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Prostate cancer DVD launched at Parliament House
May 2009

The Treasurer, the Hon. Wayne Swan launched the prostate cancer DVD “So How Do You Choose” at a cocktail function held at Parliament House Canberra on Wednesday May 27th 2009. The DVD was produced by A/Prof. Phillip Stricker & the St Vincent’s Prostate Cancer Centre through the financial support of Lang & Sue Walker and the Walker Foundation.

The DVD is a resource to enable the18,000 men who are diagnosed annually with prostate cancer in Australia to understand their treatment options and choose the best treatment for them. It aims to empower men to make the difficult decision between the various treatments currently available in a clear and personal way to achieve the best possible outcome in the treatment of their prostate cancer.

Mr Alan Jones AO was MC for the event and elaborated on his personal experience of being diagnosed with prostate cancer and subsequent treatment at St Vincent’s. Other speakers included Mr Steve Rubic CEO St Vincent’s & Mater Health Campus, Mr Paul Ramsay AO Chairman Ramsay Healthcare Ltd, A/Prof Phillip Stricker Chairman of the Urology Dept. St Vincent’s Clinic and the Treasurer the Hon. Wayne Swan who also told the audience of the impact on himself and his family when diagnosed with the disease. The audience included members of Parliament including the Prime Minister the Hon.Kevin Rudd, many members of the Prostate Cancer Foundation of Australia, National Breast Cancer Foundation representatives, Urologists and members from St Vincent’s Campus & Garvan Institute.

It was a very special launch of this high powered DVD which aims to help newly diagnosed men and their families throughout Australia. Monies raised from the sale of the DVD go towards ongoing research into prostate cancer and continues the St Vincent’s Prostate Cancer Centre commitment to education and raising awareness of this major health problem.

Robotic Training at Greenslopes Hospital, Queensland. 2009

A/Prof Phillip Stricker completes mentoring a team of surgeons on using the Da Vinci robot.The 3 day robotic workshop was held at Greenslopes Hospital, the first robotic centre in Queensland.

Robotic Cases for 2008

The number of robotic operations for A/Prof Strciker and his team continue to increase. For the year ending in Decemebr 2008 they had the highest number of operations recorded in Australia.

World Leader in Robotic Surgery Visits St Vincents

Dr Vip Patel, one of the world leaders in robotic radical prostatectomy surgery, was the visiting “Steggles Fellow” at a conference held at St Vincent’s Private Hospital and Clinic at the end of 2007. During the two and a half day conference Dr Patel performed several live operations as well as presenting interesting lectures. The conference, convened by A/Prof. Phillip Stricker was attended by Urologists from Australia and New Zealand.

Dr Patel has recently moved from Ohio to Florida where he has set up a state of the art robotic centre. He is an internationally recognised expert in minimally invasive laparoscopic and robotic urologic surgery. His experience of more than 2,000 robotic prostatectomies is one of the largest in the world. For over 20 years, the St Vincent’s Urology Department has continued the tradition of the Steggles Fellowship. This commenced after Mr Steggles made a generous donation dedicated to the education of urologists at St Vincent’s for improving the delivery of care particularly for urological cancers. The conference is held every two years and includes an international speaker who is at the forefront of their speciality.

Steggles Conference 2007.

A/Prof Phillip Stricker convenes international conference on robotic surgery with international acclaimed robotic surgeon Prof Vip Patel.

200th robotic case

St Vincent's Hospital its 200th robotric surgery. A/Prof Stricker said he was very pleased with the results of his robotic radical prostatectomies.

Robotic prostate surgery at St Vincent's Hospital

A/Prof Stricker was recently personally invited to present his initial results at the 2nd World Robotic Symposium in America. This was convened by the world leader in robotic prostatectomy Prof Vip Patel. A/Prof Stricker’s initial results show excellent results with low poitive margin rates and good continence. He said it will take longer to evaluate the initial potency results but his initial impression is very favourable.

A/Prof Stricker has been priviledged to have been personally trained by Prof Patel who is now recognized as the world leader of nerve sparing robotic radical prostatectomy. This training began at St Vincents and was completed in Ohio. A/Prof Stricker performed the 1st Australian Vip Patel nerve sparing radical postatectomy at St Vincents in Feb 2007. He said he was impressed with the improved and more rapid return of sexual function as compared to his open cases.

A/Prof Stricker will now be mentoring other urologists in this technology.

A recent review of robotic Prostatectomy and patient testimonials can be found in the Lifebuoy – the official magazine for the St Vincents Prostate cancer support group.

Associate Professor Stricker starts the first robotic prostate surgery program in NSW.

St. Vincent's Private hospital recently acquired a da Vinci Robotic system. Following an intensive training program both locally and overseas, A. Professor Stricker has now initiated the first robotic surgery program in NSW. Robotic radical prostatectomy is now one of the latest minimally invasive options available to our patients with promising results both in cancer control and side-effects. Click here for more information

Improving Detection

New molecules such as human kallikrein 2 are being investigated to find out if they are more accurate in the detection of early prostate cancer. Researchers are investigating whether high levels in the blood of a molecule called insulin like growth factor 1 contains a warning that a man has prostate cancer or is at risk for its development.

