Prostate cancer is one of the most prevalent cancers among men and poses a significant health concern, with its incidence on the rise. In Thailand, it is the 4th most common cancer among men (1), while globally, it ranks as the 2nd most common cancer among men (2). Key warning signs include abnormal urination, blood in the urine, and severe pain in the lower back, pelvis, or thighs. This disease may also have a hereditary component (3).Regular screenings are strongly recommended for men aged 50 and above. Recent advancements in novel hormonal therapies (NHT) have demonstrated high efficacy with fewer side effects, which can improve the quality of life for those diagnosed.
According to the World Health Organization (WHO) in 2022, approximately 3,829 men in Thailand die from prostate cancer each year (1), with about 7,830 new cases diagnosed annually. Globally, there are around 397,430 deaths and 1,467,854 new cases each year (2). These statistics highlight the importance of awareness and proactive health measures.
In response to the need to raise awareness about the disease, Bayer Thai Co., Ltd. recently organised a seminar titled "Driving Towards Better Living with Prostate Cancer" featuring leading experts such as Assist Prof. Pongwut Danchaivijitr from Siriraj Hospital and Prof. Dr. Kittinut Kijvikai from Ramathibodi Hospital. Together, they shed light on the critical role of the prostate gland, the importance of recognising warning signs, and the latest advancements in screening and treatment options.
The Importance of the Prostate Gland
Assist. Prof. Pongwut explains that the "prostate gland" is a small organ in males resembling a chestnut, located beneath the bladder and in front of the rectum. It produces fluid that is a component of semen. The male sex hormone is crucial for the growth of the prostate gland, but when cells in the prostate become abnormal and divide uncontrollably, they can eventually form tumours.
Understanding Prostate Cancer
Risk factors for prostate cancer include increasing age and genetics. If there is a direct family history (father, grandfather, brother, or son with the disease), the risk increases. Other risk factors include race, with individuals of European and American descent exhibiting a higher incidence than those of Asian descent. Additionally, obesity, lifestyle choices, and abnormally high levels of male hormones, such as unnecessary hormone supplementation, are also contributing factors.
Prostate cancer is classified into four stages. In the first stage, cancer is confined to the prostate and is usually asymptomatic. In the second stage, cancer cells grow but remain localised within the prostate. In the third stage, cancer cells spread to the outer layers of the prostate. In the fourth stage, cancer spreads into the bloodstream or lymphatic system to other organs, such as bones. Some patients may already be diagnosed at the metastatic stage, making treatment more challenging.
Recognising Warning Signs and Promptly Seeking Medical Consultation
Prof. Kittinut advises men to watch for warning signs of prostate cancer, including: 1. Abnormal urination, blood in urine, and difficulty urinating. 2. Severe pain in the lower back, pelvis, and thighs. 3. Other symptoms in the metastatic stage may include fatigue, body aches, numbness or weakness, bone deterioration, weight loss, loss of appetite, nausea, and vomiting. It is important to note that some patients may remain asymptomatic.
Patients may not know they have prostate cancer as the symptoms can resemble those of benign prostatic hyperplasia (BPH) in older men or other bladder issues. Therefore, to ensure clarity, initial screening should involve two complementary methods: 1. A thorough medical history and physical examination, including a digital rectal examination (DRE) performed by a physician, and 2. A blood test to measure prostate-specific antigen (PSA) levels, which serves as a biomarker for prostate cancer. Typically, PSA levels should be below 4 ng/mL; however, levels exceeding 10 ng/mL significantly elevate the risk of prostate cancer. In such cases, the physician may recommend further imaging studies, such as MRI or a biopsy for definitive diagnosis.
Prof. Dr. Kittinut states, “Patients in the early stages may have small tumours in the prostate and often show no clear symptoms. As the disease progresses, the tumours grow larger and spread through the bloodstream and lymphatic system. Early detection - improves the likelihood of curative intervention; however, if diagnosed at a metastatic stage, complete eradication of the disease is often unattainable. In such cases, a multidisciplinary team approach may be necessary to optimise patient longevity and maintain quality of life.”
Treatment options for Prostate Cancer
Treatment depends on the stage of the disease and the appropriateness for each patient. In the early stage, when the cancer has not spread, treatment focuses on localised therapy and proactive monitoring. Treatments can include radiation therapy and prostate surgery, which can now be performed safely using robotic assistance. However, if the disease progresses and begins to metastasise, pharmacological interventions become increasingly important in managing cancer cell dissemination. A multimodal treatment approach may be employed to optimise patient outcomes.
