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UPDATE
n°139 | December 3, 2020
In this issue:
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New blood test could diagnose 50 cancers

New trials will investigate if protein test is a game-changer
1 Dec 2020
Europa Uomo News

EUPROMS Study - Part two

Prostate Cancer and Sexual Function are interwoven. Most of the forms of treatment for prostate cancer can have a significant effect on sexual function. One reason is the fact that the nerves controlling sexual functioning run along the outside of the prostate gland on their way to the penis. In the course of surgery to remove the gland the nerves may get damaged or even cut on one or both sides. With radiotherapy the nerves may get damaged because they are in the path of the radiation to the prostate. Even if a man does not have either surgery or radiotherapy his sexual functioning can be seriously affected by treatments such as Androgen Deprivation Therapy (also known as Hormone Treatment). The hormone treatment reduces libido and seeks to block the normal production of testosterone. When we bear in mind that the majority of prostate cancer patients are diagnosed late in their mid to late 60s their sexual functioning may already have diminished due to lower testosterone or other reasons such as diabetes type 2. The further reduction due to their cancer treatment may be all the more dramatic.

The EUROPROM Study indicates that the level of sexual functioning after treatment is much lower than previous clinical studies of Quality of Life have shown. The study does not tell us why but the anecdotal discussions among patients suggests that in the clinical setting men may not be as comfortable about indicating the true level of their sexual functioning as when they were in the privacy of their own homes when answering the survey.

 

Slide S1 shows quality of life score: the bigger the score the better quality of life. The level of the score relates to sexual function, after different treatments this varies quite a bit, but are below the published clinical studies. In S1 the slide shows that the sexual quality of life was better after prostatectomy than radiotherapy, which may be surprising to some. But the difference of 4 points between radiotherapy and radical prostatectomy is small and may not be clinically relevant.

But quality of life scores for both treatments are obviously low compared with active surveillance.

Why is the active surveillance score not 100, which is the top of the scale in the EPIC Questionnaire score? Clearly it is because at these ages (the average age of the study is 70) sexual function is not normally 100%.

Comparing these figures to the general population, the average EPIC sexual function score for men without prostate cancer is 55.8, which is very similar to the active surveillance score shown here.

 

Slide S2: How big a problem then, is sexual functioning as men report it? You can see a big or moderate problem in around half of men. One of the intriguing questions is how these scores would be affected if we were able to ask the patients’ partners the same question.

 

Slide S3: Around three quarters of men who responded to the survey rated their current ability to function sexually as poor or very poor. This is clearly partly a reflection of the age of respondents, as well as the effects of treatment.
However, for comparison, it is interesting to look at a 2017 study of men of slightly older age (average age 74.5) who did not have prostate cancer, which used the same EPIC-26 measures (Venderbos et al, PMID: 28168601). It found that 50% of these men rated their ability to function sexually as poor or very poor. Clearly, this is a significantly lower percentage than the 76% of men with prostate cancer in our study.

 

Slide 5 Only 34% of men have tried medications and devices to improve erections, so there’s clearly a need to give men more advice on these approaches to help overcome any problems.

It appears that at least some of the men who say they have problems with their sexual function do not appear to do much about it.

In the next issue we will focus on what the survey tells about urinary incontinence.

 

You can read about our EUPROMS study and download the whole EUPROMS presentation at here.

Cracking the Code

The topic of personalised medicine appears daunting to many patients. By producing this booklet ECPC has rendered a valuable service to patients and their families. it opens up a topic that they might OTHERWISE feel unable to pursue with their doctors. With personalised medicine the number of complexities when compared to existing treatment approaches are significant. . It is important that the cancer patient is well informed as to the opportunities and challenges that personalised medicine presents, so that they can make the best and most informed decisions about their personal care.

