Wednesday, September 14, 2016

Cost to cancer treatments in Malaysia 2016

Hi all,

It is inviarably costly to treat cancer in Malaysia as with elsewhere in the world.  Best way to overcome this high cost is to be proactive in cancer prevention. Live the good lifestyle, exercise and eat well and of course prayers help. Insurance do help out in the cost but its premium is generally too high as well. Malaysian public health care services does contribute to assist cancer treatments at government hospitals. has an article published recently showing the costs involved for hospital stays, screenings and treatment of cancers in Malaysia. See link below:

However it is a general survey to the costs. The actual cost will depend on a lot of other factors; such as type of cancer, grade and stage of cancer and of course the treatment modality used to treat  / manage the cancer.

Take care all.

Allen Lai

Monday, September 12, 2016

My Story

It is quite a long story, actually 72 years of it. But briefly....

From Malignant to Remission my story.

Year 2009. I had a good life and successful career serving in the Malaysia army for 36 years.  Having retired ten years ago, I was at the prime of my life, fit as a fiddle and with annual hospital certified clean bills of health to boot. I have the normal diseases of Hypertension, Diabetes, Osteoarthritis and High Cholesterol that came with age. All under control with exercises, diet and medication.

I was not aware that I was sleeping with the enemy for the past several years. Sure, I had some urinating problem that came with prostrate enlargement. It was men talk that it was all right and nothing to worry about. It was just an inconvenience; eating pumpkin seeds will solve the problem.

Doing a PSA test and biopsy in late 2009, proved my good health was only skin deep. I should have known better than not to have PSA tests earlier. I paid the price for not listening to the advice of my family members. I was diagnosed malignant at stage three local advance.

I was offered, and opted to undergo my medical treatments for cancer at HUKM Cheras. My oncologist said the magic words “ You are curable.” He then proposed a dual modality treatment for me, comprising Zoladex hormone injections for three years and 32 daily sessions of radiotherapy.

I do not recall if my initial shock and denial stage had caused any trauma affecting myself or my family. My wife and I immediately went on a short holiday in Hatyai, Thailand; knowing fully well, that I would soon be tied down going to the hospital for treatments. I was positive throughout my ordeal. I had clear and objective discussions with my urologist and oncologist during every of my hospital appointments.

I have since then started to do wide readings into cancer on a daily basis. I was particularly interested in holistic and other comprehensive treatments for cancer. It was during my six weeks of daily radiation sessions at HUKM that I had seen and met many other cancer patients. All of them, without exception, were in a state of despair and low morale. They all looked miserable, unsmiling and had abandoned all self-esteem. Such was the profile of most cancer patients.

I am glad that I am strong and positive from day one. My leadership training in the army, quick knowledge acquisition and strong support from family members and close friends were a great help to my confidence and in my fight against cancer.

I had fought back and survived to celebrate life. Having been there and done that, I now have a strong calling to help others who are less fortunate than me. I have the empathy, dedication and skills for my new role in my life.

Today, after seven long years as I tolled in my journey with my prostrate cancer, I beat it. I am in remission. I am thankful to God, the medical team in HUKM and IKN, and everybody who had been part of my journey. I wish to write this article for others to read so that they may be more confident with themselves in their own journey with prostrate cancer. I shall mainly describe my strategy, activities and my personal thoughts for the past seven years.

To begin with I wasn’t really traumatised nor shocked as most people would. I accepted cancer as with any other medical problem. I had believed that our hospitals would be able to cure me. I did not realise its seriousness until I started to read into the disease. My father who was 80 plus years old had actually died from prostrate cancer. I did not relate its genetic impact on me and my siblings. I had left it to the hospital to sort me out so to speak. I could not afford to see any private hospital specialists as I know the cost would be exorbitant. I am really glad that I am a pensioner and would have free medical treatments at government hospitals. 

I left the decision of what treatment was best for me to my Oncologist because I had absolutely no idea. Zero. I am very thankful that my Oncologist in HUKM was quick and decisive. As soon as he had described the problem to me, he had said “you are curable”. I listened to his treatment plan without really understanding fully what it entails. So I just followed faithfully his prescription for EBRT radiation and three years of hormone therapy. I was lucky to have some acceptable side effects. Erectile Dysfunction being the most serious and the constant hot flashes till today. It is OK for that as I am still alive and I did not get incontinence, a side effect I dread most.

