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A Journey of Hope: Treating Advanced Prostate Cancer with PSMA Therapy in Singapore

  • 22 May 2024
  • 5 mins

When Mr. Eun was looking for doctors to treat his advanced prostate cancer, seeking treatment in another country became necessary.

“Our primary concern was to find a hospital that was willing to accommodate the associated risks,” said Ji Soon, Mr. Eun’s daughter.

“We found information regarding PSMA treatment through online research. We extensively researched the treatment methods by exploring various articles, and academic papers, and gathering insights from individuals in our network, including feedback from doctors here in Korea,” she added.

In addition, Ji Soon said she explored the websites of hospitals in different countries to find options for international patients, contacting several hospitals via email to express their interest in the treatment.

“We contacted Farrer Park Hospital, and we were glad that Dr. Tan responded. He not only replied quickly but also patiently addressed our ongoing enquiries,” she said.

Prostate Incidence

In South Korea, prostate cancer stands as one of the most prevalent malignancies among men aged 65 and older, and its incidence has been on the rise in recent years, primarily due to the aging population.

The highest incidence of prostate cancer is observed within the 75-79 age group. Individuals aged 65 and over make up 77.2% of prostate cancer cases, with those aged 75 and above contributing to 35.9% of reported cases.

The disease occurs when cancer cells form in the prostate, a walnut-sized gland between the penis and bladder. In its early stages, prostate cancer is usually localized, but it can spread to other organs if left untreated or late detection.

As with most cancers, it is difficult to detect prostate cancer in its early stages because it does not present any signs. Symptoms such as frequent, painful, and weak urination only appear once the disease has progressed. Another reason why it may be missed is that it has similar symptoms as benign prostatic hyperplasia—also called BPH— in which the prostate gland is enlarged but not cancerous. Other prostate cancer symptoms include erectile dysfunction, painful ejaculation, lower back pain, and blood in the urine or semen.

Virtual Consultation

“Initially, when we made the decision to seek treatment in Singapore, we were not overly optimistic about the transformative potential of the PSMA treatment, as we believed we had already received the best available care in Korea. Plus, there were concerns about potential emergencies that might arise when receiving treatment overseas,” she recounted.

However, that did not stop Ji Soon from contacting Dr Tan to learn more.

“The first meeting was an online discussion with Mr. Eun and his daughter, and we also communicated through email with regard to his medical condition. He was diagnosed with metastatic prostate cancer, with lesions to his bones,” Dr Tan said.

Prostate cancer, when it spreads to the bones (bone metastases), can lead to significant pain and bone fractures. The risk of fractures naturally increases with age in all men, and this risk is further exacerbated when coupled with a prostate cancer diagnosis

During the initial discussion phase, various options were discussed, and Mr. Eun was actively consulting with the medical oncologists in Korea.

“As he was a newly diagnosed prostate cancer patient and treatment naive, the main aim of the treatment was to see if we could achieve a complete response to PSMA followed by a progression-free survival period after treatment, and then an aggressive treatment was proposed,” he explained.

The benefits and risks of such an approach were further discussed, and since Mr. Eun was reasonably young and in good physical condition, Dr Tan said such an approach would likely offer the best outcomes.

The option of conservative treatment was not discussed with Mr. Eun and Ji Soon, as it meant just allowing the natural progression of the disease and palliative care.

Farrer Park Hospital first introduced the Lu-177 PSMA Therapy for advanced prostate cancer in 2020. It allows for specific and targeted radiation therapy, typically in cases like Mr. Eun, where the tumor cells have spread to other sites outside the prostate.

“It is a treatment for advanced-stage prostate cancer patients. This form of targeted cancer radiotherapy has been shown to achieve good prostate-specific antigen responses with generally mild and transient side effects and ongoing trials are showing a trend towards improved survival outcomes,” Dr Tan said.

Treatment Journey

“From Dr Tan, we know that the PSMA treatment consists of a total of six sessions, with the possibility of adjusting the frequency based on post-treatment symptoms,” Ji Soon said.

“Dr Tan and his team guided us through the process patiently and my father went through the treatment doctor with a relaxed mindset.”

The patient underwent the outpatient treatment at the Nuclear Medicine facility in the hospital. Before the treatment, Mr. Eun had a PET/CT PSMA scan and blood tests at different intervals. While in treatment, Mr. Eun was monitored closely for the level of radiation as small amounts of radioactive materials, known as radionuclides, are infused into the bloodstream to travel to the cancerous cells to shrink or destroy them. He was also monitored closely for side effects such as nausea and headache.

“It was an uncomplicated process where he stayed in the treatment room for 3-4 hours after a 20-minute infusion,” Dr Tan said. Immediately after receiving treatment, Mr. Eun said he felt good, and the pain in his back was lessened.

“He experienced no side effects during the treatment itself, and during the scan the next day, I went through the results with him and his daughter. He is currently back in Korea on routine follow-up,” Dr Tan said.

Back in Korea

“It has been four months since we returned home, and we are very glad that my father is responding well and is in good shape. In addition to hormone suppression therapy, he continues his chemotherapy and radiation therapy,” Ji Soon described.

The Korean hospital where Mr Eun is being treated closely monitors his progression, although the cancer cells are now inactive. And from Singapore, Dr Tan is also actively following up and monitoring his condition.

“We understand that this is not perfectly cured, but based on how my father is getting on every day, the decision to come to Singapore to treat his advanced prostate cancer is the best decision we made,” she added.

“The long-term prognosis of his condition is still uncertain, but he has tolerated a fairly aggressive course of treatment, chemotherapy in Korea followed by Lu-177 PSMA Therapy in Singapore, we hope for the best,” Dr. Tan said. 

Contributed by

Dr. Andrew Tan
Nuclear Medicine Consultant
Nuclear Medicine Suite (Farrer Park Hospital)