ကမ္ဘောဒီးယားနိုင်ငံတွင် ဆီးကျိတ်ကင်ဆာကုသမှုကို မြှင့်တင်ခြင်း- တစ်ကိုယ်ရည်နှင့် ပညာရှင်ပိုင်းဆိုင်ရာ ခရီးလမ်း

နောက်ဆုံး ပြင်ဆင်သည် ဩဂုတ် 17, 2026

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လုပ်ဖော်ကိုင်ဖက်များ၊ လူနာများနှင့် မိတ်ဆွေများအားလုံး မင်္ဂလာပါ။ ကျွန်ုပ်၏ ပညာရေးနှင့် အသက်မွေးဝမ်းကျောင်းခရီးလမ်းတွင် အရေးပါသော မှတ်တိုင်တစ်ခုကို ဝေမျှလိုက်ပါသည်။ ၂၀၂၀ ပြည့်နှစ်၊ ဇန်နဝါရီလ ၃ ရက်, ကျွန်တော်/ကျွန်မဟာ ထူးခြားတဲ့ဂုဏ်ယူဖွယ်ရာအနေနဲ့ တာဝန်ထမ်းဆောင်ခဲ့ရပါတယ် နိုင်ငံတကာ ပါမောက္ခ/ဆရာ တွင် တတိယအကြိမ် အာရှဆီးလမ်းကြောင်းဆိုင်ရာ ကင်ဆာရောဂါဗေဒ ဖိုရမ် ထိုင်ဝမ်နိုင်ငံ၊ ကောက်ရှုံ့မြို့တွင် ကျင်းပပြီး၊ ယင်းနှင့်အတူ တွဲဖက်ကျင်းပသော ထိုင်ဝမ် ဆီးလမ်းကြောင်းဆိုင်ရာ ကင်ဆာပညာ အသင်း (TUOA) ၏ (၁၂) ကြိမ်မြောက် နှစ်ပတ်လည် အစည်းအဝေး.

တော်ဝင် ဖနွမ်ပင်ဆေးရုံ (Royal Phnom Penh Hospital) ၏ ဆီးလမ်းကြောင်းနှင့် ကျောက်ကပ်ဆိုင်ရာ (ယူရိုလော်ဂျီ) ဌာနကို ကိုယ်စားပြု၍၊ လက်ရှိအခြေအနေများကို တင်ပြခွင့်ရခဲ့သည့်အတွက် အထူးပင် ဂုဏ်ယူဝမ်းမြောက်မိပါသည်။ ကမ္ဘောဒီးယားနိုင်ငံရှိ プロစတိတ် (Prostate) ကင်ဆာ ကုသ စီမံခန့်ခွဲမှု. ၎င်းသည် ကျွန်ုပ်၏အသက်မွေးဝမ်းကျောင်းအတွက် အဓိกลကျသော မှတ်တိုင်တစ်ခုဖြစ်ပြီး၊ စိန်ခေါ်မှုများနှင့် အောင်မြင်မှုများကို မျှဝေခဲ့ရသည့် သမိုင်းဝင်အခိုက်အတန့်တစ်ခု ဖြစ်ပါသည်။ ကမ္ဘောဒီးယားနိုင်ငံတွင် ရောဂါဗေဒဆိုင်ရာ ( ουρολογία - ဆီးလမ်းကြောင်းနှင့် ကျောက်ကပ်ဆိုင်ရာ) ဆေးပညာ ကျင့်သုံးခြင်း နိုင်ငံတကာ လုပ်ဖော်ကိုင်ဖက်များနှင့်အတူ.

In the spirit of that presentation, this article walks through the situation as I described it then — distilling complex medical data into a narrative that highlights where we were and where we hoped to go.

A note on the figures below. Every number in this article comes from the January 2020 presentation and rests on 2018–2019 WHO and Globocan data together with figures I gathered directly from colleagues at the time. Cambodian healthcare has continued to develop since, and I have not been practising there since 2024, so these should be read as a snapshot of that period rather than a description of Cambodia today. Anyone needing current national data should go to the Cambodian Ministry of Health and to up-to-date Globocan releases.

