MEDICAL DOCTORS
Dr. Martins Favour is a medical doctor at the University of Nigeria Teaching Hospital, and a medical writer who’s passionate about helping people understand the beauty of the medical practice in a digital world, and the need for knowledge to sponsor good healthcare. When she’s not writing, she devours pages of African literature and lives out her colorful dreams in her head. She loves the Lord, purple hearts, and yam.
Dr Martins Favour
Articles
Leukemia: the next generation therapies
Martins Favour
Keywords: haematology, CAR-T, immunotherapy, targeted therapy, cancer
Introduction
Leukemia is a group of blood cancers that originate in the bone marrow, affecting the production of white blood cells. It is characterized by the uncontrolled proliferation of abnormal leukocytes, leading to impaired immune function. The condition can be acute or chronic, with variations based on the type of white blood cells affected.
Types of Leukemia:
- Acute lymphoblastic leukemia (ALL)
- Acute myeloid leukemia (AML)
- Chronic lymphocytic leukemia (CLL)
- Chronic myeloid leukemia (CML)
Leukemia, a hematological cancer, accounts for 3.5% of all cancer cases globally, with incidence varying by age group and subtype. Acute myeloid leukemia (AML) is more common in adults, while acute lymphoblastic leukemia (ALL) is more common in children.
Chronic lymphocytic leukemia (CLL) primarily affects the elderly, while chronic myeloid leukemia (CML) can affect anyone, but adults are more likely to get it. Leukaemia is caused by genetic changes that disrupt normal blood cell development and maturation, causing immature and defective white blood cells to expand more quickly than healthy cells, crowding out healthy ones in the bone marrow.
This hematological cancer has severe negative effects on people and healthcare systems, affecting their mental well-being, physical health, and family life. I remember one of my pediatrics patients who had ALL at eight years old. It was devastating for her parents and herself. It was a major shift and her mom cried herself to sleep every night. To them, this was going to shake the very core of their family lives.
However, treatment for leukemia has evolved with advancements in chemotherapy, targeted medications, and bone marrow transplantation. Targeted medications have become increasingly popular due to our understanding of the genetics underlying the condition.
Immunotherapies like monoclonal antibodies and chimeric antigen receptor (CAR) T-cell therapy have shown promise for resistant patients. Precision medicine driven by genetic analysis has improved prognosis for specific leukemia subtypes.
In recent years, there has been a movement towards more customized and less damaging treatments, with new approaches like immunomodulation and gene editing changing the field. These developments represent a promising new era of specialized and varied interventions in the fight against this challenging and intricate disease.
Challenges in today's treatment
Leukemia treatment is a complex medical issue due to its heterogeneity, requiring individualized treatment plans.
Resistance to conventional therapy and relapses due to leukemia cell evolution are also issues that require ongoing research to develop new therapies.
Toxicities related to treatment, such as customized medications, persist despite efforts to reduce damage. Balancing treatment efficacy with patient quality of life is a delicate task. Global disparities in cost and accessibility contribute to uneven access to advanced treatments, hindering optimal patient care.
The complexity of leukemia, evolving resistance patterns, therapeutic adverse effects, and variations in accessibility all highlight the need for further research and collaboration to improve leukemia treatment outcomes.
The importance of exploring next generation therapies
Next-generation leukemia medications are crucial for improving patient outcomes and therapy options. Traditional treatments like chemotherapy and stem cell transplantation have disadvantages like toxicity and recurrence.
Next-generation medications like immunotherapies and targeted therapies offer promising avenues for advancement. Targeted therapies focus on specific molecular flaws in leukemia cells and reducing damage to healthy cells.
Immunotherapies work by recognizing and removing malignant cells using the patient's immune system. Innovations like CAR-T cell therapy show impressive outcomes in certain types of leukemia.
Precision medicine research maximizes efficacy by tailoring medications according to distinct genetic profiles. Conducting research on future leukemia therapeutics broadens therapy options and provides a platform for cutting-edge strategies.
