Kathmandu
Cancer Center
Kathmandu
Cancer Center
"My PSA is a bit high, but I feel fine." Fine today does not always mean fine tomorrow — and prostate cancer is most treatable before symptoms appear.
Prostate cancer is the most common cancer in men worldwide after skin cancer, and it spans an enormous spectrum — from slow-growing tumours that may never need treatment, to aggressive disease that requires prompt, coordinated management. The right response depends entirely on which type you have. KCC's radiation and medical oncology team provides risk-stratified prostate cancer care in Nepal — from active surveillance to advanced systemic therapy.
Medically reviewed by: The Oncology Team, Kathmandu Cancer Center — Radiation Oncology & Medical Oncology. Educational content — not personal medical advice. Last updated: 2025.
The paradox of prostate cancer is that the most treatable form — early localised cancer — usually causes no symptoms at all. By the time symptoms become obvious, the cancer is often at a more advanced stage. This is why PSA testing matters.
Benign prostatic hyperplasia (BPH) — non-cancerous prostate enlargement — is extremely common in men over 50 and causes virtually identical urinary symptoms to early prostate cancer. Urinary symptoms alone cannot distinguish BPH from cancer. What separates them is the PSA test, digital rectal examination, MRI, and ultimately biopsy. Do not assume urinary symptoms mean cancer — but do not dismiss them without investigation either.
Back pain + leg weakness + bladder problems = possible spinal cord compression. Call KCC immediately: 01-6634300.
Many Nepali men over 60 accept urinary symptoms, back pain, and fatigue as "part of getting old" and do not seek evaluation. If your father, husband, or brother has had these complaints for months and hasn't had a PSA test — bring him to KCC. A PSA blood test takes 10 minutes and can be life-changing information.
PSA (Prostate Specific Antigen) is the primary blood test used to screen for and monitor prostate cancer. Understanding it correctly prevents both unnecessary panic and dangerous dismissal.
PSA is a protein produced by prostate cells — both normal and cancerous. A small amount normally leaks into the bloodstream. Anything that irritates or enlarges the prostate — infection, benign enlargement (BPH), physical examination, vigorous cycling, or cancer — raises PSA levels.
PSA is therefore not a cancer test — it is a prostate health indicator. Its value lies in trend over time (rising PSA is more informative than a single reading), PSA density (PSA adjusted for prostate volume), and correlation with examination and MRI findings.
| Age Group | Typical Upper Limit | What It Means |
|---|---|---|
| 40–49 | 2.5 ng/mL | Higher values warrant evaluation |
| 50–59 | 3.5 ng/mL | Discuss with doctor; consider MRI |
| 60–69 | 4.5 ng/mL | MRI and possible biopsy warranted |
| 70+ | 6.5 ng/mL | Always interpret in clinical context |
* These are guidance ranges only. A single PSA value must always be interpreted with digital rectal examination findings and clinical history by a specialist.
The first step. PSA blood test and DRE (a brief examination of the prostate through the rectum) together give an initial risk assessment. An abnormal DRE — hard, nodular, or asymmetric prostate — is significant regardless of PSA level and warrants MRI and biopsy. Both tests are quick outpatient procedures at KCC.
Before biopsy is considered, mpMRI of the prostate should be performed. This 3-tesla MRI sequences — T2-weighted, diffusion-weighted, and dynamic contrast-enhanced — assigns a PIRADS score (1–5). PIRADS 4–5 lesions are highly suspicious and require targeted biopsy. PIRADS 1–2 can often be managed with enhanced surveillance. MRI-guided decision-making avoids unnecessary biopsies in many men. Available at KCC radiology.
Radiology at KCCGuided by ultrasound ± MRI-TRUS fusion, biopsy needles sample 12 or more cores from the prostate, with additional targeted cores from PIRADS 4–5 MRI lesions. Pathology confirms cancer, determines Gleason Grade Group (1–5), and assesses the extent of core involvement — all critical for treatment planning and risk stratification.