Hopelessness, fear and uncertainty started to set in slowly during my journey as I meet other prostrate cancer patients and as I read more into it. Sadly I began to loose a friend or two to prostrate cancer now and again. I feel for them and their families. They deserved more from life. How did I cope ? It was so hard to get by. I kept thinking on how do I balance Fear with Hope? I dreaded each quarterly appointment for my PSA tests, particularly on the day before and prayed that my PSA would not rise. I am thankful that my PSA held on well albeit rising in small quantities.

I began to have a personal understanding of prostrate cancer. I understand that, whilst prostrate cancer is life threatening, it is a very slow growing disease; but there are exception. The PSA reading is not a prostrate cancer marker per se. An exceptional rise may be caused by cancer, but many other activities can rise or lower the PSA reading. I had learnt not be intimidated by our PSA reading. I had learnt the significance of my cancer staged at 3 local advance and of my Gleason score of 3 plus 4. In the course of my journey, I read intensely from books purchased and also from the libraries.I also browsed the internet relentlessly, I find there are as many theories as there are writers and most of the studies presented conflict and are sometimes confusing. I also very thankful and grateful to family members and friends giving me comfort and telling me what is good or not good. But sadly whilst they mean well, these advice comes from people who do not have prostrate cancer, nor do they know much about the disease.

Conventional primary medical treatments are very effective to treat and manage prostrate cancer. Survival rates are almost 100% for the first five years after treatment. Secondary treatments for prostrate cancer relapse get more complexed and difficult, particularly when the prostrate cancer had spread out to distant sites. I am hopeful and confident that should I have a relapse later, there would be new medication and approaches to tackle the problem. I am already 72 years old and I cannot expect too much.

I believe and affirm fully to our Sarawakian Ranger Regiment’s battle cry “ Agi Idup Agi Nglaban” if there is life there is fight. With knowledge and confidence I decided to have my personal plan to maintain a status quo with the remaining prostrate cancer cells which I believed had survived my primary treatments. I am now responsible to myself to fight the prostrate cancer. I know that exercises and toning my body would be top priority, eating well and getting a balanced diet are just important and also that God will answer to our prayers. I write a personal blog to keep track of my knowledge related to prostrate cancer. I joined and participated in prostrate cancer support groups to share and contribute whatever I can. The hardest part of my plan is still personal discipline to do what I need to do daily. How do I regain my penchant for life again? How would anyone with prostrate cancer? I will try my best to live my life as best as I can and I will try my utmost to forget about my rising PSA reading. I am now into remission and I feel fine. My new PSA baseline for 2016 is 0.18 and it has plateaued out at 0.19 for the past nine months in 2016.

You may read more about my personal battle with cancer in my posts herein. It is purposely and appropriately written in military speak and in real combat situations.
Do not deny yourself or your charge of help needed. Fight back. Join your local support groups.

Not the Last Goodbye

''I knew the prognosis. Sooner or later, it would come back. I could slow down the inevitable; I could gain a few years. But there was nothing I could do to make this cancer disappear forever. So this was it. This was the relapse. The Big One.'' - David Servant-Schreiber, MD, PhD

We had lost an icon who had fought his cancer in the brain well for nineteen years. David Servant- Schreiber passed away in 2011 after a relapse of cancer in his brain. David's first book "Anti Cancer" has become mainstream reading on cancer management and coping with it. We had learnt to accept cancer, learnt how to look after our terrain and learnt all his deep insights and passion to help cancer patients.

David wrote another best seller "Not the last goodbye - On life, death, healing and cancer " just before his passing. All cancer survivors should read this book. David had put a lot of his thoughts and experience on his relapse. How did it ever happened despite he was an avid follower of his own prescriptions in anti-cancer? What went wrong? But still he had survived for nineteen years, given that cancer in the brain is somewhat more difficult to manage and cope. Thank you David for your last goodbye to us. You have made the difference in all of us cancer survivors. RIP.

Farewell Dr David Servant-Schreiber. The world shall remember you always. 