Most importantly, next-generation therapies give hope to those faced with this delicate condition. A lot of times, even without understanding the disease, most of the patients I’ve seen are so sad and withdrawn because they think there’s little to be done.
With these therapy options, we will not just cure them of this menace but also bring back the light in their eyes and the shine in their faces.
Emerging Trends In Leukemia Therapy
Recent years have seen enormous advancements in leukemia therapy due to growing research and technological advancements. These novel approaches aim to maximize therapeutic efficacy while reducing negative effects. Notable developments include:
1. Immunotherapy
2. Precision Medicine
3. Targeted Therapies
4. Epigenetic Modifiers
5. Combination Therapies
These advancements signify a paradigm shift towards more individualized, safe, and efficacious leukemia treatments, which is a significant step towards improved patient outcomes.
1. Immunotherapy:
Immunotherapy presents itself as a cutting-edge approach that creates new therapeutic options. Particularly, CAR-T cell treatment, a type of immunotherapy, has demonstrated significant potential.
A patient's own T cells can be made to detect and attack leukemia cells by reprogramming them to express chimeric antigen receptors (CARs). This is a novel way to treat it.
Immunotherapy's ability to stimulate the body's immune system and transform it into a potent leukemia-fighting weapon is the key to its efficacy. CAR-T cell therapy in particular has demonstrated amazing promise, especially when it comes to treating leukemia subtypes that might not respond to conventional treatments. Immunotherapy provides a more selective and toxic-free treatment by selectively attacking cancer cells while preserving healthy ones, reducing collateral damage.
This therapeutic method not only shows promising results but also represents a paradigm shift in leukemia therapy. As research into immunotherapy progresses, it is becoming increasingly clear that improved patient outcomes are possible, underscoring the ground-breaking impact of this recent discovery on the field of leukemia treatment.
Many patients I’ve spoken to are open to this option because of the perceived accuracy of it and the low toxicity compared to chemotherapy. However, for those who don’t have health insurance, it’s a rather expensive method.
2. Precision Medicine:
Precision medicine treatment for leukemia is a revolutionary step towards individualized therapy. Medical specialists can identify the specific genetic alterations causing leukemia through genetic profile analysis, which paves the way for targeted therapy. This approach increases treatment precision, minimizes side effects, and improves overall effectiveness.
The ability to completely understand the genetic composition of leukemia subtypes has been made possible by advancements in genome sequencing, which have expedited the field of precision medicine. It is easier to select targeted drugs that try to disrupt specific biochemical processes that support the growth of cancer when individual mutations or aberrations are found.
This customised strategy has a lot of promise, particularly in situations where conventional treatments might not work. Treatments that spare healthy tissues in addition to leukaemia cells help patients by reducing toxicity and enhancing quality of life. As our understanding of the disease's genetic makeup grows, precision medicine seems to play a critical role in the evolution of leukemia therapy, providing a more advanced and effective approach to treating this challenging condition.
3. Targeted Therapies:
With the considerable advancements in leukemia treatment, targeted medicines provide a safer and more precise means of eliminating cancer cells. This specific kind of treatment uses drugs designed to identify and target specific cancer cells in order to reduce damage to healthy cells. To determine the best course of action and tailor treatment to the individual needs of each patient, doctors conduct tests to analyze the genetic and protein makeup of cancer cells.
One popular kind of targeted therapy is the use of monoclonal antibodies. These lab-created proteins can attach to cancer cells and either destroy them directly or transfer toxins, radiation, or medications to them. Blinatumomab (Blincyto®) and Inotuzumab ozogamicin (Besponsa®) are two examples.
Chimeric Antigen Receptor (CAR) T-Cell Therapy is an immunotherapy in which a patient's T cells are genetically engineered to enhance their ability to fight cancer cells. The FDA has approved tisagenlecleucel, also marketed as Kymriah®, a B-cell ALL CAR T-cell treatment. Its objective is to fortify the patient's defenses against leukemia. Notwithstanding its effectiveness, the implementation of CAR T-cell therapy needs specialized facilities due to the potential for disastrous outcomes.