For intermediate or high-risk disease, staging scans determine whether cancer has spread beyond the prostate. Bone scan identifies skeletal metastases. CT chest/abdomen/pelvis assesses lymph nodes and visceral spread. PSMA PET-CT (Prostate-Specific Membrane Antigen) is the most sensitive staging tool — detecting nodal and metastatic disease not visible on conventional scans — and is particularly important for high-risk disease and biochemical recurrence after treatment.
The Gleason scoring system grades prostate cancer aggressiveness on the appearance of cancer cells under the microscope:
• Grade Group 1 (Gleason 6): Lowest risk. Often qualifies for active surveillance.
• Grade Group 2–3 (Gleason 3+4, 4+3): Intermediate risk. Treatment often recommended.
• Grade Group 4–5 (Gleason 8, 9–10): High risk. Aggressive treatment required.
Grade Group combined with PSA and T-stage determines the risk group that drives all treatment decisions.
BRCA1/BRCA2 germline testing is recommended for metastatic prostate cancer (BRCA2 mutations occur in ~10% of mCRPC and predict benefit from PARP inhibitors — olaparib/PROfound trial). Germline BRCA2 also carries implications for daughters (breast/ovarian cancer risk) and sons. Somatic tumour testing (CDK12, ATM, BRCA1/2, MSI status) guides second-line treatment selection in mCRPC.
Prostate cancer treatment is entirely individualised by risk group. A Grade Group 1, PSA 5, confined tumour in a 72-year-old is managed completely differently from a Grade Group 4, PSA 80, lymph node-positive tumour in a 58-year-old. The risk group is the map. Everything follows from it.
KCC's prostate oncology team classifies every patient using the EAU / NCCN risk stratification system before recommending any treatment. Risk group determines: whether active surveillance is appropriate, whether radiotherapy is alone or combined with ADT, which ADT duration to use, whether novel hormone agents are added, and which systemic therapy is first-line for metastatic disease. There is no single prostate cancer treatment at KCC — there is a treatment for your risk profile.
For localised and locally advanced prostate cancer, external beam radiotherapy (EBRT) delivers equivalent long-term cancer control outcomes to radical prostatectomy (surgery) — established in multiple prospective randomised trials over 20 years. KCC performs IMRT and VMAT (volumetric arc therapy) — the current precision standard for prostate radiotherapy.
KCC believes in complete honesty about what we offer. If SBRT or surgery is genuinely the best option for a specific patient, our team will say so and help with referral — rather than substitute an inferior alternative.
IMRT (Intensity-Modulated Radiotherapy) and VMAT (Volumetric Arc Therapy) shape the radiation dose precisely around the prostate while minimising dose to the rectum, bladder, and femoral heads. Daily image guidance (cone-beam CT) verifies the prostate position before each fraction — accounting for daily variation in bladder and rectal filling. This allows escalated dose to the tumour while protecting surrounding organs, reducing long-term bowel and bladder side effects.
Radiotherapy at KCC
Conventional (78 Gy / 39 fractions): Monday–Friday, 39 treatment days (approx. 8 weeks).
Long-standing gold standard; extensive safety data.
Moderate hypofractionation (60 Gy / 20 fractions — CHHIP protocol):
Monday–Friday, 20 treatment days (4 weeks). The CHHIP trial (Dearnaley et al., Lancet Oncology)
demonstrated equivalent tumour control and toxicity to conventional fractionation.
Preferred at KCC for most patients — fewer hospital visits, equivalent outcomes.
Each daily treatment takes approximately 15 minutes.
During treatment: Mild urinary frequency, urgency, or burning (acute cystitis);
loose stools or bowel frequency (acute proctitis). Usually resolves within 4–6 weeks of treatment completion.
Long-term: Small risk of late bowel effects (rectal bleeding, bowel frequency),
bladder effects (haematuria, urgency), and erectile dysfunction (particularly when combined with ADT).
Modern IMRT significantly reduces these risks compared to older techniques.
KCC's team reviews potential side effects in detail before consent.
