Tuesday, March 29, 2011

Prostrate cancer

Dr Murali Sundram

I attended Dr Murali Sundram’s talk on 26 March 2011 at the National Cancer Society on Treatments for prostrate cancer and its complications. About 30 participants attended this frank and informative talk about the men’s only disease.
Prostrate cancer is luckily a slow growing disease, but unfortunately there are no obvious symptoms whilst it is growing inside us. It is very prominent with the Afro-blacks in the USA. And Japanese are apparently are the lowest with Prostrate cancer. The main causes for prostrate cancer are the genes in us and the environment.
 Prostrate cancer also has an excellent tumour marker in the PSA (Prostrate Specific Antigen) readings. Whilst the PSA is not an absolute marker for the disease, it is significantly important to indicate the possibility of prostrate cancer, hence a biopsy is normally followed up to confirm malignancy or otherwise.
Good PSA readings vary from under 2.5 in the USA to under 5 in Europe to under 4 in Malaysia.
The three important indicators and status of the disease are the PSA reading, the stage of the cancer tumour and the Gleason’s grading. The combination of the three matrix will determine the prognosis of the patient. Generally PSA readings under 4 are good, Cancer stages under T2 are good and the Gleason grades under 4 are good. Life expectancy for majority of men with prostrate cancer is about 13.5 years. Life expectancy and prognosis are generally dependant on the patient’s age, health, fitness and lifestyle.
There are 4 type of conventional medical treatments, namely surgery, radiotherapy, chemotherapy and hormonal therapy. An active watching/surveillance (Do nothing yet) may be good for the patients in certain cases. There are also many adjunct therapies in support of the main therapies. Hormone and chemo therapies are used mostly in stage 4 cancers to control metastasis. Prostrate cancer cells generally spread to the bones if not treated early. Radiotherapy is an end game treatment whereby the patient cannot do surgery as follow up treatment.
There is always a chance of PSA recurrence in 27 to 53% of prostrate cancer patients. PSA recurrence will lead to prostrate cancer spreading within the time span of about 8 years. PSA recurrence normally starts about 2 years after surgery. And life expectancy after cancer spreading is about 5 until imminent death of the patient. We are also to note there are more prostrate cancer patients dying from other causes other that cancer, particularly from heart diseases.
There are also several new drugs for prostrate cancer namely Ketoconozole plus hydrocortisone, Provenge and Abiraterone. However these new drugs can only prolong life expectancy for very  short periods only, some for only 4 months or so.
PSA doubling time is also an important indicator to recurrence of cancer and it’s spreading. PSA doubling time in more than a year is good. Prostrate cancer patients can google for the prostrate cancer prediction tool to know their possibilities of cancer recurrence and also for secondary treatments post castrate resistance disease.
As for diets for prostrate cancer patients, it is best to look for evidence based foods, nutrients and supplements. Unfortunately there are no such diets today. However eating anything well for the heart should be good for the prostrate.
A final advice for patient’s whose PSA is on the recurrence, is not to do anything hastily, as there is adequate time for the correct type of treatments.
Stay healthy and take care.

Dr Murali Sundran is the present Consultant Urologist and Head of department Hospital Kuala Lumpur.

Allen Lai

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