Additionally, Tyrosine Kinase Inhibitors (TKIs) are particularly useful in cases with Philadelphia chromosome-positive ALL (Ph+ ALL) because they directly target enzymes involved in cell proliferation, signaling, and division. The field of targeted therapeutics is evolving in tandem with the persistent pursuit of improved patient outcomes and a paradigm shift towards more customized and effective leukemia treatments.
4. Epigenetic Modifiers:
New advances in the treatment of leukemia have the potential to completely transform therapeutic strategies during this ground-breaking stage of the illness's management. Notably, controlling the course of leukemia appears to be especially promising when using epigenetic modifiers. By concentrating on modifications in gene expression, these modifiers offer a complex method of disease intervention.
One well-known example of epigenetic alteration is the use of DNA methyltransferase inhibitors (DNMTIs), such as decitabine and azacitidine, in the treatment of leukemia. These drugs restore normal gene function and may prevent the development of leukemia cells by demethylating DNA. Another type of epigenetic modifiers that modify histone proteins and affect the regulation of gene expression are histone deacetylase inhibitors (HDACIs), which include vorinostat and panobinostat.
By changing the epigenetic landscape, these modifiers contribute to a more targeted and specialized approach and may help to overcome the limitations of traditional therapy. The study and use of epigenetic modifiers is a dynamic shift towards leukemia treatments that target the disease's intricate molecular underpinnings and provide hope for more effective therapy and improved patient outcomes.
5. Combination Therapies:
Combination therapies offer a multimodal approach to treating leukemia because of its complicated nature, where cancer cells can exhibit a range of features. These synergistic approaches acknowledge that targeting multiple pathways simultaneously and addressing leukemia's heterogeneity may be beyond the scope of a one-size-fits-all approach.
Many noteworthy drug combinations have been found in an attempt to enhance treatment outcomes:
- Venetoclax and Azacitidine: Studies have demonstrated the efficacy of this combination in treating acute myeloid leukemia (AML). Together with the BCL-2 inhibitor Venetoclax, the hypomethylating medication azacitidine inhibits the ability of leukemia cells to survive.
- Imatinib and dasatinib: It has been demonstrated that the combination of these two tyrosine kinase inhibitors is effective in treating chronic myeloid leukemia (CML). Dasatinib, which inhibits several tyrosine kinases, and imatinib, which targets the BCR-ABL fusion protein, both prevent leukemia cells from proliferating.
- Blinatumomab and Ponatinib: This combination has positive results in patients with chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Tyrosine kinase inhibitor ponatinib and bispecific T-cell engager blinatumomab work together to create a two-pronged attack on leukemia cells.
These combinations demonstrate a complex approach that leverages the benefits of multiple drugs to provide comprehensive and durable therapeutic outcomes.
As the biology of the illness becomes clearer, the purposeful use of combination therapy remains at the forefront of leukemia research, offering renewed hope for improved patient outcomes and durable remission.
Conclusion
The field of leukemia treatment is experiencing a positive trend due to new concepts and technical advancements. Next-generation medicines, such as epigenetic modifiers like DNA methyltransferase inhibitors and histone deacetylase inhibitors, are focusing on precision and sophistication, aiming to provide customized and targeted treatments.
This shift towards personalized and targeted procedures reduces the negative effects of traditional therapy. However, there is still much room for development in leukemia treatment. A commitment to comprehensive research is needed to advance our understanding of the molecular complexity of leukemia and develop strategies that reduce side effects while boosting efficacy.
Collaboration between researchers, physicians, and pharmaceutical corporations is essential to ensure leukemia therapy remains a dynamic field that helps patients worldwide. The combination of epigenetic modification, immunotherapy, and precision medicine offers hope for a future where leukemia can be treated more successfully.
Finally, more than anything, there’s an increased need for awareness of these new therapy options. We should talk about them, write about them and even discuss them with our patients. Empathetic medical writers and medical doctors are the sponsors of renewed hope in the next-generation leukemia therapies.
