Prostate Cancer in Younger and Older Patients: Do We Treat Them Differently?

Situmorang, Gerhard Reinaldi,Umbas, Rainy,Mochtar, Chaidir A.,Santoso, Rachmat Budi Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.9

Diagnostic and therapeutic strategies of prostate cancer may largely influenced by patients' age at presentation. This study is aimed to evaluate the characteristics, diagnostic and treatment strategies in prostate cancer patients in our centres. A cross-sectional analytic study of prostate cancer data in two main referral cancer centres, Cipto Mangunkusumo General Hospital and Dharmais National Cancer Centre from 1995-2010, was therefore performed. Patients were divided into 2 sub-populations; below 60 years (younger patients) and 75 years old and above (older patients). PSA levels, diagnostic modalities, Gleason score and therapeutic options were analysed for both and compared using bivariate analysis. 152 patients were <60 years and 210 were ${\geq}75$ years. There was no statistical difference in mean PSA level (797.9ng/mL vs 345.3 ng/mL, respectively; p>0.05) and diagnosis was made by biopsy in majority of patients in both groups (68.2% and 71.6% in younger and older groups respectively). Most presented with an advanced disease stage (65.1% and 66.0%, respectively) and there was no statistically significant difference in mean Gleason scores f (8.1 vs 7.7; p>0.05). Primary androgen deprivation therapy (PADT) was the main treatment for overall patients (48.0% and 50.7%, respectively). Radiotherapy and radical prostatectomy are the main therapeutic modalities for younger patients with local and locally advanced disease (39.6% and 35.4% respectively), while the majority of older patients with the same disease stage were treated with radiotherapy and PADT (45.8% and 39.0% respectively). Differences observed in treatment modalities were statistically significant (p<0.0003). We conclude that there is no difference in disease clinical aggressiveness of the two groups but significant differences were observed in therapeutic strategies utilised with younger and older patients.

Correlation between Low Gleason Score and Prostate Specific Antigen Levels with Incidence of Bone Metastases in Prostate Cancer Patients: When to Omit Bone Scans?

Sanjaya, I. Putu Gde,Mochtar, Chaidir Arief,Umbas, Rainy Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.9

Background: To identify correlation and incidence of bone metastases in prostate cancer patient with low Gleason scores (GS) and prostate specific antigen (PSA) levels. Materials and Methods: This descriptive restrospective study covered patients with prostate cancer in Cipto Mangunkusumo Hospital in 2006-2011. Of a total of 478, those who had PSA values, histological examination, and bone scan were included, resulting in 358 eligible cases. PSA values were measured using the sandwich electrochemiluminescent immunoassay. Histological examination was graded according to Gleason's grading system and divided into 3 categories: well differentiated ($GS{\leq}6$), moderately differentiated (GS 7) and poorly differentiated (GS 8-10). Bone scans were performed using a radiopharmaceutical agent ($T_c$ 99m methylenen diphosphonate) with images captured by gamma camera. Results: The mean age was $67.5{\pm}7.8$, mean GS was $7.7{\pm}1.3$ and median PSA was 56.9 (range: 0.48-17000 ng/mL). There were 11 patients (3.0%) with positive bone scan with PSA<20 ng/mL and GS<8. Furthermore, there were 2 patients (0.6%) with $GS{\leq}6$ and PSA<10 ng/mL showing bone metastasis. Conclusions: In our study, there were still small percentage of patients with bone metastasis even when low values of PSA (PSA<10 ng/mL) and GS ($GS{\leq}6$) were applied.

Clinical Factors Predictive of Metastases from Renal Cell Carcinomas

Widia, Fina,Hamid, Agus Rizal AH,Mochtar, Chaidir A,Umbas, Rainy Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.9

Background: Lymph node and distant metastases are known as the prognostic factor in renal cell carcinoma (RCC). Clinical parameters are needed to predict metastases preoperatively. The aim of this study was to assess clinical predictive factors for lymph node and distant metastases. Materials and Methods: We collected RCC data from January 1995 until December 2015 at Cipto Mangunkusumo hospital in Jakarta. We only reviewed data that had renal cell carcinoma histopathology by operation or biopsy. Clinical information such as patient age, gender, hemoglobin (Hb), erythrocyte sedimentation rate (ESR), and tumor size (clinical T stage) were reviewed and analyzed by Chi-squre and logistic regression to establish clinical predictive value. Results: A total of 102 patients were reviewed. There were 32 (31.4%) with lymph node metastases and 27 (26.5%) with distant metastases. Age, Hb and clinical T staging were associated with nodal metastases. However, only Hb and clinical T staging were found to be associated with distant metastases. By logistic regression, we found T3-4 in clinical T-stage to be the only predictor of nodal metastases (OR 5.14; 1.87 - 14.09) and distant metastases (OR 3.42; 1.27 - .9.23). Conclusions: Clinical T-stages of T3 and T4 according to The AJCC TNM classification could be used as independent clinical predictive factors for lymph node or distant metastases in patients with RCC.

