Friday, May 30, 2014

The Prostrate Diaries –Dr McHugh's decision process

Dr John McHugh in the cover of his book

Dr McHugh decision flowchart

Even Urologists are not spared from prostrate diseases including prostrate cancer. Dr John McHugh MD is one urologist who has prostate cancer.
Dr McHugh has developed two tools to assist new prostrate cancer patients to decide what would be the best treatments for them by firstly knowing about themselves and acknowledging it honestly. Next is to understand prostrate cancer and finally to evaluate acceptable risks and side effects from several conventional treatments.
Visit Dr McHugh’s very informative website here:
Download Dr McHugh’s decision worksheet and evaluation sheet from here:
and here;

Thank you Dr McHugh for your excellent and inspiring website. We wish you well. Newly diagnosed patients should read Dr McHugh's best selling prostrate cancer book "The Decision - Your prostrate biopsy shows cancer. Now What?"

Take care.
Allen Lai

Sunday, May 25, 2014

Prostate cancer - Why take the risk? has an excellent article on the subject title.

Read the article here:

Take care

Allen Lai

Friday, May 23, 2014


I came across these red flags of quackery in the Alternatives to Medicine website. These red flags are self explanatory.

Be very cautious. It will save your life.

Take care

Allen Lai

Wednesday, May 21, 2014

Survival rates for prostate cancer

The American Cancer Society has updated its survival rates statistic in March 2014 as follows:

According to the most recent data, when including all stages of prostate cancer:
                         The relative 5-year survival rate is almost 100%
                         The relative 10-year survival rate is 99%
                         The 15-year relative survival rate is 94%

(Relative survival rate is calculated with death removed from all other causes except death from cancer after diagnosis.)
Keep in mind that just as 5-year survival rates are based on patients diagnosed and first treated more than 5 years ago,10-year survival rates are based on patients diagnosed more than 10 years ago (and 15-year survival rates are based on patients diagnosed at least 15years ago).
5-year relative survival by stage at the time of diagnosis

         5-year relative survival rate
         nearly 100%
         nearly 100%

Visit website below:

Survival rates are getting progressively better. Good luck.

Take care

Allen Lai

Features in the new IKN

Tuesday, May 20, 2014


Everybody needs to be hopeful to survive cancer. Hope is a very powerful element for survivorship. The National Coalition for Cancer Survivorship discuss hope in the extract below:
Remaining Hopeful
Survivorship is the challenge faced daily by millions of Americans who have a history of cancer. Current statistics note that nearly 10 million people are cancer survivors. Today, over 62 percent of all persons with cancer are living 5 years after diagnosis. Survivorship, however, is not just about long-term survival. Instead, it is about one’s quality of life from diagnosis onward. It is living with, through, and beyond cancer. 
As detection and treatments have improved, many types of cancers have shifted from acute to chronic diseases, and some cancers are now highly curable. The statistics are positive, but numbers do not really tell very much about how persons with cancer survive—physically, psychologically, socially, economically or spiritually. They do not tell us how people with a cancer diagnosis learn to live with fear and uncertainty or how they manage to be hopeful.
Summary Points About How People Hope
¨     People hope differently. While hope is individualistic, your own hope strategies are impacted by how your family of origin and your present family use and maintain hope.

¨     Families tend to have similarities in the ways they hope, but family hope constellations are not mutually exclusive. For example, you may be religious and academic at the same time.

¨     Different types of hope constellations may lead to conflict between the person with cancer and family members or friends. It also can lead to conflict between the patient/family and the health care professionals who care for them, because health care professionals also hope in individual ways.

¨     Most people have never thought about “how” they hope. They just assume everyone hopes in the same manner that they themselves do.

¨     This does not refer simply to optimism or pessimism, but to the strategies people use to look forward and for maintaining a positive future outlook.

¨     Most health care professionals are not trained to do “hope assessments” or to recognize different hoping styles. They often think only in terms of “therapeutic” hope, and equate other hope with denial. This can have a negative impact on your interactions with them and can make you vulnerable to broken hope.

It is important to think about your own hoping strategies and to be direct with family, friends and professional caregivers about what is most helpful to you with regard to using and maintaining hope. Never let anyone tell you that there is nothing further to hope for or that there is no hope. There is always something to hope for, and you, as an individual, have the right to determine for what, when and how you hope.

View the full article here.

Take care

Allen Lai

Monday, May 19, 2014

Know yourself worksheet

The National Coalition for Cancer Survivorship and Dr Thomas J. Smith has developed an easy questionnaire for you when you visit your doctor.