Osteosarcoma in children
Martins Favour
Keywords: paediatric, bone cancer, new therapy, prevention
When 12-year-old Jacob started limping after football practice, his parents thought it was just another sports injury. Maybe a pulled muscle, or growing pains. But weeks passed, and the pain worsened.
Eventually, an X-ray revealed something far more serious—osteosarcoma, a type of bone cancer.
As a doctor, I’ve seen the fear that grips families when they hear the word “cancer.” But I’ve also seen the incredible strength children like Jacob show, and the life-changing difference early diagnosis and treatment can make. Let’s talk about osteosarcoma in children—what it is, how it shows up, and how we fight it.
What is Osteosarcoma?
Osteosarcoma is a high-grade malignant mesenchymal neoplasm characterized by the production of osteoid or immature bone matrix by malignant osteoblastic cells. It is the most common primary malignant bone tumor, predominantly affecting metaphyseal regions of long bones, particularly around the distal femur, proximal tibia, and proximal humerus.
The tumor typically arises during periods of rapid skeletal growth, most commonly in adolescents and young adults, although it can occur at any age. Histologically, osteosarcoma is heterogeneous and may exhibit varying degrees of osteoblastic, chondroblastic, and fibroblastic differentiation, often with marked cellular atypia, high mitotic activity, and regions of necrosis. Osteosarcoma has a strong predilection for metastasis to the lungs.
In the United States, around 400 children and teens are diagnosed each year. In the UK, it affects about 35–40 children annually. It's rare, but among pediatric bone cancers, it tops the list.
Its defining microscopic feature is the presence of malignant osteoid produced by these transformed cells.
While typically solitary, osteosarcoma can also present with multiple lesions. When multiple sites appear within a six-month period, this is referred to as synchronous osteosarcoma. If lesions appear more than six months apart, it is termed metachronous osteosarcoma. These multifocal forms are extremely rare and are generally seen in children under the age of 10.
Causes
We don’t fully understand what causes osteosarcoma, but several factors are known to increase the risk:
● Rapid bone growth, especially during puberty
● Certain genetic conditions like Li-Fraumeni syndrome or hereditary retinoblastoma
● Previous radiation therapy (for another cancer)
● Previous bone fracture
Still, most children with osteosarcoma have no known risk factors—no family history, no prior treatments—just like Jacob.
How Do They Present? Symptoms
Symptoms often sneak up quietly. A child might complain of pain in a leg or arm that doesn't go away, or gets worse at night. Swelling may follow, but it's not always obvious.
Here are some red flags:
● Persistent bone pain, especially near joints
● Swelling or a noticeable lump
● Limping or trouble moving a limb
● Occasional fracture from minor injuries (the bone is weakened by the tumor)
Unfortunately, these symptoms can mimic sports injuries or growing pains, so it's important not to brush them off if they persist.
Examination Findings
In clinic, we look for:
● Tenderness or swelling over the affected area. This is usually the most common symptom,a s they mostly present with an unexplainable swelling that won’t go away.
● Warmth over the bone: This is mostly as a result of inflammation in the area.
● Decreased range of motion in nearby joints: This is due to the growth of new cells around the joint, causing rigidity and a decrease in range of movement.
● Limping or altered gait: Mostly when it happens in bones of the lower limbs. They may be unable to walk or may have an altered walking gait.
In some advanced cases, we might notice enlarged lymph nodes or signs the cancer has spread (e.g., difficulty breathing if it reaches the lungs).
Investigation Results
Diagnosis involves a few key steps:
● X-rays: Often the first clue. Osteosarcoma gives a “sunburst” appearance due to abnormal bone formation.
● MRI: Helps determine the extent of the tumor.
● Bone biopsy: A small sample is taken to confirm the diagnosis under a microscope.
● CT scans of the chest: To check if the cancer has spread to the lungs.
● Blood tests: May show elevated alkaline phosphatase or lactate dehydrogenase (LDH), which can support the diagnosis but aren't specific.
X-ray and bone biopsies, are usually the mainstay for diagnosis of osteosarcoma.
Treatment Options
Treating osteosarcoma in children is a full-scale team effort, multidisciplinary and patient-centered. The approach is not just about removing the tumor—it's about preserving life, limb, and quality of life.
