Prostate Cancer

PROSTATE CANCER (PC) 

PC is the most common noncutaneous cancer among males. Although prostate cancer can be a slow-growing cancer, thousands of men die of the disease each year. PC is the second most common cause of cancer death in males.

4th commonest cancer(7.3%) in male in Malaysia after cancers of large bowel, lung and nasopharynx. Some PC can grow and spread quickly, but most of them grow slowly.

Marked variation in rates of PC among populations in different parts of the world suggests the involvement of genetic factors. Familial predisposition also occurs. Environmental factors, notably diet, are important.

Currently, 47% of PC are identified in patients who are asymptomatic. Diagnosis in such cases is based on abnormalities in a screening prostate-specific antigen (PSA) level or findings on digital rectal examination.

Screening for PC is a controversial topic, in large part because of the limited understanding of the natural history of the disease. Education is important to help men make informed decisions regarding the screening and, in those diagnosed with PC, the various treatment options.

Standard treatments for clinically localized PC include radical prostatectomy, radiation therapy, cryotherapy, or active surveillance. The historic term of watchful waiting suggested waiting for symptoms to develop, not actively observing for progression. Management of locally advanced PC is often with external beam radiotherapy. For these tumors, radiation therapy along with androgen ablation is generally recommended, although radical prostatectomy may be appropriate as an alternative to radiation therapy in some cases.

The biopsy grade, clinical stage, and PSA level provide prognostic information that helps stratify patients to particular treatments. Patient preference plays an important role in treatment decisions.

Androgen deprivation therapy is considered the primary approach in the treatment of symptomatic metastatic PC. However, androgen deprivation therapy has been found to be palliative, not curative, in metastatic disease.

RISK FACTORS FOR PROSTATE CANCER.

1. Age:- PC is very rare before the age of 40, but the chance of having PC rises rapidly after age 50.

2. Race/ethnicity:- In Malaysia, commonest in Indian, followed by Chinese and Malay.

3. Nationality:- PC is most common in North America, northwestern Europe, Australia, and on Caribbean islands. It is less common in Asia, Africa, Central America, and South America.

4. Family history:- PC seems to run in some families, which suggests some inherited or genetic factor. Having a father or brother with PC more than double the risk.

5. Genes:- Scientists have found several inherited genes that seem to raise PC risk, but they probably account for only a small number of cases overall.

6. Diet:- Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting PC. These men also tend to eat fewer fruits and vegetables.

7. Exercise:- High levels of physical activity, particularly in older men, may lower the risk of advanced PC.

8. Smoking:- Small increase in the risk of death from PC.

9. Inflammation(radang) of prostate:- Inflammation may be linked to an increased risk of PC.

SYMPTOMS (tanda2)

Urinary frequency, decreased urine stream(panchutan kecil), urinary urgency(tak lawas) and hematuri (kencing berdarah). None of these is unique to PC; each could arise from various ailments.

EXAMINATION

After 50 yrs old, it’s advisable to do blood examination for PSA(prostate specific antigen – cancer marker for prostate) and digital rectal examination( pemeriksaan prostate melalui dubur). If PSA is raised and ultrasound shows lump, then biopsy (tissue sample taken) will be performed for confirmation of PC.

TREATMENT

Treatment depends on 3 factors. Age and present of other chronic diseases, type of cancer (aggressiveness) and preferences of patient.

Standard treatments
a) localised cancer-radical prostectomy(semua prostate dipotong),
b) radiation, or active surveillance, and if advanced cancer, ablation androgen (testis-teloq Akan dipotong) is recommended as part of treatment.

If cancer has spread to other organs like bone, then it’s incurable, and treatment is directed at pain relief (ubat atau radiation untuk kurangkan sakit).

 

Dr Abdullah Daud

 

 

 

 

 

One Response to Prostate Cancer

  1. Nek Kamal Yeop

    Assalam…Dr,
    I am your junior(72-79) age 53, I frequently go to toilet (tak lawas) especially at night always twice or more. Hopefully I am not having PC problem. Aint got no diabetes, please advice Dr.
    Thank you

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