Allen Lai

I do my biannual checkups with my Urologist in HUKM. My recent visit on 05 September 2016 confirmed that my PSA had maintained its base at 0.19. Yes it looks good. I did not have a slow and steady rise in my PSA readings. My PSA has plateaued out. Hopefully it will allow me more quality time before I face a relapse, if ever. My Urologist said that I am doing well and that I should continue to do whatever that I am doing.

Yes looking after our terrain is paramount to cancer management and coping. After cancer treatments, the ball is on our feet. Our Oncologist had done their part well, we are to do the necessary to maintain our health. We cannot afford to face another battle. That will be too much.

Take care.

Allen Lai

Friday, June 3, 2016

Bi-annual report June 2016

I had two medical reviews at the IKN and Putrajaya Hospital on 1 June 2016. Overall my health is as best as any 71 year old man can be. But my usual medical pointers are on a slight decline, whilst my PSA has risen slightly to 0.191. The slight rise in my PSA is to be expected but it is not too alarming. My PSA readings are still on the plateau and stable. It would be fluctuating up and down at the base level of 0.18. No real worries there as the DRE done by the doctor showed up normal.

A quick look at my blood test shows:
1. Oxygen level in my body is 95%. Good
2. BP - 131/ 59. Good
3. Pulse - 86 bpm - Good
4. Weight - 70 Kg - Bad, up by about 3 kg. Need to do more exercises.
5. HBA1C - 7.6 - Bad. Rising over the past several months. Need to control my food.
6. LDL -2
7. HDL -1.4
8 Trigs - 2 - Bad. High trigs. Need to lower trigs to below 1.7
9. Urea -3.5
10. Sodium - 139
11. Potassium - 4.6
12. Albumm - 42.
13. Creatinine - 85.

The above tests showed that I am on track in my PSA and health management. However I have slacked in my physical exercises somewhat. Got to get my act together to reduce my weight, and burn up more trigs in my blood. A doable regime.

Take care

Allen Lai

Saturday, March 5, 2016

New PSA baseline for 2016

I reviewed my PSA in HUKM yesterday. My PSA is 0.18. My reading has plateaued at 0.18 and my Urologist had said that it should remain fluctuating at that level, baring any untoward issues.

 I am now into my 6th year post External Beam Radiation and hormone treatments. And although my Gleason score remains at 3+4, I am coping very well. My Urologist suggest that I continue to do what I had being doing all these years. My activities have a great positive impact in controlling my PSA level. He also suggested  that I would be looking at my hormone levels for my next visit.

I attribute my success to my dedication to exercising daily, eating well, and a great change to my lifestyle. My daily prayers are also answered.

My new PSA baseline for 2016 is now 0.18

Take care

Allen Lai

Thursday, December 3, 2015

In equilibrium

I had my latest biannual checkup at the IKN on 1 December 2015. To my delight my PSA remained in plateau at 0.162. It had remained in this range for the past 9 months. Flat but with a slight down trend.

My doctors say that I am a model patient and expects me to do what I have been doing to keep my PSA stable. I acually see my Urologist at HUKM and Oncologist at the IKN biannually. Both are monitoring and observing my personal fight with PCa.

Whilst I am into remission, I still keep myself abreast with the latest in PCa and the new treatments/drugs available. Thanks to dedicated doctor-scientists there are many new innovative treatments and approaches/options available. But one thing is reasonablely clear, the doctor-scientist are slowing down in finding a cure for cancer. It looks futile. The trend is now looking at cancer managements. They are looking into approaches for patients to treat cancers as manageable chronic dieseases and not terminal cases. We are agreeable that cells mutate into cancerous cells in harsh environments due to stresses, toxicity and environmental impacts. Cells perform optimally in good body health.

The present treatments regime still stands. The strong paradigm shift is towards attaining good health and quality of life.

 Good health means daily exercising, eating well, happy and stress free activities, resting and prayers. Today I am in equilibrim with my daily regimes and routines. Everything is well balanced. I am in good health, eats well, rest well and happy with my hobbies. I pray daily too.

My body metrics are:
Weight - 67 kg
Blood pressure - 120/81
Heart beat - 68 bpm
Oxygen level in my body - 98%
Trigs - 1.29 mmol/L
Total cholesterol - 3.42 mmol/L
HDL - 1.5 mmol?l
LDL - 1.33 mmol/L
HbA1c - 6.7

All the above readings are excellent for my age.

The above graph shows my PSA readings. 

