According to statistics from the Ministry of Health and Welfare, the incidence and mortality rates of prostate cancer are increasing annually, ranking as the 5th and 6th most common cancer among men, respectively. While early detection ensures a nearly 100% five-year survival rate, metastasis drops this rate to below 40%, making it a silent killer for men.
The rising number of prostate cancer patients is attributed to several factors: an aging population (as prostate cancer predominantly affects middle-aged and elderly men), increased PSA (Prostate-Specific Antigen) screenings detecting early-stage cancer, dietary habits (such as high consumption of red meat and fatty foods), environmental factors like air pollution, and advancements in genetic testing revealing gene mutations as potential risk factors.
Early-stage prostate cancer typically presents no symptoms, often going unnoticed by patients. Symptoms such as difficulty urinating or frequent urination only appear when the tumor invades the urethra or bladder neck. Severe cases may involve urinary incontinence, hematuria, and, in later stages with bone metastasis, bone pain, pathological fractures, or neurological symptoms due to spinal cord compression.
Dr. Neng-Chuan Tseng, Director of Nuclear Medicine at Tung's Taichung MetroHarbor Hospital, stated that treatment for localized prostate cancer primarily involves surgery and radiation therapy. With medical advancements, surgical options now include robotic surgery, cryotherapy, hydrodissection, prostate lift, and HIFU (High-Intensity Focused Ultrasound). Locally advanced prostate cancer requires additional hormone therapy, while metastatic prostate cancer is treated with chemotherapy, new hormone therapies, targeted therapy, immunotherapy, and radiopharmaceuticals.
Compared to other cancers, prostate cancer treatment and prognosis are generally better, requiring long-term follow-up and precise management. Post-treatment, patients' tumor control is monitored using the PSA blood test. However, clinical scenarios often show abnormal PSA levels (e.g., consecutive PSA tests exceeding 0.2 ng/ml or an increase of over 2 ng/ml), necessitating further imaging to confirm lesion location and potential metastasis. Traditional imaging methods like bone scans, CT, and MRI typically only detect lesions when PSA levels are significantly elevated (>10 ng/ml), limiting early intervention for recurrent or metastatic disease.
To improve prostate cancer diagnosis and treatment outcomes, Tung's Taichung MetroHarbor Hospital has introduced next-generation imaging techniques aligned with European and American standards. These advanced imaging methods can detect over 50% of microrecurrences and distant metastases at low PSA levels (>0.5 ng/ml), enabling precise treatment adjustments and reducing unnecessary treatments and side effects. In 2021, the hospital introduced Axumin PET imaging for accurate detection of recurrent or metastatic prostate cancer, followed in 2023 by FDA-approved PSMA PET imaging for early diagnosis and recurrence detection. PSMA PET is recognized as the best imaging technique for detecting primary prostate cancer lesions and metastases in lymph nodes and distant organs.
Dr. Tseng noted that PSMA PET imaging includes Ga-68-PSMA-11, F-18-DCFPyL, F-18-PSMA-1007, and the recently approved F-18-rhPSMA-7.3 (as of May 31, 2024), and can evaluate castration-resistant bone metastasis treatment with Ra-223 dichloride and the latest European and American Lu-177 PSMA Radioligand Therapy (RLT).
In addition to next-generation precision imaging, radiopharmaceutical therapies with targeted characteristics and minimal side effects are being adopted globally. For instance, Ra-223 dichloride therapy, introduced domestically nearly five years ago, uses short-range alpha particles to kill cancer cells and can now be combined with other treatments for castration-resistant bone metastatic prostate cancer. The latest Lu-177 PSMA RLT from Europe and the US releases beta particles to eliminate prostate cancer cells with PSMA molecules, lowering PSA levels and extending patient survival.
Prostate cancer diagnosis and treatment technologies are rapidly advancing, with Tung's Taichung MetroHarbor Hospital leading in Taiwan. The hospital focuses on innovation in cancer treatment and optimizing patient care by continuously adopting the most advanced diagnostic and medical technologies internationally, aiming to provide the best treatment outcomes and quality of care for patients.
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