Alterowitz, Ralph and Barbara – “Intimacy with Impotence” The Alterowitzs are well known throughout the prostate community as being an excellent source for learning about sexuality after the male partner has been “sexually crippled” by some primary PC therapy or other. Impotence is a widely resulting problem after surgery, radiotherapy, or hormonal manipulation. Given the specific nature of the males sexual plumbing and the integral role played by the prostate gland, it’s no wonder there are so many post therapy sexual issues that result. Mr. and Mrs Alterowitz write and speak with authority since they have had to learn sexuality following his experience with PCa. They have a book out which deals in great depth with the possible approaches to “loving” without penetration. They even discuss techniques that include “partial penetration”, or as the colloquial term has it, “stuffing”. In their presentation they make a strong argument that human imagination and improvisation can make “loving” following prostate therapy a real, and exciting phenomenon. There is no need to write off loving after the male has suffered partial or total impotence. They reviewed the available aids, both medical and mechanical, that can be tried. The most important point they made is that a loving relationship can be maintained absent traditional or “normal” lovemaking is over. They used a couple of acronyms to make their point: first, was RUT meaning the relationship was Routine, Unappreciated and Tired. They offered the corrective CREST acronym: Creativity, Respect, Excitement, Sensitivity and Togetherness. Finally they presented and briefly reviewed the available meds, etc. Among these is the new generation of ED drugs like Viagra, Levitra, and Cialis. They also talked about penile prostheses. Their takeaway message was to re-assure the audience that there is not only life after sex but that sex can continue albeit in different ways and forms. Their book on the subject is available at: www.renewintimacy.org Coffey, Donald PhD – Developing Pathways to Treat Prostate Cancer” Dr. Coffey is a Professor of “everything” at Johns Hopkins Brady Urological Institute. He has been one of the leading researchers in prostate cancer for many years and has a long list of scientific publications in which he is either the lead or co-author. These papers run the gamut. This presentation was a brief review of the history of PCa treatment and a look into future directions that might be useful. He pointed out that the first radiation “therapy” was introduced in 1917 by Brady who used radium containing needles to treat prostate cancer. Then the first surgical approach to removing cancerous prostate glands was developed. In 1941-46 the linkage between the male hormone testosterone and prostate cancer was discovered by Dr. Charles Huggins. That led to the use of orchiectomies (male castration) to treat men with PCa. No more change was introduced to the treatment of PCa for another half century! Coffey pointed out that there are typically 1.6 million prostate biopsies annually in the US resulting in some 230,000 cancer diagnoses. There are still some 29,000 deaths annually from PCa. Of all the biopsies performed there are 86% negative. Although Dr. Coffey didn’t give any stats, we believe that within the 86% negatives are a large number of false negatives. The needle biopsy procedure itself hasn’t been improved for many years. Image guided methods are increasing the accuracy of the procedure but it remains uncomfortable (painful in some cases) and still in need of greater accuracy. He raised the issue of how to determine, in his words, “the pussycats from the tigers”. PCa is multi-focal, i.e., occurs in different locations within a single gland. Within a given gland how many different grades of PCa can exist simultaneously? Does the Gleason Score of a given lesion progress is the lesion is left alone? Is it possible to have a small volume of high grade tumor co-exist with a large volume of low grade tumor and what are the implications of such conditions for the patients future welfare? Having PSA as a good marker for tumor progression allows the kinetics of individual cancers to be followed with good accuracy. He then went into a discussion of genetic changes involved in PCa and raised the question of how many changes might be necessary before the combination pushes the prostate cell into the tumor stage. Is it the prostate stem cells that are left after the cancer cells have been ablated and if this is true, have these very stem cells been altered so that their progeny are more tumor cells? Dr. Coffey pointed out that one of the trends in drug development today is in the direction of small molecules that can get into cellular structures and possibly disrupt the rapid cell division characteristic of tumor progression. Sophisticated analyes like X-ray diffraction are being applied to look at the physical structure of complex proteins and to design tailor-made small molecules that might get into these structures and interrupt the process. An important point was made by Dr. Coffey, to wit, that cancer cells will always develop resistance to all therapeutic approaches! He used the expression: “One Drug Does not A Cure Make!” “One cell type is not the target”. Coming from a scientist of Dr. Coffey’s background, one has to face the reality that we are still struggling today to understand the basic mechanism(s) of tumor formation and progression. And further, current attempts to treat PCa with chemotherapy drugs are inherently unlikely to produce long term cures. He used the term “anoikis” to describe another type of cell death. (ED. NOTE: Anoikis is the word used to describe apoptosis that occurs in cells that have left the ECM which is the Extra Cellular Matrix). The thrust of Dr. Coffey’s remarks is that the mechanisms of development of PCa and the approaches to curing it will benefit from some of the new approaches being taken. He made the statement that “stable disease is a response” when it comes to evaluating drug performance. Many new and exciting ideas are being studied by PCa researchers around the world. NPC Program Review, 6/05 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.