancer thinks they might benefit, they can ask their doctor whether they should be referred to a radiation oncologist for consultation. At the Mid North Coast Cancer Institute we bulk bill, so there is no cost to patients.
Can you run us through a few statistics about the number of cases of prostate cancer that are generally diagnosed in the Mid North Coast area each year, and also what age group are most likely to be affected by this condition?
Around 300 men are diagnosed with prostate cancer each year in our region, and it is the most common cancer on the Mid North Coast. Men can be affected in their late 30s or early 40s, and it becomes more common as we get older.
There is an old belief that you don’t die of prostate cancer. That is simply not true; and in fact, more men die of prostate cancer than any other cancer except lung and colon cancer. Any man over 40 should consider getting checked out by their family doctor with a Prostate-Specific Antigen (PSA) blood test.
What’s the future looking like with regard to these new guidelines and how they’re working? Will there be a formal review conducted at some point, or the likelihood of further guideline development?
I plan to look at our early results as part of a MNCCI quality assurance evaluation next year. We have one of the best cancer centres in NSW, with the best staff and equipment that you could hope to find!
We are about to publish national guidelines on the treatment of men newly diagnosed with prostate cancer that has spread to the lymph nodes. There have been some breakthroughs in treating these men, and for the first time they are considered to be curable. Hopefully these will be published quickly, so watch this space!
Thanks Professor Shakespeare.
Interview: Jo Robinson.
Photo: Lynn Lelean.