Treatment is typically delivered by a specialized team including pediatric oncologists, orthopedic surgeons, radiologists, physiotherapists, psychologists, and nurses.
Let’s break down the treatment into key components:
1. Chemotherapy: The First Line of Attack
Chemotherapy is usually the first step once the diagnosis is confirmed, even before surgery. This neoadjuvant chemotherapy helps shrink the tumor, makes surgery easier, and starts tackling any hidden cancer cells that may have started spreading.
After surgery, adjuvant chemotherapy is used to “mop up” remaining cancer cells and reduce the risk of recurrence.
Common Chemotherapy Regimens Include:
● High-dose Methotrexate
● Doxorubicin
● Cisplatin
● Ifosfamide (used in some protocols)
These are typically given in cycles, spaced out over weeks or months. The total treatment course usually spans 6 to 12 months, depending on response and surgical outcomes.
Side Effects May Include:
● Nausea, vomiting
● Hair loss
● Fatigue
● Increased infection risk (due to low white cells)
● Potential long-term effects: heart, kidney, or fertility issues—though closely monitored
In practice, children often amaze us with how well they bounce back after chemo sessions. Supportive care, including anti-nausea meds like ondansetron, hydration with IV fluids or orally, and emotional support, makes a big difference.
The chemotherapy treatments are usually not so expensive, but may require huge sums as they’re taking over a long period.
2. Surgery: Saving Limbs, Saving Lives
Surgery is the next course of treatment after initial chemo. The goal is to remove the entire tumor with clear margins (more than 1-2cm tumor-free regions), while preserving as much function as possible.
Types of Surgery:
● Limb-Sparing Surgery: The preferred option whenever feasible. Surgeons remove the tumor and reconstruct the bone using metal implants, bone grafts, or custom prostheses.
● Amputation: Still necessary in some cases—especially if the tumor involves major nerves, blood vessels, or if infection complicates reconstructive surgery.
● Rotationplasty: A fascinating technique where the lower leg is rotated and reattached so the ankle acts as a functional knee joint, often used in younger children.
Post-operative physiotherapy is important. Children work with physiotherapists to regain strength, flexibility, and independence. Many go on to walk, run, and even play sports with the help of prosthetics or adaptive equipment.
3. Lifestyle Modifications: Supporting Recovery
Though not curative on their own, certain lifestyle adaptations play a critical role in supporting treatment:
● Nutrition: Children undergoing chemo often lose their appetite or experience nausea. Dietitians help create meal plans rich in calories, protein, and immune-supportive nutrients.
● Physical Therapy: After surgery, tailored rehab programs help regain movement, reduce stiffness, and rebuild muscle.
● Psychosocial Support:
○ Therapy or counseling to help kids cope with body image changes, trauma, and fear
○ Peer support groups to meet others facing similar journeys
○ Support for parents and siblings—because cancer affects the whole family
Emerging and New Therapies: The Future of Osteosarcoma Treatment
In recent years, research into osteosarcoma has accelerated, driven by the urgency to improve survival rates—especially for children with metastatic or recurrent disease.
1. Targeted Therapy
These drugs zero in on specific cancer cell mechanisms, sparing healthy cells:
● mTOR inhibitors (e.g., Sirolimus, Everolimus): Target pathways that help cancer cells grow.
● IGF-1R inhibitors: Being studied for osteosarcoma's growth factor pathways.
● Tyrosine kinase inhibitors (TKIs) like Cabozantinib, Pazopanib, and Regorafenib have shown promise in relapsed or resistant osteosarcoma, especially in adults and adolescents.
2. Immunotherapy
This area is still developing in bone cancers, but shows incredible promise:
● Immune checkpoint inhibitors (e.g., nivolumab, pembrolizumab) are being trialed in tumors that express PD-L1.
● Cancer vaccines and CAR-T cell therapy are being explored—though not yet standard, they're potential game-changers in the coming years.
3. Bone-Targeting Agents
Drugs like Denosumab or Bisphosphonates help control bone resorption and may slow tumor growth. Their use is still largely experimental in children.
