Posted on 19 March 2012 - 02:58pm
ALTHOUGH the incidence of prostate cancer in Malaysia is currently quite low, it might rise in future in tandem with the increase in life expectancy in men.
Despite being the third most common cancer affecting men in 2008, Asia has the lowest rate of prostate cancer in the world. The highest rates occur in Australia and New Zealand, Western and Northern Europe and North and South America.
Dr Amit Bahl, the clinical director and research leader of the Bristol Haematology & Oncology Centre in the UK who was recently in Kuala Lumpur, noted that the incidence of prostate cancer is actually quite low in Malaysia, according to statistics.
On the numbers, Bahl said: “Is that a true reflection of whether it’s not a health problem or is it because of various factors (like) under-reporting? If a man of 70 dies in a village, does it get reported as prostate cancer? It probably gets reported as heart attack (or) chest infection.”
He pointed out that the increased life expectancy of men in Asia would also mean a higher chance of developing prostate cancer in the future.
The statistics seem worrying. In 2008, there were over 28,000 prostate cancer cases reported in Southeast Asia. According to the World Heath Organisation, by 2017 the number is expected to triple to 86,000.
Prostate cancer is a disease that affects the prostate gland and it can spread to the lymph nodes and other parts of the body.
► Detecting prostate cancer
Stage 1 means the cancer is localised in the prostate gland. In Stage 2, the cancer is still localised, but the prostate is enlarged.
During Stage 3, the prostate is enlarged, cancer is on both sides of the prostate and also breaking through the capsule of the prostate.
“In Stage 4, it has progressed beyond the prostate and gone into other organs,” explained Bahl.
He said Stage 1 cancers are usually diagnosed in blood tests during general health screenings, and not because of any symptoms experienced.
Bahl also recommends opportunistic PSA (Prostate-specific antigen) tests, where patients undergo tests whenever they experience discomfort or problems in the urinary tract area.
Diagnosis can also be made through a digital rectal examination. Testing is especially important for men with a family history of prostate cancer.
“Most of the diagnosis of patients in the west is of early disease,” he said, “whereas most of the diagnosis of men with prostate cancer in southeastern countries is of locally advanced or advanced disease because they don’t go for initial check-ups with their doctor.”
While prostate cancer is usually discovered in older men, that does not mean younger men are immune.
“One of the symptoms of prostate cancer in youngish men is erectile dysfunction (ED) or blood in the semen,” he said.
Previously, PSA tests were recommended for men when they turn 50, but now some doctors are recommending it at 40.
► Differences between stages and grades
Clearing some misconceptions about categorisations of cancer, Bahl said the stage and grade of a cancer are two different things.
“Grade is what we see under the microscope in a biopsy. It’s how nasty the cancer looks under the microscope. But the fact that it looks nasty doesn’t mean that it will behave in a nasty manner.
“So, stage means it behaves in a nasty manner. Sometimes when we see patients and we say, ‘Your cancer is high grade’, they go home thinking it’s high stage.
“You can have early cancer which is still localised, but it could still be high grade cancer. So don’t confuse the Grade (appearance) with the Stage (progression).”
► Forms of treatment
During early stage, patients can opt to have their prostate gland removed in a procedure known as radical prostatectomy.
Other options are modern radiotherapy, which involves directing beams of ionising radiation into the prostate; or internal radiotherapy, also known as brachytherapy. Doctors will also sometimes put the patient under observation, carrying out regular blood tests and only proceeding with treatment when the cancer starts to grow.
The most common form of treatment in the next stage is hormone therapy, because prostate cancer is a testosterone-driven cancer. The first step is to block the production of the male hormone, also known as medical castration.
If that does not work, then the next step is chemotherapy with the medication Docetaxel, the internationally-accepted standard of treatment for patients who fail the first-line hormone therapy. Docetaxel chemotherapy has been proven to improve survival, quality of life and pain-control in the patients.
However, there were no other treatments after Docetaxel, until last year. Now, there are four drugs to help improve survival for patients in the post-Docetaxel category, known as castrate-resistant prostate cancer.
The advantage of these new drugs is that they have increased the life expectancy for patients who are in the late stages of the disease.
Previously estimates were usually two years, but now with ‘judicious’ use of these new agents in the right patients, it is possible to help them live up to four or five years.
http://www.thesundaily.my/news/325250
