It’s time to be aware: Most prostate cancer patients seek treatments late!

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Illustration of prostate cancer. (Source:

Cancer occurs when the body’s cells turns malignant. Cancer can start from various body tissues, including the prostate. Prostate cancer often affects older men. Urinary problems or disruption of urinating in male patients over 55 can be caused by enlarged prostate, which can be benign or turn to malignant prostate cancer.

In Indonesia, most patients seek treatments late, and they are often diagnosed when the cancer already at an advanced stage. The cancer death rate in men in 2014 was 103,100. Lung cancer (21.8%), then liver cancer (12.3%), colorectal cancer (10.2%), and prostate cancer (8.9%) contributed the largest cancer mortality rate.

There are at least 3 examinations that can be done in diagnosis of prostate cancer, digital rectal exam (DRE), Prostate Specific Antigen  (PSA) level test and prostate biopsy. DRE and PSA level test are called the initial examination. Both tests are performed to determine the necessity for prostate biopsy. Through the biopsy, a tissue can be assessed for the degree of malignancy. Then it proceeds with a CT scan of the abdomen to assess how far the cancer cells have spread. From these data, the clinical stage can be determined.

Some prostate cancer patients show symptoms and some don’t. To find out whether the patient really has prostate cancer, it is necessary to check with the PSA level and digital rectal exam. If the PSA level is above 4 ng / mL and the digital rectal exam showed hard, asymmetrical, or even lumpy nodules, then a prostate biopsy is necessary. Prostate biopsy results determine the degree of malignancy assessed by the Gleason pattern.

The Gleason pattern is divided into 5, from grade 1 to grade 5 with grade 5 indicating the most virulent. There are 2 points on Gleason scores, so the lowest total score is 2 (1 + 1) and the highest is 10 (5 + 5). The Gleason pattern determines the Gleason score, grade 1 (total score <6), grade 2 (3 + 4), grade 3 (4 + 3), grade 4 (4 + 4), and grade 5 (total score> 8). To determine the stage of prostate cancer, another examination is needed, a CT scan of the abdomen. CT scans are useful in determining TNM data. The results of the TNM and biopsy determine the clinical stage.

There are 4 levels of stages, stage I, stage II, stage III, and stage IV. Apart from the division based on the stage level, there is another division, the risk group. The risk group was determined by PSA level, gleason score, and TNM. There are 5 levels of risk groups, low, intermediate, high, very high, and metastatic.

This study uses secondary data in the form of patient medical records in Dr. Soetomo from 2014 to 2018. Medical records were taken from 3 places, in the IT department for electronic medical records, the central medical records section for inpatient care, and the poly section for outpatient medical records. The independent variables that were assessed were digital rectal data, PSA, biopsy results, and TNM. The dependent variables assessed were clinical stage and risk group. To determine the clinical stage and risk group, data on PSA levels, prostate biopsy and TNM results are needed. Incomplete medical records, i.e. one of the PSA data, prostate biopsy results and TNM were excluded.

As a result, the number of complete medical records was 75. The largest population age group was 60-69 years at 51%. The mean age was 63.64 ± 9.41 years and the population range was 23-83 years old.

The enlargement, nodularity, and consistency of the prostate are determined through a digital rectal exam. An enlarged prostate was found in 35% of patients. The surface with prostate lumps was 4% and with nodules was 25%. A hard prostate consistency was found in 24% of patients. A total of 95 patients had PSA levels> 4 ng / mL. 53% of patients had a grade 5 gleason score.

From the stage data, as much as 52% were stage IV prostate cancer. 47% of patients were stage 3 prostate cancer. By risk group, 52% of patients were metastatic, 35% were very high, and 12% were high. It means that at Dr. Soetomo Regional Hospital, 99% of prostate cancer patients are advanced stage patients and 99% of prostate cancer patients are at high risk group or higher.

From these data, awareness of prostate cancer should be improved, both for health care providers and patients. The mortality rate can be reduced if the patient arrives at an earlier stage. Low patient awareness, late diagnosis, and late referral are some of the factors causing the high clinical findings at an advanced stage.

Authors: Nando Reza Pratama, Reny I’tishom, Wahjoe Djatisoesanto

The full article can be viewed at the following link:

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Media komunikasi dan informasi seputar kampus Universitas Airlangga (Unair).

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