Blocking Angiogenesis

Angiogenesis is the body’s process of creating new blood vessels, generally controlled by some chemicals in our bodies. At the same time our body can also generate angiogenesis inhibitors to interfere with blood vessel formation. Cancer cells rely on angiogenesis to grow, that’s where it draws its blood together with its supply of oxygen and nutrients to grow and spread.

The following are known to have natural angiogenesis inhibitors properties or as anti-angiogenesis food:

Red wine,

Turmeric.

Berries.

Tomato.

Lemon.

Dark Chocolate.

Green tea.

There many types of drugs that block blood vessel growth, namely drugs that block the vascular endothelial growth factor(VEGF) from attaching itself to the receptors on the cells lining the blood vessel to drugs that block signaling within the cell. Drugs like Avastin are used block VEGF and Sunitinib is used to block signals inside the cell.

There are also drugs that interfere signals between cells. These type of drugs include Revlimid.

There is so far only one anti angiogenesis treatment for PCa. The FDA has approved Provenge (Sipuleucel-T) to be used for advanced PCa. However Provenge is only approved for asymptomatic metastasis PCa.

Hopefully FDA will approve more drugs for advanced PCa in the near future as there are many on -going clinical trials at its ending phase.

Take care

Allen Lai

UMMC EXERCISE SUPPORT GROUP -ESG

The ESG was founded in 2014 at the University Malaya Medical Centre. The Support Group provide full gym works and active fun activities for all types of cancer survivors. Sessions are organised every Saturday morning at the UMMC under the supervision of the Sports medicine Department. Faculty staff will be at hand to assist and monitor all sessions. Fun activities include Zumba dances, runs, excursions and trekking. The ESG caters to all cancer survivors.

Below is the link to the UMMC ESG.

https://www.facebook.com/pg/exercisesupportgroup/about/?ref=page_internal


Take care, have fun and enjoy.

Allen Lai

Prostate Cancer and Exercise

I cannot over emphasise the importance of exercise for PCa, or for that matter exercise for all types of cancers.
Most cancer treatment centres today prescribe exercise as a form of therapy. Exercises does wonders to the body, no matter how old you are or how frail you are. I thank my belief that exercising is the least I can do for myself. Exercising over the years have paid off. It has helped me to cope with the harsh treatments and also calm myself when I start to worry. Now I have combined exercise with a passion to photograph birds. Yes a dual therapy. Birding has taught me to be patient and calm as I stalk near to photograph the bird. I can be very focused when I go birding. Of course the exercise part is actually carrying the heavy load of the camera gears and tripods and tracking long distances into the bird's habitats.

Below is a link to The Institute For Prostrate Cancer Research's video on PCa and Exercising. Read it  for better assurance.


https://www.youtube.com/watch?time_continue=2&v=YAgUtHNt530


Take care

Allen Lai

Systemic Therapies for Metastatic Pca cancer

Most of are out of the woods after our initial primary treatments which has an almost "8 years remission  period". We just monitor our PSA on a scheduled programme as prescribed by our Oncologist. The 8 years honeymoon period is a given, to all who had done the primary treatments after scanning positive. Yes eventually there will  be a rise in the PSA, some faster than others. And rise it will until we reach the next PCa biomarker, when our Oncologist will propose the next round of treatments. Systemic therapies are the buzz words today. All is not lost, just another round of treatments with new drugs and with better efficacies, precision and focus.

View MSKCC's available systemic therapies below


https://www.mskcc.org/cancer-care/types/prostate/treatment/systemic-therapies

Take care

Allen Lai

New Drugs approved by the FDA 2017

Yes I have not been posting articles and references for sometime now. How time has passed. And that is good because the FDA is approving more drugs for PCa. Here is the full list as at March 2017.
See link below.


https://www.cancer.gov/about-cancer/treatment/drugs/prostate



Take care

Allen Lai

PSA baseline 2017 is now 0.25

It has been a good year for me in 2016 with a total PSA rise from 0.162 to 0.250. The second half of 2016 rose by 0.06

Yesterday I visited IKN for my biannual checkup. My PSA reading was 0.260, only a 0.01 point rise. The first half of 2017 rose by only 0.01. A DROP of 0.05 points. It looks like my new PSA baseline is now 0.25.

Weight constant at 70 kg

BP good at 117/76

Pulse rate at 104 bpm

Body Oxygen level at 97%

I am good save for my blood sugar level. I even had an EGC done to confirm my heart beats and rhythm.

Take care

Allen Lai

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.

Cilisos.my has an article published recently showing the costs involved for hospital stays, screenings and treatment of cancers in Malaysia. See link below:

http://cilisos.my/how-much-does-it-cost-to-treat-cancer-in-malaysia-we-try-to-break-it-down/

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

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 www.feelgoodfeelinggood.blogspot.com 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

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

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

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

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:

http://www.nejm.org/doi/full/10.1056/NEJMoa1506859?query=featured_home

Good things are a-coming.

Take care

Allen Lai

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:

http://www.esmo.org/Guidelines/Genitourinary-Cancers/Cancer-of-the-Prostate

Take care 

Allen Lai

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:

http://www.pctrf.org/comparing-treatments/

Do read the tutorial and explanations before viewing your chart.

Take care

Allen Lai

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:

http://lifestyle.au.truenth.org/why-exercise

Take care, happy exercising and enjoy your physical activities.

Thank you Movember Foundation.

Allen Lai