More accurate staging

Despite our best attempts at staging up to 40 to 50% of cancers thought to be curable are already outside of the capsule making cure much more difficult. Tools able to provide more informative images of the primary tumour are beginning to improve the accuracy of clinical diagnoses. Special new ultrasound machines are being designed and also magnetic resonance imaging using special coils in the rectum are being designed to better assess tumours. Magnetic resonance spectroscopy measures the metabolic activity in a viewed area and may further help distinguish between normal and cancerous tissue. The aim is to reveal microscopic extensions and currently no technology is able to do that. New forms of PET scanning are being developed using Choline to stage prostate cancer.

New assessments of aggressiveness

Scientists are now looking at genetic alterations, which will predict tumour behaviour. One such genetic alteration is that is the P53 gene. This may predict the likelihood of a more aggressive tumour. BCL2 and BCL6 enzymes are further enzymes being looked at. This may sort out the patients who are less or more likely to be cured with current treatment.

Making therapy more effective

Newer forms of radiotherapy such as conformal radiotherapy and high dose rate boosting are making radiotherapy much more accurate. Hormonal therapy with radiotherapy appears to prolong survival.

Prevention

A large study with finasteride with 18, 000 patients is looking at a means of preventing cancer in patients at risk of developing it. Similar studies are being currently performed with various vitamins and the mineral selenium.

Future therapies, gene therapies and vaccine are being developed. The most popular type of gene therapy is to deliver genes coding for substances that are toxic for cells. If those genes were engineered to switch on only in prostate cells, they could give rise to the toxin in the prostate and in metastatic deposits but would have no effect on and do no damage to other kinds of cells.

Vaccines are also being developed to stimulate the immune system to cure the cancer cells. These therapies will no doubt be a little time away.

Surgery

The newer therapies for surgery include careful nerve sparing prostate cancer surgery and sural nerve grafting. With nerve sparing surgery it is important that one selects the right cancer to perform this surgery on otherwise one will tend to leave cancer behind. This tends to occur if the cancer has eaten into the nerve tissue. Certain factors relating to the tumour give one an indication as to whether it is suitable or not suitable for nerve sparing surgery. These factors are: the clinical stage, the number of biopsies positive on that side and the presence or absence of perineural invasion. The technique of nerve sparing surgery has become more and more refined and one can more confidently say that one can preserve nerves in patients with the right tumour. Potency rates as high as 80% or 90% can be achieved in young patients who are potent and have very early stage tumours.

Sural nerve grafts have now been used when nerves have to be removed. In some cancers, to ensure that the cancer is completely removed, it is safer to remove a nerve on one side than it is to preserve it. In these patients a recent development involving stitching in a nerve from the leg (the sural nerve) can be used. Although this is still fairly experimental it is gaining popularity and with careful surgical technique can be accomplished. Certainly Dr Peter Scardino, one of the pioneers of the technique, has several years of case histories. Only certain people are suitable for this treatment. They are younger patients who are potent and who require one of their nerves to be removed to ensure a high likelihood of clearing the cancer. They must be prepared to accept a relatively experimental procedure and the possibility of some side effects from grafting of the nerve.

The technique of nerve sparing and nerve grafting has led to the development of an electrical instrument, known as Caver Map, which can help identify these microscopic erection nerves. This not only helps identify the nerves but also helps predict whether potency will ultimately return.

For more information click here.

Brachytherapy.

Brachytherapy using radioactive seeds is another new therapy which is an option for patients with localised and early prostate cancer. It is only suitable for those with very early stage cancers and Gleason scores less than 7 and a PSA less than 10. The rapid strand system, where the seeds are linked together, can help place seeds on the outside edge of the prostate to ensure the tumour is covered. The technique to do this involves making a volume assessment of the prostate, constructing a template and preparing a plan to place the seeds correctly. Ultimately the procedure places the radioactive seeds in the predetermined position. This therapy gives an excellent outcome if one chooses the right tumour and particularly if patients with severe urinary obstruction are excluded. It tends to be used more in a slightly older group as results are only out to 14 years at this stage.

High dose rate brachytherapy is a more invasive new treatment where very high doses of radiotherapy can be placed accurately into the prostate by wires. This therapy is always combined with external beam radiotherapy and is appropriate for more advanced cancers where the PSA is greater than 10, the Gleason score is greater than 7 and the clinical stage is greater than T2B. These cancers generally are difficult to cure with surgery and high dose rate brachytherapy may be more appropriate.

For more information click here.

Other Treatments.

The other options include ordinary radiotherapy, hormone therapy and active surveillance. In older patients with better differentiated tumours, hormone therapy or active surveillance may be the appropriate treatments

For more information click here.