Symposium: “Oncology Leadership in Asia”

노동영,노재경,김열홍,Kazuhiro Yoshida,Hideo Baba,Marie Cherry Lynn Samson-Fernando,Sanjeev Misra,Zeba Aziz,Rainy Umbas,Yogendra P. Singh,Tony Shu Kam Mok,양한광,Hideyuki Akaza 대한암학회 2017 Cancer Research and Treatment Vol.49 No.2

The symposium on “Oncology Leadership in Asia” was held as part of the official program of the 42nd Annual Meeting of the Korean Cancer Association with International Cancer Conference. Given the increasing incidence of cancer in all countries and regions of Asia, regardless of developmental stage, and also in light of the recognized need for Asian countries to enhance collaboration in cancer prevention, research, treatment and follow-up, the symposium was held with the aim of bringing together oncology specialists from eight countries and regions in Asia to present the status in their own national context and discuss the key challenges and requirements in order to establish a greater Asian presence in the area of cancer control and research. The task of bringing together diverse countries and regions is made all the more urgent in that while Asia now accounts for more than half of all new cancer cases globally, clinical guidelines are based predominantly on practices adopted in Western countries, which may not be optimized for unique ethnic, pharmacogenomic and cultural characteristics in Asia. Recognizing the need for Asia to better gather information and data for the compilation of Asia-specific clinical guidelines, the participants discussed the current status in Asia in the national and regional contexts and identified future steps towards integrated and collaborative initiatives in Asia. A key outcome of the symposium was a proposal to combine and integrate the activities of existing pan-Asian societies, including the Asian Pacific Federation of Organizations for Cancer Research and Control (APFOCC) and Asian Clinical Oncology Society (ACOS). Further proposals included the expansion of pan-Asian society membership to include individuals and the essential need to encourage the participation of young researchers in order to ensure self-sustainability of cancer control efforts in the future.

Report of the Second Asian Prostate Cancer (A-CaP) Study Meeting

Kim, Choung-Soo,Lee, Ji Youl,Chung, Byung Ha,Kim, Wun-Jae,Fai, Ng Chi,Hakim, Lukman,Umbas, Rainy,Ong, Teng Aik,Lim, Jasmine,Letran, Jason L.,Chiong, Edmund,Wu, Tong-lin,Lojanapiwat, Bannakij,Tü,rk Asian Pacific Prostate Society 2017 Prostate international Vol.5 No.3

<P>The Asian Prostate Cancer (A-CaP) Study is an Asia-wide initiative that has been developed over the course of 2 years. The study was launched in December 2015 in Tokyo, Japan, and the participating countries and regions engaged in preparations for the study during the course of 2016, including patient registration and creation of databases for the purpose of the study. The Second A-CaP Meeting was held on September 8, 2016 in Seoul, Korea, with the participation of members and collaborators from 12 countries and regions. Under the study, each participating country or region will begin registration of newly diagnosed prostate cancer patients and conduct prognostic investigations. From the data gathered, common research themes will be identified, such as comparisons among Asian countries of background factors in newly diagnosed prostate cancer patients. This is the first Asia-wide study of prostate cancer and has developed from single country research efforts in this field, including in Japan and Korea. At the Second Meeting, participating countries and regions discussed the status of preparations and discussed various issues that are being faced. These issues include technical challenges in creating databases, promoting participation in each country or region, clarifying issues relating to data input, addressing institutional issues such as institutional review board requirements, and the need for dedicated data managers. The meeting was positioned as an opportunity to share information and address outstanding issues prior to the initiation of the study. In addition to A-CaP-specific discussions, a series of special lectures was also delivered as a means of providing international perspectives on the latest developments in prostate cancer and the use of databases and registration studies around the world.</P>