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.


http://www.nccn.org/patients/guidelines/cancers.aspx#prostate

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.

http://cancerprogressreport.org/2015/Documents/AACR_CPR2015.pdf


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:

http://feelgoodfeelinggood.blogspot.my/2014/09/rise-and-fall-of-psa-post-radiotherapy.html

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:

http://www.cancerresearch.org/prostate-cancer


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 :
https://www.youtube.com/watch?v=wWPup3QEVjw

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:





Year
2/7/2013
26/5/2015
Weight (Kg)
69.5
69.3
Body Fat
27.9%
27.3%
Actual age (1944)
68
70
Bio- age
63
63
BMI
25.4
25.1
Basal Metabolic Rate
1554
1553
Viseral fat
14%
13.5%
Skeleton
27.7%
27.7%
Trunk fat
17.3%
16.9%
Leg fat
24.6%
23.9%
Arm fat
24.1%
23.5%
Whole body fat
19.2%
18.8%
Trunk Muscle
20.4%
20.8%
Leg Muscle
45%
45.2%
Arm muscle
34.2%
34.4
Whole body muscle
27.5%
27.8%


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


Serum PSA profile following Radiation Therapy for Prostrate Cancer: Implication for patterns of failure and definition of cure






Another Pub Med.Gov report in April 1998. Study still valid.

Abstract

OBJECTIVES: 

A reference range of prostate-specific antigen (PSA) values compatible with cure following radiotherapy (RT) for prostate cancer (PCa) has yet to be established. Various thresholds, as low as 0.5 ng/mL, have been used to define biochemical disease-free status. We report PSA profiles in 118 patients who were systematically biopsied following standard RT, with a minimum 4-year follow-up.

METHODS: 

One hundred eighteen patients were treated with standard external beam RT from May 1987 to October 1991, and were followed prospectively with transrectal ultrasound (TRUS)-guided biopsies and measurement of serum PSA levels. Stage distribution was as follows: T1b: 25 patients, T2a: 27 patients, T2b/c: 42 patients, T3: 23 patients, T4: 1 patient. Median follow-up for patients without clinical failure is 68 months (range 48 to 108). Treatment failures were categorized as biochemical (biochemical failure [chemF]: PSA level of 2.0 ng/mL or more and greater than 1 ng/mL over nadir), local (local failure [LF]: positive biopsy and PSA level greater than 2.0), and distant failure (DF).

RESULTS: 

PCa recurred in 55% of patients: 38% LF (n = 45; 30 isolated and 15 with DF), 25% DF (n = 30; 15 isolated and 15 with LF), and 4% chemF (n = 5). Mean PSA nadir was 0.4 for patients with no evidence of disease (NED) and occurred at 33 months, 3.2 for LF at 17 months, 7.7 for DF at 12 months, and 1.4 for chemF at 24 months. After reaching the nadir, PSA in patients with recurrence followed first-order kinetics, rising exponentially over time. The mean PSA doubling time was 12.6 months for LF, 5.2 months for DF, and 21.8 months for chemF (P = 0.004). At last follow-up, the median PSA for patients without evidence of disease is 0.5 ng/mL. Four such patients had PSA values that rose to between 1 and 2 ng/mL for 5 to 38 months, but these eventually fell again to less than 1 ng/mL. Three patients had PSA values between 2 and 3 ng/mL, but 2 now have decreasing levels and the third has a rising level. All patients whose PSA levels rose to greater than 3 ng/mL exhibited a persistently rising pattern and ultimate tumor recurrence.

CONCLUSIONS: 

There is a range of PSA values following RT for PCa that is compatible with cure. A definition of biochemical disease-free status at any absolute threshold of PSA level less than 3 ng/mL will overdiagnose failure in a significant proportion of patients. Patients with a PSA level between 1.5 and 3 ng/mL should be observed until there is unequivocal evidence of disease recurrence. In the absence of known biopsy status, PSA doubling time can be a useful indicator of whether failure is local or distant.
View report here:


Take care
Allen Lai

Pattern of local failure following Radiation Therapy for Prostrate Cancer




A study report from Pub Med.Gov dated 14 May 2015

Abstract

INTRODUCTION: 

Little is known about patterns of local failure following radiation therapy (RT) for prostate cancer (PCa). We aimed to characterize post-radiation biopsy (PRB) findings, including the presence of treatment effect, and the zonal distribution of recurrent disease after RT in men experiencing biochemical recurrence (BCR).

MATERIALS AND METHODS: 

We identified patients who received PRB in the setting of BCR following primary radiation for localized disease. Histologic PRB results were categorized by the absence of tumor, demonstration of radiation treatment effect, failure (recurrent cancer), or a combination of treatment effect and failure. We describe patterns of histologic failure and compared them to the diagnostic biopsy findings.