ADT is added to radiotherapy for intermediate and high-risk disease:
• Favourable intermediate risk: Short-course ADT — 6 months (neoadjuvant + concurrent)
• Unfavourable intermediate risk: 6–18 months ADT (RTOG 9910 / DFCI data)
• High/very-high risk: Long-course ADT 2–3 years (EORTC 22961), with
consideration of adding enzalutamide or abiraterone (STAMPEDE data)
The combination of RT + ADT is significantly superior to either treatment alone for high-risk disease.
Prostate cancer is exquisitely sensitive to testosterone — the hormone that drives its growth. Androgen Deprivation Therapy (ADT) reduces testosterone to castrate levels (<50 ng/dL), suppressing tumour growth across all stages. Modern "novel hormone agents" go further — blocking androgen signalling at the receptor and synthesis level, dramatically extending survival in both hormone-sensitive and castration-resistant disease.
Monthly (7.5 mg) or 3-monthly (22.5 mg) depot injection. Most widely used ADT worldwide. Initial testosterone flare — cover with 2–4 weeks bicalutamide at start. Suppresses testosterone within 2–4 weeks of start.
Monthly (3.6 mg) or 3-monthly (10.8 mg) subcutaneous implant. Equivalent efficacy to leuprolide. Same flare precautions apply. Widely available and familiar to most oncologists.
Monthly subcutaneous injection. Suppresses testosterone immediately without the initial flare — no anti-androgen cover required. May have cardiovascular advantage over LHRH agonists in men with pre-existing cardiac disease.
Oral tablet (50 mg daily) — used as flare cover at ADT initiation, or as monotherapy in selected patients (preserves sexual function, bone density). Weaker than LHRH agonists for PSA suppression. Not appropriate for high-volume or high-risk metastatic disease.
These oral agents have transformed prostate cancer outcomes in the past decade. Originally approved for castration-resistant disease, they are now used earlier — in metastatic hormone-sensitive prostate cancer combined with ADT — where they roughly double survival compared to ADT alone.
160 mg orally once daily. Blocks androgen receptor directly — prevents binding, nuclear translocation, and DNA activation. Approved for mHSPC (ARCHES/ENZAMET trials) + nmCRPC (PROSPER) + mCRPC (PREVAIL/AFFIRM). No steroid co-medication needed. Main side effect: fatigue. Available at KCC.
1000 mg orally once daily (fasting) + prednisolone 5 mg BD. Blocks androgen synthesis in adrenal glands, testes and tumour. Approved for mHSPC (LATITUDE/STAMPEDE) + mCRPC (COU-AA-301/302). Requires blood pressure and liver monitoring. Available at KCC.
600 mg BD orally. Approved for nmCRPC (ARAMIS trial) and mHSPC (ARASENS trial, with docetaxel). Penetrates blood-brain barrier less than enzalutamide — fewer CNS side effects, less drug interaction. An important option for patients on anti-epileptics or with neurological co-morbidities.
240 mg (4 tablets) once daily. Approved for nmCRPC (SPARTAN trial) and mHSPC (TITAN trial). Skin rash is more frequent than with other agents (about 23%). Dose-adjusted for specific drug interactions. An alternative to enzalutamide and darolutamide in its approved settings.
Common side effects of long-term ADT:
How KCC manages ADT side effects:
When prostate cancer progresses despite testosterone suppression — castration-resistant prostate cancer (CRPC) — ADT is always maintained. What changes is the addition of further agents targeting the tumour through different mechanisms. The modern mCRPC treatment landscape offers multiple lines of effective therapy.
75 mg/m² IV every 3 weeks × 6 cycles, with prednisolone. The first chemotherapy proven to extend survival in prostate cancer (TAX-327 trial). Now used in both mHSPC (where early docetaxel + ADT significantly improves survival vs ADT alone — CHAARTED/STAMPEDE) and mCRPC. Delivered in KCC's Day Care unit. Side effects include fatigue, neuropathy, alopecia, and neutropenia — managed with G-CSF support and dose modification.