The Know Yourself Worksheet helps patients prepare for a visit to their doctor and discuss their preferences with their family and health care team.  Use these prompts to help you prepare for your doctor's visit and discuss your wishes with your physician and family.

The worksheet explores:

a. Hopes and goals about your diagnosis.
b. Personal goals and milestones.
c. Quality of life during and after treatment.
d. Impact of disease and side effects.
e. Other concerns.

Take care 

Allen Lai

Managing salvage treatments for advanced prostrate cancer

Prostrate Cancer Research Institute featured an interview  on “Living with advanced prostrate cancer” with Dr Mark Scholz from Prostate Oncology Specialists. Dr Scholz’s approach to salvage treatments are precise and effective.

Below are some extracts of the interview.

Men with advanced prostate cancer tend to live longer than men with other types of cancer. One major reason is because prostate cancer doesn’t usually spread to critical organs like the brain, the liver or lungs.  Another reason is the availability of so many effective treatments.
Men with ROYAL BLUE (advanced prostrate cancer) who have never had hormone therapy should start testosterone inactivating pharmaceuticals (TIP) beginning with Lupron and Casodex in combination.
Men who have become resistant to Lupron should take Provenge to boost their immune system. Studies show that Provenge works better when treatment is started as early as possible.
Potent medications to strengthen the bones —Xgeva and Zometa—are  routine treatment for bone metastases. There have three benefits: Inhibiting cancer growth in the bones, reducing bone pain; and counteracting calcium loss caused by hormonal therapies.
After Provenge men in ROYAL BLUE the first step should be to stop Casodex and start one of the following three options:
1. Second-line TIP such as Zytiga or Xtandi
2. Chemotherapy with Taxotere or Jevtana
3. Xofigo, a form of injectable radiation
Three additional treatment options can be considered if these first three options are no longer effective:
1. Combination chemotherapy using Carboplatin or Xeloda with a Taxane or the combination of both Revlimid and Avastin added to a Taxane.
2. The “off label” use of XL-184, a medication being researched for prostate cancer but already FDA-approved to treat thyroid cancer
3. Other investigational medications
Fatigue is one of the biggest challenges faced by men in ROYAL. Stimulants such as Provigil or Nuvigil may be helpful, but the most important priority is consistent, diligent exercise. An aggressive and imaginative treatment plan should be designed that has the specific goal of attaining and maintaining a complete remission.
The above extracts are taken from Prostrate Cancer Research Institute. Read the whole interview here.

Take care

Allen Lai

Monday, May 12, 2014

Metformin and cancer

If you have cancer and diabetes like me, we are in for a bonus. Recent studies since 2012 have indicated that Metformin, a common drug for treatment of diabetes may also be effective to prevent cancer and treat cancer.  Glucophage is a common trade name for Metformin. More trials are being conducted now. I do not normally recommend something without first approval for cancer treatments by the FDA, but I choose this exemption because I believe in Metformin. I am also killing two birds with one stone. I hope.

Metformin is a cheap drug and has minimum side effects. Taking 1500 mg/day is safe. I have just started to take Glucophage XR in addition to my other drug for diabetes. I take 1000 mg daily as I also take Diamicron for my diabetes.  My blood sugar level has since stabilised and I hope too with my PSA. It is too soon to know but I am hopeful. I have very little side effects from Metformin. Only some stomach discomfort.

People without diabetes may also take Metformin. Metformin may have contradictions for pregnant ladies. Please discuss taking Metformin with your physician before doing so.

Google Metformin and Cancer for more information.

Take care


Sunday, May 11, 2014

Links to online support groups

Knowledge is confidence. There are many help for prostrate cancer patients and survivors. Online support groups and forums are very informative and useful.

Below is a link to several more popular support groups.

Do participate and update yourself. There are several support groups in Kuala Lumpur. Contact them.

Take care

Allen Lai

What is your SHADE?

The prostrate cancer blue community (PCBC), which is a community from the prostrate cancer research institute has a unique and innovative way to analyse your prognosis/stage in prostrate cancer.

Blue is the colour for prostrate cancer.  PCBC creatively made five shades of blue to differentiate levels of patients with prostrate cancer. The shades are Sky, Teal, Azure, Indigo and Royal. The first three shades are for patients that has not taken any treatments and the bottom two shades are for survivors, with treatments.

Shade is easy to use and to find out the various actions to be taken. Knowing your SHADE will enable you to know the appropriate treatments. The objective in selecting the most appropriate therapies is to ensure maximum benefits and minimum side effects from the treatments.

Read and know more of  your Shade here

Take care

Allen Lai

Saturday, May 10, 2014

Salvage Therapies and treatments

After primary treatments, a period of remission is followed until cancer cells start to resurface again. The period of remission will depend on the age, health and type and effectiveness of primary treatments. Five years remission is considered the gold standard, before failure situations occurs, followed by PSA anxieties.