4. Clinical Trials
For children with recurrent or high-risk disease, clinical trials offer access to cutting-edge treatments not yet available in standard care.
As a clinician, I always encourage eligible families to consider clinical trials—especially when conventional therapy options run out. They offer hope and help advance science for future generations.
Prevention
Unfortunately, there’s no guaranteed way to prevent osteosarcoma, because most cases are sporadic, meaning they occur randomly without any known cause.
However, here’s what we can do:
1. Early Recognition
● Educate parents, coaches, and healthcare providers about warning signs:
○ Persistent bone pain
○ Swelling that doesn't go down
○ Limping or reduced limb use
○ Pain that wakes the child up at night
● Don’t ignore these signs, especially in active or growing kids
2. Genetic Counseling
For families with known hereditary cancer syndromes (like Li-Fraumeni or hereditary retinoblastoma), regular check-ups and genetic screening may help detect issues early
3. Avoid Unnecessary Radiation
In kids treated for other cancers, radiation should always be tailored and minimized to reduce the risk of secondary malignancies, including osteosarcoma.
Prevention may not always mean stopping the disease before it starts—but it does mean recognizing danger signs, acting fast, and supporting early diagnosis.
Prognosis
The outlook depends on several factors: tumor size, location, if it’s spread, and how well it responds to chemotherapy.
● If caught early and hasn’t spread, about 70% of children survive long-term.
● If the cancer has spread (especially to the lungs), survival drops to around 30–40%, though newer treatments are improving these odds.
Early diagnosis and strong medical support give children the best fighting chance.
Conclusion
Osteosarcoma is rare but serious. It hides behind everyday symptoms like leg pain or limping, making awareness and early action crucial. As a doctor, I’ve watched kids like Jacob go from devastating diagnosis to hopeful recovery.
It’s not an easy road, but it’s one filled with resilience, science, and love.
If your child—or any child you know—is having ongoing bone pain or swelling, don’t wait. Ask the questions. Seek the scans. Trust your gut.
Because sometimes, catching something early doesn’t just save a leg—it saves a life.
Prostate cancer: the what, why and principles of management
Martins Favour
Keywords: Adenocarcinoma, PSA (prostate-specific antigen, screening
Michael was 67, recently retired, and living his dream life. He gardened, played with his grandkids, and finally had time to travel with his wife. When he went in for a routine check-up, his doctor mentioned checking his Prostate Specific Antigen(PSA). “It’s probably nothing,” Michael said, brushing it off.
Two weeks later, he got the call: elevated PSA. A biopsy confirmed it—prostate cancer.
As a physician, I’ve walked alongside many men like Michael. Prostate cancer is often slow-growing, but when aggressive, it can take lives quietly. Fortunately, early diagnosis and personalized treatment are changing that story.
What is Prostate Cancer?
Prostate cancer develops in the prostate gland, a walnut-sized organ located below the bladder in men. The prostate produces seminal fluid, which helps transport and nourish sperm.
Most prostate cancers are adenocarcinomas, originating from the glandular cells. It’s one of the most common cancers in men worldwide, especially over the age of 50.
In the United States, ~288,000 new cases were diagnosed in 2023, with about 34,000 deaths. In the UK, ~52,000 men are diagnosed each year, making it the most common male cancer.
Risk increases with age, and many men live with it asymptomatically for years. Often, the disease spreads locally, but most commonly affects the bones.
Causes and Risk Factors
Prostate cancer doesn't have one single cause, but a mix of genetic, hormonal, lifestyle, and environmental factors play a role.
Established Risk Factors
Age – Rare under 45, common after 50. However, in my practice, I have seen a few men who came in with early signs of the disease below 45 years old. This is a secular trend as more younger people are coming down with diseases like this.
Family History – Having a father or brother with prostate cancer doubles the risk. It’s not hereditary but familial.
Ethnicity – More common and more aggressive in Black men, less common in Asian men.
Genetics – Mutations in BRCA1, BRCA2, and HOXB13 genes increase risk.