RESULTS: 

284 underwent mapped PRB for BCR. Mean age at initial diagnosis was 63 years, median PSA was 8.2 ng/ml; 33% of men were classified as low, 32% intermediate, and 35% high risk, based on clinical CAPRA categories. Median time to PRB was 61 months post-treatment and findings were negative in 4%, treatment effect in 31%, failure in 45%, and a combination in 20%. Failure rates were similar across sextants. Among 140 patients with mapped pre-and post-treatment biopsies, 4% demonstrated cancer in a new location previously identified as negative. Gleason upgrading occurred in 43%, with 85% upgraded ≥ 4+3.

CONCLUSIONS: 

Men with rising PSA after radiotherapy for PCa most often recur in dominant tumor sites. Whether failure is due to inadequate targeting, dosing or intrinsic radiation resistance remains unknown, and further study is warranted.

See study report here




take care

Allen Lai

Saturday, June 6, 2015

Rosetta Stone for Prostate Cancer found



Prostrate cancer cells



Researchers say that doctors could now start testing for the mutations and give patients with advanced prostate cancer existing drugs or drug combinations which are known to targeted the specific genomic aberrations



Hi all,


Read report published in Cell :


Almost 90 per cent of men with advanced prostate cancer carry genetic mutations in their tumours that could be targeted by either existing or new cancer drugs, a landmark new study reveals.
Scientists in the UK and the US have created a comprehensive map of the genetic mutations within lethal prostate cancers that have spread around the body, in a paper being hailed as the disease's 'Rosetta Stone'.

Researchers say that doctors could now start testing for these 'clinically actionable' mutations and give patients with advanced prostate cancer existing drugs or drug combinations targeted at these specific genomic aberrations in their cancers.

The study was led in the UK by scientists at The Institute of Cancer Research, London, in collaboration with researchers from eight academic clinical trials centres around the world.
Uniquely, doctors at The Royal Marsden NHS Foundation Trust and at hospitals in the US were able to collect large numbers of samples of metastatic cancers -- cancers that had spread from the original tumour to other parts of the body.

Normally these samples are extremely hard to access, and this is the first study in the world to carry out in-depth analysis of metastatic prostate cancers that are resistant to standard treatments.
The research is published in the journal Cell, and is funded by Stand up to Cancer and the Prostate Cancer Foundation.
Researchers analysed the genetic codes of metastatic tumours from the bone, soft tissues, lymph nodes and liver of 150 patients with advanced prostate cancer.
Nearly two thirds of the men in the study had mutations in a molecule that interacts with the male hormone androgen which is targeted by current standard treatments -- potentially opening up new avenues for hormone therapy.
Mutations in the BRCA1 and BRCA2 genes -- most famous for their roles in breast cancer -- were found in nearly 20 per cent of patients. Recent work at The Institute of Cancer Research (ICR) and The Royal Marsden has shown that these patients can be treated effectively by drugs called PARP inhibitors.
Researchers also discovered new mutations, never detected before in prostate cancer, but which do occur in other cancers. These include mutations in the PI3K and RAF gene families which can also be targeted by existing drugs, either currently in trials or approved for use in the clinic.
The researchers also took blood tests to analyse patients' own genomes, and found that 8 per cent were born with DNA errors that predisposed them to prostate cancer.
They said this could strengthen the case for genetic screening for people with a family history of the disease.
Previous genetic studies on prostate cancers had mostly analysed tissue from the primary tumours, which tend to carry fewer mutations than metastatic sites.
Studies of metastatic sites had been small and mostly used tissue taken during post mortems -- whereas in this study doctors took needle biopsies taken from patients during the course of their treatment.
Professor Johann de Bono, Professor of Experimental Cancer Medicine at The Institute of Cancer Research, London, and Consultant at The Royal Marsden NHS Foundation Trust, said: "We have for the first time produced a comprehensive genetic map of the mutations in prostate cancers that have spread round the body. This map will guide our future treatment and trials for this group of different lethal diseases. We're describing this study as prostate cancer's Rosetta Stone -- because of the ability it gives us to decode the complexity of the disease, and to translate the results into personalised treatment plans for patients.
"Our study shines new light on the genetic complexity of prostate cancer as it develops and spreads -- revealing it to be not a single disease, but many diseases each driven by their own set of mutations. What's hugely encouraging is that many of the key mutations we have identified are ones targeted by existing cancer drugs -- meaning that we could be entering a new era of personalised cancer treatment."
Professor Paul Workman, Chief Executive and President of The Institute of Cancer Research, London, said: "Cancer becomes lethal at the stage when it spreads round the body and stops responding to treatment -- but until now it has been incredibly difficult to find out exactly what is going on genetically at that critical point.
"This major new study opens up the black box of metastatic cancer, and has found inside a wealth of genetic information that I believe will change the way we think about and treat advanced disease. The study found that almost 90 per cent of metastatic tumours had actionable mutations, which means that these findings could make a real difference to large numbers of patients."

Read BBC's article here:
http://www.bbc.com/news/health-32818060


Take care all

Allen Lai

The scientific link between happiness and exercise






Hi all,

View the scientific link between happiness and exercise.  Now that you know, be happy.

Visit the link below:




Take care

Allen Lai