KUALA LUMPUR, Sept 25 \u2014 When a 72-year-old patient found himself unable to enjoy even the simplest pleasures, such as sharing meals with his family and playing golf with friends, he thought it was just part of ageing. <\/p>\n
But persistent reflux and unexplained vomiting led to a devastating diagnosis: advanced prostate cancer that had spread to his neck, chest, and abdomen.<\/p>\n
\u201cHis quality of life was significantly affected,\u201d recalled Dr Andik Fadilah Abdul Aziz, consultant nuclear medicine physician at Thomson Hospital Kota Damansara. <\/p>\n
\u201cHe struggled to eat properly, he couldn\u2019t enjoy his hobbies, and the emotional toll on both him and his family was immense. But once we started targeted nuclear medicine therapy, his symptoms improved significantly. He was back on the golf course and eating normally again.\u201d<\/p>\n
Another patient story stays close to Dr Fadilah\u2019s heart. \u201cOne gentleman was completely bed-bound as cancer had already spread to his bones. <\/p>\n
\u201cAfter just a few cycles of treatment, he was able to walk again with the assistance of a walking stick and resume daily activities. That kind of recovery changes not only the patient\u2019s life but also gives families hope.\u201d<\/p>\n
These stories highlight how nuclear medicine is quietly transforming the landscape of prostate cancer care in Malaysia, bringing new hope to men facing advanced disease.<\/p>\n
The Hidden Burden Of Prostate Cancer<\/strong><\/p>\n Prostate cancer often develops silently. \u201cIn Malaysia, almost three out of four men only find out when the disease is already advanced, often when it has spread to the bones or other organs. <\/p>\n \u201cBy comparison, the picture is slightly better across Southeast Asia, where about four in 10 are diagnosed late, while in the United States, only a small fraction, around one in 10, are caught at that stage,\u201d said Dr Fadilah. <\/p>\n \u201cUnfortunately, here, urinary symptoms are usually dismissed as ageing, and by the time patients come forward, their options are limited and their outcomes less positive.<\/p>\n \u201cAwareness is crucial. We need men to pay attention to symptoms earlier, but we also need to support general practitioners and other healthcare professionals with better knowledge of advanced diagnostic tools. <\/p>\n \u201cFamilies\u2013wives, children, and loved ones\u2013also play a vital role in urging men to seek medical help instead of delaying.\u201d<\/p>\n Treating What You See, Seeing What You Treat<\/strong><\/p>\n Nuclear medicine stands out because it combines the precision of diagnosis with the power of targeted treatment. \u201cI like to say we \u2018treat what we see, and see what we treat,\u2019\u201d Dr Fadilah explained.<\/p>\n Unlike traditional scans, which could only show bone changes or detect enlarged lymph nodes, prostate-specific membrane antigen (PSMA) PET\/CT scans allow physicians to detect tumours as small as 3mm, including in soft tissues.<\/p>\n \u201cPSMA is a protein found in high amounts on prostate cancer cells\u2013over 80 per cent of men with advanced disease show high PSMA expression [iv]. Importantly, this protein is also present when the cancer spreads to other organs such as the bones, lymph nodes, lungs, or liver. <\/p>\n \u201cBy using a radioactive tracer that binds to PSMA, like a key fitting into a lock, we can detect cancer activity with remarkable accuracy, almost like having a GPS for prostate cancer,\u201d she said.<\/p>\n And once the cancer is visible, it can be targeted with radioligand therapy (RLT). \u201cThe treatment goes directly to the cancer cells, minimizing damage to healthy tissue. <\/p>\n \u201cMost patients find it generally well tolerated, and the procedure itself typically takes about 20 to 30 minutes, with many able to return home on the same day.\u201d<\/p>\n A Different Kind Of Specialist<\/strong><\/p>\n So, where do nuclear medicine physicians fit in a patient\u2019s journey?<\/p>\n \u201cUrologists are specialists in the urinary tract and male reproductive system. They perform biopsies to confirm a prostate cancer diagnosis, and if the tumour is detected early and hasn\u2019t spread, they can surgically remove it. <\/p>\n \u201cOncologists, on the other hand, usually lead systemic treatments such as radiotherapy, chemotherapy, hormone therapy, or immunotherapy. <\/p>\n \u201cNuclear medicine physicians sit at the crossroads\u2013we use advanced imaging to map out the disease, and we can also deliver highly targeted treatments,\u201d Dr Fadilah explained.<\/p>\n Traditionally, nuclear medicine physicians were brought in only at later stages. But today, their role can begin much earlier\u2013from diagnosis and staging, through to monitoring and treatment.<\/p>\n Safety And Reassurance<\/strong><\/p>\n The word \u201cnuclear\u201d often raises concerns. But Dr Fadilah is quick to reassure: \u201cWe\u2019ve been using radioisotopes in medicine for decades. <\/p>\n \u201cThe doses used in scans are very small and have a very short half-life, they break down within an hour. In my experience, I have never seen patients develop side effects from the radioactive material used in scans.\u201d<\/p>\n With RLT, most side effects are generally tolerable. \u201cRLT is designed to target cancer cells that light up with PSMA, which helps limit exposure to health cells.\u201d<\/p>\n Improving Survival And Quality Of Life<\/strong><\/p>\n For men with advanced prostate cancer, the benefits of nuclear medicine are not just clinical, but deeply personal.<\/p>\n \u201cRadioligand therapy doesn\u2019t cure prostate cancer, but it can delay progression of the disease. <\/p>\n \u201cPatients often see improvements in appetite, mobility, and energy,\u201d said Dr Fadilah. \u201cThat makes a huge difference, not only to survival, but to quality of life.\u201d<\/p>\n Access And The Road Ahead<\/strong><\/p>\n \u201cCurrently, RLT is only available in hospitals with full nuclear medicine facilities, both public and private. Access remains limited, as there are only about 50 to 60 nuclear medicine specialists nationwide, but the number is growing. <\/p>\n