Applying this knowledge has been a key driver for better patient care and quality of life. Personalised medicine is making inroads into clinical practice and it allows the targeting of a patient’s tumour in a way that may also lead to less treatment side effects. The tests most frequently used in this approach are called cancer biomarkers or companion diagnostics, detecting specific feature(s) within the patient sample that characterize their individual tumour The treatment may involve targeting of a gene or protein that is characteristic of your particular tumour, or of a biological pathway that is in some way altered in your cancer. The key feature of personalised medicine is the specificity of the treatment approach, such that tumour cells are targeted for elimination while normal cells and tissues in your body are spared from any potential treatment side effects.

The problem of cost is flagged as one of the most prominent barriers yet to be overcome. The booklet’s compilation of 10 questions a patient might ask their doctor is a most valuable first tool for a patient seeking to have the best possible treatment and outcomes.

The new booklet is available here.

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Prostate Research and Treatments

Olaparib (LYNPARZA®) – EU Approval for Treatment-Mutated mCRPC

Only PARP Inhibitor to Demonstrate Overall Survival Versus New Hormonal Agent Treatments in BRCA1/2-Mutated mCRPC

AstraZeneca and MSD, last month announced that the PARP inhibitor Olaparib has been approved by the European Union as monotherapy for the treatment of adult patients with metastatic CRPC with BRCA1/2 mutations whose prostate cancer has progressed having had a prior therapy that included a new hormonal agent.

In the Phase 3 PROfound trial Olaparib demonstrated an improvement in radiographic progression-free survival (rPFS) and overall survival (OS) versus enzalutamide or abiraterone in men with BRCA1/2 mutations. The BRCA mutations occur in about 10% of men with prostate cancer.

The AstraZeneca spokesman said that BRCA testing should now become a critical step in the diagnosis and determination of treatment for men with advanced prostate cancer in the EU.

The PROfound trial showed Olaparib significantly reduced the risk of disease progression and reduced the risk of death by 37% compared with enzalutamide or abiraterone.

Read more

Items of Interest

Free from Cancer: Achieving Quality of Life for All Cancer Patient and Survivors

With Europe’s Beating Cancer Plan under development, the Survivorship and Quality of Life Network of the European Cancer Organisation has collated its recommendations to help more cancer patients and survivors achieve a life truly free from cancer and its often under-appreciated impacts.
Launched recently at the European Cancer Summit, the 7 priority areas suggested in Free from Cancer are:

  1. Take action on cancer distress
  2. Elevate management of pain and other symptoms: core parts of the cancer patient pathway
  3. Cancer patients and survivors have sex lives too. Recognise sexuality in health system approaches.
  4. Cancer comorbidities and complications: An ever-growing challenge in need of additional focus
  5. Empower cancer patients and survivors. The importance of education and information.
  6. Provide cancer patients and survivors with the right to reintegration into the workplace
  7. Ensure cancer survivors have a right for their cancer to be forgotten by financial service providers

Read more

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Let's talk prostate cancer - Digital Atlas

The Let’s Talk Prostate Cancer (LTPC) Digital Atlas provides an overview of prostate cancer outcomes across the EU and for each of the EU 27 countries and the UK.

The assumption that men with prostate cancer die with, rather than of prostate cancer, is a common misconception.1 Prostate cancer is a major health challenge with over 2 million people living with the disease across Europe, causing an estimated 107,000 deaths in 2018 alone.2,3 The time to act is now.

You can also download the LTPC Call to Action to raise awareness of the challenges faced by people with advanced prostate cancer in Europe. The Expert Group, including Europa Uomo, the European Oncology Nursing Society (EONS), The European Cancer Patient Coalition (ECPC), The European Association of Urology (EAU), and The European Association of Urology Nurses (EAUN), is a collaborative initiative bringing together EU level stakeholders with a shared interest in promoting policy change, education and awareness to ensure that people with advanced prostate cancer receive the right treatment and care at the right time in a shared decision-making process between patients and medical professionals.

Follow this link to read more.

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