What are the associated factors of prostate cancer?

Prostate cancer is now the third most likely cancer a Malaysian man may develop. Like many developing economies, the number of cases is increasing and there appears to be a correlation between cancer incidence and standard of living. High consumption of red meat is thought to contribute towards cancer development and there is also a link between obesity and diabetes; conditions which are quite prevalent in Malaysia. As more and more men enjoy longer life expectancy, an increase in the incidence of prostate cancer is more apparent, as explained by Dr. Loh Chit Sin, Consultant Urologist at Gleneagles Hospital Kuala Lumpur.

Lifestyle may also be a contributing factor to prostate cancer. High consumption of red meat, animal fat, processed food, and obesity, especially with diabetes and hypertension are thought to increase cancer risk. Approximately 10% of prostate cancer have a genetic basis and may run in the family. Protective measures are believed to include the consumption of tomatoes, broccoli, green tea, and soya-based food. There are also some data suggesting that active sex life can be protective. There had been some studies looking at using certain drugs such as Finasteride and Dutasteride to prevent the development of prostate cancers, but the outcome of these studies was mixed and none of these drugs had received recommendations from the experts.

What are the associated factors of prostate cancer?

In Malaysia, many of the recent increases in cases of prostate cancer can also be attributed to better detection. Many men, especially those who have ready access to well-men examination have their cancer detected from a routine blood test; the PSA blood test. Indeed, almost all cases of early cancer are detected through this test and no symptoms are felt at the early stages of cancer.

What is a prostate-specific antigen (PSA) test?

This blood test is widely available in all pathological laboratories and both government and private clinics. This test has a very powerful predictive value when normal. Normal results (less than 4 ng/ml) are fine but very low values are very reassuring. For example, values of less than 1 ng/ml imply a very low risk of cancer development a couple of decades into the future. Generally, awareness about this disease and this blood test varies very widely across the different communities with the highest awareness seen among urban-dwelling men and the lowest among rural folks, many of whom only seek treatment at later stages of the cancers.

Some non-cancerous conditions of the prostate may lead to slight increases in PSA and cause false alarms. However, it is important to note that cancers always grow relentlessly and never come and go or stand still. Thus, when each PSA reading is higher than the earlier one successively, prostate cancer must be suspected and hunted down. In cases where cancer is present, the level of PSA indicates the quantity of cancer. Thus, when cancer is only discovered after PSA has become quite high, cancer will be in its later stages and treatment will be less effective.

Detecting Cancer

Cancer can only be confirmed through a biopsy test when a sample of cancer tissue is obtained for microscopic examination. However, when the cancer is still quite early and entirely curable, it can prove quite elusive and difficult to detect. In recent years, imaging, and detection technology such as multi-parametric MRI scan; according to the PIRADS protocol, has improved vastly and biopsy tests are now guided by these images and not done at random based on suspicion which can result in missing underlying cancer. In some western countries, these MRI/USS fusion biopsies using specialising designed equipment has vastly improved detection rate and become normal standard practice in cancer diagnosis. Both PIRADS multi-parametric MRI prostate scans and MRI/USS fusion biopsies are available in several hospitals in the Klang Valley.

Curing Prostate Cancer

Prostate cancers at their early stages are entirely curable and there are several options, each with its advantages and disadvantages. These include surgery, radiation, and heat (e.g., high-intensity focused ultrasound – HIFU) or cold treatment cold destruction (cryotherapy) of the tumours. Focal therapy, the focused destruction of just cancer alone and not the entire prostate gland, is currently being investigated but the juries are still out with regards to its effectiveness.  

Da Vinci® Surgical System For Prostate Cancer

Some 80% of early prostate cancers are treated with surgery. Surgery for prostate cancers runs the risk of causing erectile dysfunction and a small risk of urinary incontinence but despite these, it is still the most popular among patients because of its perceived highest efficacy. The invention of the operating robot had revolutionised prostate cancer surgery and robotic prostatectomy has become the gold standard in early prostate cancer treatment, especially in Western countries.

Robotic surgery is an advanced form of keyhole surgery which significantly reduces pain, and blood loss, speeding up recovery whilst at the same time reducing the risk of urinary incontinence and erectile dysfunction. There is currently only one type of operating robot for prostate cancer surgery, namely the Da Vinci® Surgical System. This technology, with all its benefits to the patients, adds approximately RM20K to their treatment cost. This system is available in a couple of Ministry of Health and private hospitals in the Klang Valley. In the years to come, other makes of operating robots may become available, and the procedure will become more affordable to many.

Written by

Dr Loh Chit Sin

Consultant Urologist and Robotic Surgeon

Gleneagles Hospital Kuala Lumpur