Diet – High consumption of red meat and dairy may be linked to increased risk.
Other Factors:
● Obesity
● Sedentary lifestyle
● Inflammation or infections of the prostate (e.g., prostatitis)
Symptoms: How Does It Present?
Early-stage prostate cancer often has no symptoms. Many cases are picked up during routine PSA (Prostate-Specific Antigen) blood testing or digital rectal exam (DRE).
When symptoms do occur, they’re mostly due to pressure effects on the lower urinary tract, nervous involvement, and metastasis if advanced. They may include:
Lower Urinary Tract Symptoms
● Difficulty starting urination: Hesitancy
● Urgency
● Straining to urinate
● Weak or interrupted stream
● Frequent urination, especially at night
● Painful or burning urination
● Dribbling at the end and a feeling of incomplete bladder emptying
Advanced Disease Symptoms
● Blood in urine or semen
● Erectile dysfunction
● Pain in the hips, back, or chest (from bone metastases)
● Unexplained weight loss or fatigue
As a clinician, I always tell patients: just because these symptoms may be common doesn’t mean it’s harmless. A lot of times, patients who have benign prostatic hyperplasia (BPH) also present with similar symptoms. But the distinction is usually in the examination and investigation findings.
Examination Findings
While physical exam may be normal, there are some classic signs doctors look for:
● Digital Rectal Exam (DRE): On inserting your finger, a hard, irregular, or enlarged prostate may suggest malignancy. The irregularity is mostly what differentiates it from BPH, as that’s a sign that rings the bell for malignancy.
● Lymphadenopathy: This is rare, but may occur if disease has spread, most common lymph nodes involved are the inguinal lymph nodes.
● Bone tenderness or pain: May signal metastasis. Pelvic and lower back pain are very particular in bone metastasis.
Investigation Results
Diagnosis involves a combination of clinical assessment, tumor marker tests, imaging, and tissue sampling.
1. Blood Tests
● PSA (Prostate-Specific Antigen): This is a protein produced by the prostate gland, so, when there’s a hyperplasia, it’s produced more due to an increase in cells. So, it's a tumor marker for prostate cancer. Elevated blood levels can indicate prostate cancer, but it’s not specific as it can also rise in BPH or prostatitis. High PSA levels are usually between 4ng/l to 10ng/l.
● Free vs. Total PSA: When you’re unsure what is the cause of an elevated PSA, a free vs total PSA test is done to improve specificity. If the free PSA is significantly lower than the bound and total PSA, then prostate cancer is suspected.
2. Imaging
● Multiparametric MRI (mpMRI): Helps identify suspicious lesions and guides biopsy
● CT scan: To check for lymph node involvement
● Bone scan: Especially if bone pain or high PSA, to detect skeletal spread
● PSMA PET-CT scan (Prostate-Specific Membrane Antigen): Emerging gold standard for detecting metastatic or recurrent prostate cancer
3. Biopsy
● Transrectal or transperineal needle biopsy is the gold standard for confirmation.
● Pathologists assign a Gleason score (now known as Grade Groups 1–5) to assess aggressiveness. Gleason score is based on how the biopsied cells look under a microscope in comparison to normal prostate cells.
Pathologists assign these grades to the most and second most common cell patterns they observe, with 1 being the most normal and 5 being the most abnormal.When these scores are added, they are graded over 10.
Treatment
Treatment of prostate cancer is multidisciplinary, and depends on:
● Cancer stage and grade
● Patient age, health, and preferences
● Life expectancy
The treatment options available include:
1. Active Surveillance (for Low-Risk Disease)
Ideal for men with:
● Low PSA
● Grade Group 1 (Gleason ≤ 6)
● No symptoms
● Limited life expectancy or comorbidities
Involves:
● Regular PSA monitoring
● Repeat biopsies and MRIs
● Deferred treatment unless cancer progresses
It’s a safe option for many, avoiding unnecessary side effects while preserving quality of life.
