Prostate cancer in the Philippines and the hope offered by LUTETIUM PSMA for the Filipino patients

By Ambassador Victor Raja David V. Gumabon

Prostate cancer is still the leading form of cancer among males in the world. In 2022, there have been 1,467,854 total cases of prostate cancer and a total of 397,430 deaths (World Cancer Research Fund International, 2022). According to Department of Health, prostate cancer is the third most common type of cancer among Filipinos; prostate cancer affects about 19.3% per 100,000 men in the Philippines.

Prostate cancer is caused by an abnormal growth of cells in the prostate gland of a male located under the bladder and toward the front of the rectum. The prostate plays an important role in the male’s reproductive system through production of fluids that serves as protection for the sperm cells. The size of a prostate is that of a walnut in younger men, however, it can grow larger as age progress. According to most of medical professional’s belief, prostate cancer is slow-growing and older men are mostly affected.

Due to the prostate cancer’s slow progression compared to other forms of cancer, most of the patients are highly unlikely to exhibit and experience obvious symptoms, not until the cancer is in its advanced stages. Prostate cancer patients may feel an increased urge to urinate and/or a significantly weaker urine flow, difficulty in starting to urinate, and feeling or sensation that the bladder has not been emptied. These aforementioned symptoms, however, may also indicate a benign enlarged prostate; best bet is to consult a medical professional in order to have a proper diagnosis. Signs and symptoms for advanced-stage prostate cancer may include blood in urine and semen, erectile dysfunction, weight loss, persistent pain around the back and hips area and shortness of breath and easy fatiguability caused by anemia.

The key statistics for prostate cancer as presented by the American Cancer Society, around 6 out of 10 prostate cancers are diagnosed in men aged 65 or older, and 67 is the average age where men are first diagnosed with this type of cancer. It is noted that prostate cancer is rare in men aged below 40. Age is just one of the risk factors for prostate cancer, genetics also plays a vital role of having one; ethnicity is also a factor as African males have a higher risk of having this type of cancer as compared to Caucasians, Hispanics and Asians. Inappropriate use of medications, long term usage of high doses of vitamin E and being on the heavy side (obesity) also contributes to having an increased chance of developing prostate cancer.

In order for a doctor to make a proper diagnosis, various medical examinations will be needed; most common tests for prostate cancer are physical exam and health history, prostate specific membrane antigen positron emission tomography (PSMA PET) scan, blood tests including prostate-specific antigen (PSA), digital rectal exam (DRE), biopsy, transrectal ultrasound (TRUS) and transrectal magnetic resonance imaging (MRI). The ACS do not recommend routine screening if symptoms are not apparent as the negative effects of the examination/testing procedures may overshadow its benefits.

Having prostate cancer is not a death sentence as there are various treatments for it depending on its progression and stage; the doctor will know and suggest the best treatment option/s. Treatment choices include Surveillance, Localized Therapy (Prostatectomy, Radiation Therapy, Cryotherapy and Focal Therapy) and Drug Therapies (Hormonal Therapy, Chemotherapy and Immunotherapy).

A relatively new prostate cancer treatment has arrived in the Philippines called Radionuclide Therapy or Lutetium Prostate-Specific Membrane Antigen (Lutetium PSMA); another name for this treatment is Lutetium-177 (Lu-177) radionuclide therapy. This advancement in the treatment for prostate cancer binds to specific receptors in prostate as well as neuroendocrine cancers. The beta radiation it emits targets the cancer cells and its radiation damages and destroys the cancer cells directly. Through this, the rest of the body is safe from the exposure (St. Luke’s Medical Center, 2023). Lutetium PSMA is mainly offered when cancer cells have spread beyond the prostate and was effective in lessening the pain produces long-term remission for most patients. Additionally, Dr. Andrew Dominic Kalaw, a Nuclear Medicine Specialist at Cardinal Santos said, “Essentially, Lutetium PSMA is a liquid radiation which is given intravenously to the patient. If a prostate cancer patient has already been through more common treatments like hormonal therapy or chemotherapy, but the cancer is still metastasizing or progressing, they can be offered Lutetium PSMA as another form of treatment, which is what we’re already doing here in Cardinal Santos”.

Lutetium PSMA is currently offered in only two hospitals in the Philippines, the St. Luke’s Medical Center and Cardinal Santos Medical Center as this treatment is new. Lutetium PSMA is mainly ordered in Europe and is delivered on the day it will be used. According to Dr. Kalaw, the first patient to undergo Lutetium PSMA in Cardinal Santos Medical Center presented promising results. The patient was admitted overnight and was discharged the day after, he tolerated the procedure and showed no complications. It is also worth noting that this treatment may have some short-term side effects for the first 24 hours such as lightheadedness, nausea, and in a rare instance, abdominal pain. Lutetium PSMA can be done around 3 to 4 sessions and was found to be a safe treatment and can be used together with an oral or injectable hormonal therapies without any issues.

This medical advancement in Lutetium PSMA can do wonders to prostate cancer patients and their family, however, most of healthcare professionals are still unfamiliar with it let alone those people outside the medical sphere. Doctors and other health practitioners who are aware of this procedure must present this to their patients as another or a better option for treatment, after all it is their duty to not withhold any information as it is the right of the patients to be knowledgeable of every option.