Annual Report 05 - International Union Against Cancer

the ability to determine risk by PSA
baseline and kinetics and to identify
“indolent” or low-risk disease. But
there is also good evidence of overdetection,
over-treatment, morbidity
and complications from treatment,
and cost to health providers. If 1 million
asymptomatic men agreed to a
PSA test, 100,000 would receive
biopsies, 20,000 would have cancer,
10,000 might receive radical prostatectomy,
4,000 would have erectile
dysfunction, 300 would have some
degree of incontinence, and 10
would die.
For localized prostate cancer,
patients have a choice of radical
prostatectomy, radiotherapy or
watchful waiting. Metastatic disease
is treated with hormone therapy
(androgen deprivation therapy) or,
where hormone insensitive, by
chemotherapy. Prof Hein Von
Poppel of the Catholic University
Hospital in Leuven, Belgium, and
director of the European School of
Urology, focused on the intermediate
case: locally advanced (cT3-4)
cancer.
Randomized trials showed that
treating locally advanced disease with
a combination of radiotherapy and
hormone therapy (ADT) was superior
to radiotherapy alone. But they
never showed that radiotherapy,
with or without ADT, was better
than surgery (alone or in combination).
Radiotherapy was not optimal
in localized cancer: why then would
it be preferred for locally advanced
disease that is operable? ADT also
raised safety concerns: even shortterm
use was dangerous, increasing
the risk of cardiovascular death. The
case for surgery needs to be reconsidered.
Not all cT3 cancers can be operated.
The prognosis of these patients is
often poor, and the only possibility is
radiotherapy combined with hormone
therapy, or perhaps hormone
therapy alone. But many cT3
prostate cancers are good candidates
for surgery. Surgery as a monotherapy
can be enhanced by a multidisciplinary
approach, with radical prostatectomy
supplemented by adjuvant
or salvage radiation treatment or hor-
Connecting, mobilizing, supporting
mone treatment. Patients must be
counselled about the possibility of
starting with radical prostatectomy.
Primary radiotherapy and hormone
therapy is not the treatment of choice
for all locally advanced prostate cancers.
Effective psychological interventions
can have a positive effect on
quality of life, said Prof Suzanne K
Chambers of Griffith University,
Australia. But there is scant highquality
research on effective ways to
support men with prostate cancer
and their families. Consumer groups
and advocates, NGOs, and health
services should work together to set
priorities and develop and translate
research.
Nurses play an important role in
the supportive care of men with
prostate cancer, said Sarah Faithfull
of the University of Surrey, UK –
particularly in providing information,
support after cancer diagnosis and
symptom management. But this role
is often under-resourced in many
countries, and specialist training for
oncology nurses is lacking.
Chrigu wins grand prize in Reel Lives film festival
Grand prize in a international documentary
film festival on cancer – the
first of its kind - that ran in parallel to
the World Cancer Congress went to
Chrigu, an entry from Switzerland.
Reel Lives: The cancer chronicles was
organized by the UICC to raise
awareness of the complex realities of
cancer globally, to shatter taboos and
myths surrounding the disease, and to
challenge stigma. The film festival
paid tribute to those whose lives have
been impacted by cancer, and gave
them the opportunity to tell their
story to a global audience.
Chrigu tells the story of a young
man who had great plans for his
future until, at the age of 21, an
advanced-stage tumour was discovered
in his neck. Director Jan
Gassmann follows Christian Ziörjen’s
(Chrigu) fight to live and creates a
moving and surprising portrait of his
best friend.
“The medium of film is very powerful,
especially in such a complex,
personal project,” says Jan Gassmann.
“Through film, Christian was able to
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Making connections