2. Surgery: Radical Prostatectomy
Complete removal of the prostate gland (plus surrounding tissue and seminal vesicles), done via:
● Open surgery
● Laparoscopic (keyhole) surgery
● Robotic-assisted (Da Vinci) – Now the most common in the US/UK
Risks:
● Urinary incontinence
● Erectile dysfunction
● Bleeding or infection
Nerve-sparing techniques aim to preserve function when possible.
3. Radiation Therapy
External Beam Radiation Therapy (EBRT) or brachytherapy (radioactive seed implantation) may be used alone or with hormonal therapy.
Side effects:
● Urinary or bowel irritation
● Erectile dysfunction
● Fatigue
Modern techniques like IMRT (Intensity-Modulated Radiation Therapy) and proton therapy minimize damage to healthy tissue.
4. Androgen Deprivation Therapy (ADT)
Prostate cancer depends on testosterone to grow. ADT reduces testosterone levels using:
● LHRH agonists/antagonists (e.g., leuprolide, degarelix)
● Orchiectomy (surgical castration – rarely used now)
● Used in advanced, metastatic, or recurrent disease
Side effects:
● Hot flashes
● Fatigue
● Osteoporosis
● Weight gain
● Loss of libido
Emerging and New Therapies
This is where things get exciting. Research is rapidly advancing to improve survival and reduce side effects.
1. Next-Generation Hormonal Therapies
Used in metastatic and high-risk localized disease:
● Abiraterone (Zytiga) – blocks testosterone production
● Enzalutamide, Apalutamide, Darolutamide – block androgen receptors
● Often combined with ADT
2. PARP Inhibitors
For men with BRCA1/2 mutations or DNA repair defects:
● Olaparib, Rucaparib
● Target cancer’s DNA repair pathways
● Approved for metastatic, castration-resistant prostate cancer (mCRPC)
3. PSMA-Targeted Radioligand Therapy
● A groundbreaking treatment!
● Lutetium-177 PSMA-617 delivers radiation directly to prostate cancer cells expressing PSMA
● Minimal impact on healthy tissue
● Approved in several countries for advanced disease
4. Immunotherapy
● Checkpoint inhibitors (e.g., pembrolizumab) show limited effect unless MSI-high or high TMB
● Cancer vaccines like Sipuleucel-T offer mild benefits in selected cases
5. Clinical Trials
Always an option for eligible patients—offering access to novel drugs, combinations, and precision medicine approaches
Prevention: Can We Lower the Risk?
While not all prostate cancer is preventable, certain lifestyle strategies may reduce the risk or slow disease progression.
1. Healthy Diet
● High in fruits, vegetables, whole grains
● Reduce red meat, dairy, and saturated fats
● Include tomatoes (lycopene), green tea, cruciferous vegetables (broccoli, kale)
2. Physical Activity
● Regular exercise helps regulate hormones, weight, and immune function
● Reduces inflammation and insulin resistance
3. Weight Management
● Obesity is linked to more aggressive forms and poorer outcomes
4. Avoid Smoking and Excess Alcohol
● Linked to worse prognosis and other cancers
5. Screening
● PSA screening is controversial but beneficial in high-risk men:
○ Begin screening at age 40–45 for men with family history or African ancestry
○ Otherwise, start at 50, individualized by risk factors
Prognosis
Prostate cancer often has an excellent prognosis, especially when caught early:
● Localized cancer: ~99% 5-year survival
● Locally advanced: ~90–95%
● Metastatic: ~30%, but new treatments are improving this
Many men die with prostate cancer, not from it—particularly if it's low-grade or slow-growing.
Conclusion: Changing the Story
Prostate cancer is one of the most common and most curable cancers in men. But it's also one that thrives in silence.
Thanks to early screening, minimally invasive surgery, and exciting new therapies like PSMA therapy and PARP inhibitors, we’re rewriting the narrative. Men like Michael, once facing daunting diagnoses, are now living full, active lives.
If you’re over 50—or over 40 with risk factors—talk to your doctor about PSA screening. If you’re diagnosed, know this: you are not alone, and you have options.
And remember, prevention starts with simple choices—what you eat, how you move, and when you speak up.