Failure situations.
a.     A biochemical failure occurs when the PSA rises again but there is no visible evidence of cancer on the MRI/ CT scan, bone scan or any other imaging.
b.     Local failure occurs when PSA rises with the disease recurring in the area of the prostate gland.
c.      Distant failure occurs when PSA rises as metastases show up in other parts of the body.

Milestones to note
a.     Failure of EBRT is deemed when the PSA value of 2 ng/mL is greater than the absolute nadir it represents. Nadir is the lowest PSA value achieved post treatments and during remission.
b.     Biochemical recurrence post ERBT is seen in having more than 3 consecutive PSA risings after achieving PSA nadir.

The Phoenix Definition for cancer recurrence is nadir point plus 2 ng/mL. The definition is valid only after two years PSA test past radiation treatment. Nadir point is the lowest PSA reading after treatment. It is reached at 12 to 42 months after treatment should be under 0.5ng/ml and no further rise. (Phoenix definition. An annual conference of Oncologist defines cancer recurrence.) 

The value of PSA at 2 ng/mL plus PSA nadir (as in (a) above) is considered the gold standard when to take salvage therapies.

Options for salvage treatments
Salvage Therapies are the blanket term used for medical treatments when initial treatments failed.
These treatments may include:
a.     Salvage / Adjuvant radiation.
b.     Surgery (Radical Prostatectomy).
c.      Cryosurgery. (Freezing)
d.     High Intensity Focus Ultrasound (HIFU).
e.     Systemic treatment via hormone ablation.

Take care

Allen Lai

Thursday, May 8, 2014

Know the symptoms for prostrate cancer recurrence

During our remission mode, we are always in anxiety to the smallest symptoms, whether real or perceived. We tend to imagine somewhat unnecessarily. Below are some of the symptoms that we should be focused on:

Symptoms of local spread are:
a. Blood in the urine.
b. Pain when passing urine.
c. General lower abdominal pain not linked to passing urine.
d. Impotence.
e. Incontinence.
f. Pain in the loin.
g. Signs of back pain.
h. Severe constipation and bleeding from the rectum.
j. Blood in the sperm.

b. Symptoms of distant spread
a. Bone pain at the new site.
b. Spontaneous bone fractures.
c. General weakness and numbness.
d. Paralysis of a leg.
e. Enlarged glands.
f. Swelling of the legs.
g. Pain in the groin.
h. Weight loss causing a bad situation called Cachexia or what is commonly known as wasting syndrome, which is almost irreversible.

j. Bleeding from skin and bowels.

Take care

Allen Lai

The journey that you take

The journey that you take to fight prostrate cancer or any type of cancer matters.

If you are still looking for a golden rule to practice, look no further. The golden rules of this journey are:
a.     Believe in yourself.
b.     Believe in faith and hope.
c.      Believe in having knowledge makes the difference.
d.     A journey forward has no turn around.
e.     Helping each other along the journey makes our journey more purposeful. 
f.      It is best to talk to one who has been there, and not to others who will only offer sympathies and half- truths at best. Our journey together will teach you to take the falls and overcome each and every obstacle.

Success is an ability. First is to recognize an opportunity. Second is to form a plan and strategy to leverage on the opportunity and lastly to acquire the necessary skills to execute the plan and strategy. Your journey, which starts with the first step, will take you to a victorious end.

Prostate cancer is generally a slow growing cancer. It is treatable and you should have adequate time on your side. Early detection is key to successful prognosis. Medical science is progressing by leaps and bounds with new drugs, imaging tools and sustainable treatment protocols. Be knowledgeable with Prostate cancer. Join social and support groups to allay your anxiety and improve the quality of your lifestyle. Enjoy the benefits of joining your nearest Prostate Cancer Support group.

In summary, you should always assess yourself. How old and healthy are you? How aggressive is your prostrate cancer? Are your symptoms real or perceived?  Are your symptoms related to your cancer or due to other ailments? Knowledge is empowering. Doing the necessary at the critical time may save your life, or at the least lengthen your survival period by years or months. Maintain a diary to discuss and share your prognosis. Read recommended books, Dr David Servan-Schreiber’s classic book Anti Cancer – a new way of life being a good book to start with. Also read Terry Herbert’s booklet  A Strange Place – An Information Guide to Prostrate Cancer. Be cautious of misinformation and false expectations to remedies. Note that Louis Pasteur (1813 -1878) said “The microbe is nothing. The terrain is everything”.

Take care

Allen Lai