“For patients in the early stage who undergo surgical intervention, physicians will closely monitor PSA levels. If PSA levels remain within the normal range, this suggests that the surgery was successful in achieving oncological control. However, if PSA levels remain elevated, adjuvant radiation therapy may be necessary to inhibit the metastasis of cancer to other organs, such as the bones. Additionally, systemic oral medications may be incorporated to complement the surgical treatment,” stated Prof. Dr. Kittinut.
Novel Hormonal Therapy (NHT) in Advanced Prostate Cancer Treatment
Assist. Prof. Pongwut said that “Testosterone is the primary driver of prostate cancer growth. For advanced or metastatic prostate cancer, androgen deprivation therapy (ADT) is essential to prevent cancer cells from spreading to other organs. Currently, there are new oral hormonal therapies (NHT) that are more effective than before and can be used in conjunction with androgen deprivation therapy. These therapies can inhibit testosterone's action through multiple mechanisms, significantly slowing disease progression, with high efficacy and low side effects compared to other treatments, allowing patients to live longer with a good quality of life.”
Considerations for Treatment Intensification
Treatment intensification refers to the combination of multiple drugs and methods, such as:
- Androgen deprivation therapy alone
- Androgen deprivation therapy combined with chemotherapy
- Androgen deprivation therapy combined with novel hormonal therapy
- Androgen deprivation therapy combined with novel hormonal therapy and chemotherapy
Key factors in consideration include:
- Disease stage: For patients with advanced prostate cancer or high-risk features, physicians may propose combination therapies to enhance efficacy.
- Other conditions: Comorbidities (diabetes, hypertension, heart disease) that may limit or affect treatment options.
- Age and performance status: Older patients often undergo performance assessments and other conditions.
- Input from a multidisciplinary team, including urologists, medical oncologists, radiologists, etc.
Physicians will use this information to formulate treatment plans and select the most appropriate approach, with the primary goals being disease control, reducing metastasis, extending lifespan, and maintaining quality of life.
Potential Side Effects of Treatment
- Androgen Deprivation Therapy (ADT/NHT): Patients may experience symptoms similar to menopause, including hot flashes, night sweats, fatigue, and reduced libido. Additionally, there may be a decrease in bone and muscle strength, increasing the risk of osteoporosis.
- Chemotherapy: Patients might encounter side effects such as nausea, vomiting, hair loss, and a reduction in white blood cell count, which can lead to a heightened susceptibility to infections.
- Radiation Therapy: Patients may suffer from irritation of the bladder or rectum, resulting in frequent urination, abnormal bowel movements, or skin irritation in the areas exposed to radiation.
- Prostate Surgery or Orchiectomy: There are risks of complications, including bleeding, infection, and urinary incontinence.
Despite these side effects, advancements in medication and new technologies have improved patient tolerance to treatment and maintained satisfactory quality of life.
Regular Health Checks for Timely Treatment
Prof. Kittinut emphasises that there are prostate cancer patients without identifiable risk factors or clear causes. Therefore, men should undergo annual health screenings, starting prostate cancer screening at age 50, regardless of symptoms. However, for those with a direct family history of prostate cancer, screening should begin earlier, at ages 40-45.
Assist Prof Paneeya Sutabutra, Country Medical Director of Bayer Thai Co., Ltd., said that as a global leader in pharmaceuticals with expertise in prostate cancer care, Bayer supports awareness campaigns to encourage men aged 50 and over to undergo regular prostate cancer screenings. This ensures timely diagnosis and treatment planning with specialists, aiming for a better quality of life and enabling patients to live as happily as possible.”
Prostate cancer is a silent threat that men should pay attention to. Early detection and prompt treatment can significantly reduce mortality rates and improve quality of life. Despite potential side effects from treatment, advancements in technology and novel hormonal therapies (NHT) provide patients with effective treatment options. It is essential to consult with specialists to plan the most appropriate treatment for individual.
Reference
- https://gco.iarc.who.int/media/globocan/factsheets/populations/764-thailand-fact-sheet.pdf
- https://gco.iarc.who.int/media/globocan/factsheets/populations/900-world-fact-sheet.pdf
- https://res.cloudinary.com/pcf/images/v1693262092/PCF_PatientGuide_8.2023/PCF_PatientGuide_8.2023.pdf?_i=AA
COR-NUB-TH-0012-1 (01/2025)