Take care

Allen Lai

Sunday, November 1, 2015

Olapalib in metastatic PCa

Pca is a heterogeneous diesease and hence would probably respond well with polymerase inhibition. The New England Journal of Medicine posted a report on 29 October 2015 on the successful trials of Olapalip. PCa patients who had not responded to standard treatments and who had defects in their DNA repair genes achieved a high degree of success.

Olaparib is produced by AstraZeneca and recently approved by the FDA.

Visit site below for full report:

Good things are a-coming.
Take care

Allen Lai

Monday, October 26, 2015

ESMO Clinical Practice Guidelines for PCa treatments 2015

The European Society for Medical Oncology published their updated Clinical Practice Guidelines for for PCa treatments 2015.

The updated ESMO Clinical Practice Guidelines on prostate cancer provide information on the current management of prostate cancer including recommendations for screening and diagnosis, along with stage-matched therapeutic strategies.

ESMO recommendations include:

Patients with intermediate- or high-risk disease should have nodal staging using computed tomography (CT), MRI, choline positron emission tomography/CT (PET/CT) or pelvic nodal dissection. 
Patients with intermediate- or high-risk disease should be staged for metastases using technetium bone scan and thoraco-abdominal CT scan or whole-body MRI or choline PET/CT

Watchful waiting with delayed hormone therapy is an option for men with low-risk disease.
Watchful waiting with delayed hormone therapy is an option for men with localised or locally advanced disease who are not suitable for, or unwilling to have, radical treatment. 
Active surveillance is an option for men with low-risk disease.
RP or radiotherapy (external beam or brachytherapy) are options for men with low- or intermediate-risk disease.
Primary ADT alone is not recommended as standard initial treatment of non-metastatic disease.
Options for patients with high-risk or locally advanced prostate cancer include external beam RT plus hormone treatment or RP plus pelvic lymphadenectomy. 

For full review and recommendations visit ESMO website below:

Take care 

Allen Lai

Wednesday, October 14, 2015

Comparing Treatment Options for PCa

We want to survive PCa and remain PCa free. Our survivability and prognosis will depend largely on the strategies and treatments adopted. Most of us would like to know what is best for us. Indeed there are many treatments for PCa at each degree and level of PCa. It will be best to discuss with our Oncologist what is best for us. Studies have given some statistics to assist us in choosing what could be the best options for us.

However we should always realise that statistics are just guidelines only. Your age, overall state of health and physicals are more important at any point of time. Do not depend on statistics only. Keep fit and moving to achieve the best prognosis post treatments.

The Prostrate Cancer Treatment Research Foundation has produced a very comprehensive tool to show the effectiveness of the many types of current standard treatments and to compare them for three levels of risks groups. These statistics represent not just survivability but include survival without PCa recurrence.

Visit the site here:

Do read the tutorial and explanations before viewing your chart.

Take care

Allen Lai

Wednesday, October 7, 2015

The Movember Founder - TrueNTH

Physical activity and regular exercising are strongly recommended as part of cancer treatments and recovery. Any exercise is better than no exercise. Get to know that exercises have no contradictions to any form of cancer treatments. There are special considerations for every cancer stage and treatment types. Get to know specifically the stress and limitations to metastastic cancer, particularly when cancer has spread to the bones. See above chart.

One of the best websites dedicated to exercises for PCa patients is TrueNTH, an initiative by Austrialian's Movember Foundation. This site is comprehensive and has programmes for starters and advance levels of exercises for every stage of the cancer. 

Get qualified explanations on the benefits of exercising and more so the cautions and special programmes for matestastic cancer. How to exercise safe. Be mindful of the Dos and Donts when exercising. The FAQ section has answers to most of our questions. And there are downloads for all your exercise needs with specific exercises planers.

Visit TrueNTH here:

Take care, happy exercising and enjoy your physical activities.

Thank you Movember Foundation.

Allen Lai

Tuesday, September 29, 2015

Keep moving - Exercises for cancer survivors

Exercising is now a main stream adjunct treatment for cancer patients. All major cancer centers in the world avocate exercises to enhance better health and tolerance to cancer treatments. There are tremendous benefits from exercising.

