When it comes to managing prostate cancer, there is no one-size-fits-all approach. Men must consider a variety of factors before making treatment decisions, from the stage of cancer to their age, overall health, and personal preferences.
Prostate cancer treatment often involves a multidisciplinary approach, and the decision-making process should always involve open discussions with healthcare professionals, weighing the benefits and potential side effects of each option to craft a treatment plan that suits their unique needs.
University Malaya Urologist Dr Ahmad Nazran Fadzli outlined the diagnostic process, treatment modalities, and side effects men should consider.
While prostate cancer often presents itself without symptoms, early detection through prostate-specific antigen (PSA) tests and regular medical consultations can make a critical difference.
"Prostate cancer screening primarily involves the prostate-specific antigen (PSA) test.
"While this test is specific to the prostate, it’s not always specific to the disease. Conditions like urinary tract infections or a naturally large prostate can also raise PSA levels," he said in a podcast video with Sinar Daily.
Despite the risk of false positives, PSA testing remains a key strategy for early detection. Dr Nazran highlighted that men over the age of 50 should consider PSA testing.
"For those with a family history of prostate cancer, we advise starting PSA tests at 40 after a discussion with a healthcare professional," he said.
DIAGNOSTIC PATHWAY
Dr Nazran outlined the diagnostic pathway for prostate cancer, starting with a thorough patient history and a physical examination of the prostate.
"We perform a digital rectal examination, where we use a lubricated finger to feel the prostate—it’s the only way to physically assess the gland,” he said.
The next steps depend on the patient’s PSA levels and examination findings.
"If the PSA level is normal and the examination reveals nothing concerning, we proceed with shared decision-making to determine if further tests are necessary," Dr Nazran said.
However, if PSA levels are significantly elevated, advanced imaging like magnetic resonance imaging (MRI) is the next step.
"If the MRI indicates potential abnormalities, we perform a prostate biopsy to confirm the diagnosis," he added.
Following this, staging tests such as CT scans, bone scans, or advanced positron emission tomography (PET) scans help determine the cancer’s progression and guide treatment decisions.
For men diagnosed with localised prostate cancer, surgery is not the only option.
Dr Nazran explained there are several alternative treatments, tailored to the patient’s risk profile—low, intermediate, or high.
"One approach is active surveillance, where we monitor the patient closely and intervene only if the cancer shows signs of progression," he said.
For patients who prefer or require intervention, radiation therapy is a common choice.
"There are two types: external beam radiation therapy, where a machine delivers radiation over several sessions, and brachytherapy, where we implant radiation seeds inside the prostate to treat it from within," he added.
For those who cannot undergo treatment, Dr Nazran said watchful waiting is another option.
"This approach involves managing symptoms as they arise, such as addressing bone metastases or anemia," said Dr Nazran.
He also stressed the need for patients to make informed decisions about their care.
"Websites like 'Beat Prostate Cancer' provide excellent resources, including videos, to help men understand their options," he shared.
Early detection, combined with a personalised treatment plan, offers the best outcomes for men facing this disease.