KUALA LUMPUR, Sept 25 — 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.
But persistent reflux and unexplained vomiting led to a devastating diagnosis: advanced prostate cancer that had spread to his neck, chest, and abdomen.
“His quality of life was significantly affected,” recalled Dr Andik Fadilah Abdul Aziz, consultant nuclear medicine physician at Thomson Hospital Kota Damansara.
“He struggled to eat properly, he couldn’t 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.”
Another patient story stays close to Dr Fadilah’s heart. “One gentleman was completely bed-bound as cancer had already spread to his bones.
“After 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’s life but also gives families hope.”
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.
The Hidden Burden Of Prostate Cancer
Prostate cancer often develops silently. “In 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.
“By 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,” said Dr Fadilah.
“Unfortunately, here, urinary symptoms are usually dismissed as ageing, and by the time patients come forward, their options are limited and their outcomes less positive.
“Awareness 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.
“Families–wives, children, and loved ones–also play a vital role in urging men to seek medical help instead of delaying.”
Treating What You See, Seeing What You Treat
Nuclear medicine stands out because it combines the precision of diagnosis with the power of targeted treatment. “I like to say we ‘treat what we see, and see what we treat,’” Dr Fadilah explained.
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.
“PSMA is a protein found in high amounts on prostate cancer cells–over 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.
“By 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,” she said.
And once the cancer is visible, it can be targeted with radioligand therapy (RLT). “The treatment goes directly to the cancer cells, minimizing damage to healthy tissue.
“Most 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.”
A Different Kind Of Specialist
So, where do nuclear medicine physicians fit in a patient’s journey?
“Urologists 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’t spread, they can surgically remove it.
“Oncologists, on the other hand, usually lead systemic treatments such as radiotherapy, chemotherapy, hormone therapy, or immunotherapy.
“Nuclear medicine physicians sit at the crossroads–we use advanced imaging to map out the disease, and we can also deliver highly targeted treatments,” Dr Fadilah explained.
Traditionally, nuclear medicine physicians were brought in only at later stages. But today, their role can begin much earlier–from diagnosis and staging, through to monitoring and treatment.
Safety And Reassurance
The word “nuclear” often raises concerns. But Dr Fadilah is quick to reassure: “We’ve been using radioisotopes in medicine for decades.
“The 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.”
With RLT, most side effects are generally tolerable. “RLT is designed to target cancer cells that light up with PSMA, which helps limit exposure to health cells.”
Improving Survival And Quality Of Life
For men with advanced prostate cancer, the benefits of nuclear medicine are not just clinical, but deeply personal.
“Radioligand therapy doesn’t cure prostate cancer, but it can delay progression of the disease.
“Patients often see improvements in appetite, mobility, and energy,” said Dr Fadilah. “That makes a huge difference, not only to survival, but to quality of life.”
Access And The Road Ahead
“Currently, 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.
“To improve access, the Malaysian Society of Nuclear Medicine and Molecular Imaging (MSNMMI) recently launched MyNuCLEaR (Malaysia Nuclear Medicine Care Locator, Education and Resources), a searchable directory to help patients and doctors locate centres offering these services.
“Awareness is increasing, and more hospitals are preparing to make them available,” said Dr Fadilah.
Looking ahead, Dr Fadilah believes nuclear medicine (PSMA PET/CT scans and RLT) will become a standard of care for prostate cancer within the next decade.
“We will see more PET scanners across hospitals, more specialists trained, and greater awareness among referring physicians, not just for prostate cancer, but for other cancers as well.”
A Call To Action
Dr Fadilah’s message to patients and families is clear: “It is your right as a patient to know about advanced options like PSMA imaging and radioligand therapy.
“Ask your doctor. Doctors have a responsibility to explain, and families play an important role in encouraging men to seek timely care.”
She adds that collaboration is key: “Family medicine physicians, general practitioners, urologists, oncologists, and nuclear medicine physicians must work together so patients can fully benefit from these advancements.”
Nuclear medicine may not yet be the first step in every patient’s journey, but as stories like the 72-year-old prostate cancer patient show, it has the potential to be the breakthrough men have been waiting for.
This article was provided by IN.Deed Communications.