Donna Wilson, the Fitness Instructor and Fitness coordinator at the Integrative Medicine Center, Memorial Sloan-Kettering Cancer Center shows us how simple it is. Studies show strong links between physical activities and a reduced risk of prostrate,lung and endometrial cancers.

The American Cancer Society recommends adults to engage in at least 30 minutes of moderate to vigorous physical activity, 5 of more days a week;45 to 60 minutes of intentional physical activity are preferred.

Prostrate cancer exercise outcomes determine that it is safe, it does not affect PSA, shows improvement in ADT treatment, radiation treatments, improved musclular strength, lower incontinence, and also improve balance.

On the contary, exercising is not confined to the gym or outdoor activities. It can be safely done in the comfort of your home. The exercises demonstrated in the video below are just as effective in cardiac health, breathing and musclular developments. It will certainly be a good start in preparing for other outdoor exercises like walking, jogging, swimming and cycling. Gym works and weight resistance exercises will complement on whatever you had intended to do.

However do exercise with caution and great care. Do it slowly and incremental in time and levels of difficulties.

View the video.

Thank you Memorial Sloan-Kettering Cancer Centre.

Go for it, keep moving !

Allen Lai

Sunday, September 27, 2015

National Comprehensive Cancer Network's Patient and Caregiver Resources

H all,

Below is the link to NCCN's latest patient and caregiver guidelines on PCa. Published in 2015 and the guidelines provides us with the latest information and guidelines for us in standard of care and treatment decision making.

Thank you NCCN.

Note: NCCN provides guidelines for other types of cancers too.

Take care

Allen Lai

American Association for Cancer Research's Cancer progress report 2015

Hi all,

It is good to read the latest statistics and progress reports in fighting Cancer. AACR has been producing such reports on a yearly basis. This report is very informative and comprehensive as it covers all aspects that we need to know about the latest in cancer research. It provides us the hope and knowledge to make critical decisions on treatment plans.

Do read this report to be up-todate. Thank you AACR.

Take care

Allen Lai

Saturday, September 5, 2015

On track with my PSA readings

I am happy today. Very happy. My visit to my Urologist bi-annual reviews on 4 September 2015 showed that my PSA had indeed reduced another notch at 0.16. It is fantastic as this is the second time my PSA had shown a down trend. Do note that I had two doubling times for the first two years post primary treatments.

See my graph above.

I am on track at fighting my PCa. I attribute my success to my Oncologist at the IKN and Urologist at the HUKM hospitals. They have been giving me all their reviews and advice. Of course changing my lifestyle and taking daily exercises were key components to my regime. I pray daily and watch my food intake.

I had posted a theory about the rise and fall of PSA post radiotherapy and hormonal therapy last year. I firmly believe in this theory and it is showing the results in my personal case. My PSA reading should continue to fall in tandem with my new lifestyles and physical activities.

Read my post below:

Today I shall put cancer in the rear seat. My six years battle had made cancer centerstage and now I will have to be focused on my other ailments, namely diabetes, hypertension, and high cholesterol.
Take care

Allen Lai

Saturday, August 8, 2015

Castrate Resistant Prostrate Cancer - 2013 Perspective by Professor Gavin Marx

The Pca Continuum Chart

There have been tremendous research made and successes achieved in treatments for prostrate cancer in the past 10 years, particularly prostrate cancer in its advanced stage and castrate restistent. The Prostrate Cancer Foundation of Australia and Professor Gavin Marx from the Sydney Adventist Hospital, Australia published a talk and discussion in U-tube on 16 October 2013.

Some important points to note from the talk are:

Prostrate Cancer is now identified and seen as a heterogeneous disease. Each prostrate cancer patient will definitely respond differently from another patient. Hence individualised treatments are based on the patient.

The use of Taxotere can reduce the risk of death by 24%, the median of survivorship is incereased to 18.9 months and 30% patients treated with Taxotere survived two years more than the previous Mitoxantrone.

Emerging therapies are seen in chemotherapy, targeted therapies and immunotherapy and timming and sequencing the modality is a better option than combination modality. Combinations modalities with biologics are now researched into with clinical trials. Second and Third line therapy is now available. eg. Cabozantonib.

And the best news of all is that newer drugs are now better tolerated.