Chemotherapy at KCC25 mg/m² IV every 3 weeks × 6–10 cycles. The standard second-line chemotherapy after docetaxel progression (TROPIC trial). Requires prophylactic G-CSF. The CARD trial showed cabazitaxel superior to enzalutamide or abiraterone in patients who progressed on a prior novel hormone agent — an important sequencing consideration.
Approximately 25–30% of mCRPC tumours carry homologous recombination repair (HRR) gene alterations — BRCA2 (most important), BRCA1, ATM, CDK12, PALB2, FANCA. The PROfound trial showed olaparib significantly improved radiographic progression-free survival and overall survival in BRCA1/2-mutant mCRPC after prior novel hormone therapy. KCC performs HRR somatic and germline testing for all mCRPC patients to identify PARP inhibitor candidates. Olaparib is available at KCC.
Prostate cancer frequently metastasises to bone, causing pain, fracture risk, and spinal cord
compression. Bone-protective agents are a mandatory part of mCRPC management:
• Zoledronic acid (Zometa) — 4 mg IV every 4 weeks. Reduces skeletal-related events.
• Denosumab (Xgeva) — 120 mg SC monthly. Superior to zoledronic acid for
preventing skeletal events in mCRPC (HALT trial). Requires calcium + Vitamin D supplementation.
• Dental review before starting either agent (osteonecrosis of jaw risk — rare but important).
For low-risk prostate cancer, the most harmful thing we can do is treat unnecessarily. Grade Group 1 (Gleason 6) prostate cancer rarely — if ever — spreads or causes death. The side effects of radiotherapy or surgery are real and sometimes permanent. Active surveillance monitors the cancer closely, initiates treatment only if progression is detected, and spares the patient side effects they may never have needed.
Whether you have a high PSA, a recent diagnosis, or an established prostate cancer needing systemic management — here is exactly what the journey at KCC looks like.
Call or WhatsApp us. Bring your PSA results, biopsy report, and any scans. Our radiation and medical oncology team will give you a clear, honest picture of your situation and options.
प्रोस्टेट ग्रन्थि पुरुषको मूत्राशय मुनि हुने एक सानो ग्रन्थि हो जसले वीर्य उत्पादन गर्छ। प्रोस्टेट क्यान्सर विश्वभर पुरुषहरूमा सबैभन्दा सामान्य क्यान्सरहरूमध्ये एक हो। ६० वर्ष माथिका पुरुषहरूमा यो बढी देखिन्छ। धेरैजसो प्रोस्टेट क्यान्सर सुस्त गतिमा बढ्छ र सही समयमा पत्ता लागेमा राम्रोसँग उपचार हुन्छ।
PSA (Prostate Specific Antigen) रगतको परीक्षण हो जसले प्रोस्टेट ग्रन्थिको स्वास्थ्य बारे जानकारी दिन्छ। ५०–७० वर्षका पुरुषहरूले वार्षिक PSA परीक्षण गर्नु राम्रो हुन्छ। परिवारमा कसैलाई प्रोस्टेट क्यान्सर भएको छ भने ४५ वर्षदेखि नै परीक्षण सुरु गर्नुहोस्।
⚠️ महत्वपूर्ण: पिसाबको समस्या भनेको सधैं क्यान्सर होइन — धेरैजसो पटक BPH (सामान्य प्रोस्टेट ठूलो हुने) कारण हुन्छ। तर PSA परीक्षण र डाक्टरको जाँच बिना भिन्न्याउन सकिँदैन। पिसाब समस्या भयो भने PSA परीक्षण गराउनुहोस्।
ध्यान दिनुहोस्: KCC मा प्रोस्टेट शल्यक्रिया (prostatectomy) उपलब्ध छैन। शल्यक्रिया चाहने बिरामीहरूलाई KCC को टोलीले उचित सल्लाह र रेफरल गर्नेछ। Radiotherapy र medical oncology मार्फत धेरैजसो प्रोस्टेट क्यान्सरको सम्पूर्ण उपचार KCC मा नै हुन्छ।
KCC, सूर्यबिनायक, भक्तपुर — प्रोस्टेट क्यान्सरको उपचार नेपालमै। फोन: 01-6634300 | WhatsApp