Listen to the very informative and excellent talk here:

Take care

Allen Lai

Friday, August 7, 2015

Immunotherapy for Prostrate Cancer, present availability and on going trials

Systemic Immunotherapy treatment for cancer looks promising and is currently the most preferred treatments since 2010. And prostrate cancer seems to be in the forefront with approved drugs by the FDA. Today there are several immune based cancer treatments available, albeit extending survivability by seven or so months. Currently there are three approaches in Immunotherapy for prostrate cancer. Therapeutic cancer vaccines, Checkpoint inhibitors/immune modulators and Adoptive T cell therapies.

Hopefully more trials will come to its end periods with successful results sooner than later. Let us continue to keep fit and healthy , until full fledged immunotherapies are readily available.

Read the latest report on Immunotherapies for prostrate cancer as at September 2014 here:

Take care

Allen Lai

Monday, August 3, 2015

The Emperor of all Maladies

This classic Pulitzer Prize winner book in 2011 is now a sensation on TV production with US prime time PBS TV. The documentary film produced by Ken Burns is scheduled to be viewed over 3 two hours series. The book The Emperor of all Maladies is written by Dr Siddhartha Mukherjee MD, PHD.  Dr Mukherjee is a professor of medicine in Columbia University, USA.

The film is very interesting and worth every minute watching it. It describes the historical biography of cancer, its past and its future. It describes the battles with cancer fought won and lost. And most important of all it describes the fight is now a teamwork with you and your Oncologist fighting back to back to fend off cancer. A fight that can be won with your personal efforts, determination and true grit.

View the first instalment of the TV series on U-tube here :

You will definitely feel better and have a better of understanding of cancer after watching it. Read the book if you have the time.

Take care.

Allen Lai

Wednesday, July 8, 2015

Quality Living

Whist treatments and care for cancer are improving by leaps and bounds, the undertaking is still quality life with cancer; as there is still no cure yet for this dreaded disease. Yes I do believe in living life to the fullest, but how ? with daily thoughts of relapse overhanging in our heads?

My first realisation to quality life is prompted by my Oncologist in the IKN. She had said very clearly that we should not be too anxious about our PSA rising. That is the job of the Oncologist and Urologist to monitor us. We just go about and live a full life. Cancer is now viewed together with all other aspects of our health. Oncologists are more interested in our body metrics, our other ailments and health issues. Cancer treatments are now addressing in totality to sum up what and when our next treatments are going to be. Basically we should be as healthy as possible.

So what is a quality life? How to we get it? The first thing is not to focus all our attention to being cured of cancer. We should be focused totally into what we want in life. What are we passionate about? Determine that and we are begining to have quality life.

There are many hobbies that delights. It is very individual depending on what we like, have the talents for and are interested in. Things like travels, painting, music, sports, movies, readings etc etc are all very good hobbies. I like photography and I have just started into it in a more passionate way. I do not just point and shoot now. 

Photography combines well with what I like to do; which are travelling, exercises and reading. I take the trouble to visit the wetlands and nature parks to do wildlife photography. I carry my huge camera for all my walks and photograph anything which catches my attention. And of course there are so much to read up in photography. 

This is my new quality living.

Below are some of my favourite captures. I use FLICKR to share my photos.

Take care and have a quality life with anything you can be passionate about.

Allen Lai

Sunday, June 7, 2015

Body metrics

During my last visit to the IKN on 2/6/2015 my body metrics were as follows:

Weight  -  69 Kg
BMI       - 25.3
BP        - 122/69
Pulse    - 68 BPM
Oxygen level in body - 99%

I was given a clean bill. You may want to know my secret to good health? It is no secret actually. I t is all about exercising daily and eating well. The key to this is discipline and consistency.

For your information my body metrics hardly changed over the last two years. See table below:

Weight (Kg)
Body Fat
Actual age (1944)
Bio- age
Basal Metabolic Rate
Viseral fat
Trunk fat
Leg fat
Arm fat
Whole body fat
Trunk Muscle
Leg Muscle
Arm muscle
Whole body muscle

Keeping a record of your body metrics is a good way to maintain discipline and consistency.
As I grew older by 2 years, my bio-age remained the same. I had a slight improvement in my visceral and overall body fats. This is important to keep fats in the stomach and hormone levels stable. My body muscles were slightly up, but as expected building muscles gets more difficult with age.

I hope to maintain the same results come next year.

Take care 

Allen Lai