If You Are Reading This as a Patient: What Cannot Wait

This article is written mainly for colleagues, but men and families dealing with prostate cancer read it too. So before the health-system discussion, the symptoms that need care today rather than at the next appointment:

• New or worsening back pain with leg weakness, numbness, unsteadiness, or loss of bladder or bowel control. In a man with known or suspected prostate cancer this may be spinal cord compression — an oncological emergency where treatment within hours protects the ability to walk. Do not wait to see whether it improves.
• Complete inability to pass urine with a painful, swollen lower abdomen — acute urinary retention needs same-day drainage.
• Fever with urinary symptoms, particularly in the days after a prostate biopsy. Infection after biopsy can progress quickly to sepsis.
• Visible blood in the urine with clots, or bone pain severe enough to disturb sleep.

In Thailand the emergency number is 1669.

ကမ္ဘောဒီယားနိုင်ငံ၏ အခြေအနေကို နားလည်ခြင်း

To understand the state of cancer care, one must first understand the demographics of the nation. At the time of the presentation, Cambodia was home to approximately နိုင်ငံသား ၁၆ သန်း. Within this population there was a growing group of elderly citizens — over 850,000 people above the age of 65, including roughly 330,000 elderly men, the group at primary age risk for prostate cancer.

အရှေ့တောင်အာရှ၏ အလယ်ဗဟိုတွင် တည်ရှိပြီး ထိုင်း၊ လาว (လာအို) နှင့် ဗียดနမ် (ဗियतနမ်) နိုင်ငံတို့ နယ်နိမိတ်ချင်း ထိစပ်နေသော ကမ္ဘောဒီးယားနိုင်ငံသည် ၎င်း၏ ကျန်းမာရေးစောင့်ရှောက်မှု အခြေခံအဆောက်အအုံကို ခေတ်မီစေရန် မမောမပန်း ကြိုးပမ်းနေသည့် ဖွံ့ဖြိုးဆဲနိုင်ငံ တစ်နိုင်ငံ ဖြစ်ပါသည်။.

ဂဏန်းများ- ဖုံးကွယ်ထားသော စိန်ခေါ်မှုတစ်ရပ်

According to the 2018–2019 World Health Organization and Globocan data available at the time, prostate cancer was recorded as the ကမ္ဘောဒီးယားနိုင်ငံတွင် ၁၉ ခုမြောက် အဖြစ်အများဆုံး ကင်ဆာရောဂါ.

• ဖြစ်ပွားမှုနှုန်း approximately 1.15 per 100,000 population.
• သေဆုံးမှုနှုန်း approximately 0.75 per 100,000 population.

At first glance these numbers look low against a worldwide incidence of around 33 per 100,000. But as I put it to my colleagues in Taiwan, they almost certainly represent substantial underdiagnosis rather than genuinely low disease. Many cases were simply never found, for want of awareness, screening and a registry to record them in. The mortality-to-incidence ratio of roughly 0.65 tells the same story from the other direction: where cancer is found late, a large proportion of those diagnosed die of it. A country that diagnoses few cancers and loses most of the men it does diagnose does not have less cancer. It has less detection.

ပြည်သူ့ကျန်းမာရေးစောင့်ရှောက်မှု အခင်းအကျင်း

One of the greatest hurdles in managing prostate cancer in Cambodia was the absence of a centralized, digital National Cancer Registry. Most government hospitals still relied on စာရွက်စာတမ်း အခြေခံ စာရွက်စာတမ်းများ, which made it difficult to track long-term outcomes or build a national strategy on evidence.

To get a clearer picture for my presentation, I reached out directly to the heads of the urology departments at the three largest public institutes in Phnom Penh:

1. ကယ်လ်မက်ဆေးရုံ
2. ခမာ-ဆိုဗီယက် ဆေးရုံ
3. ကုဿမက် ဆေးရုံ

It is worth being plain that figures assembled this way — by asking colleagues what they saw in their own departments — are the best available rather than the most rigorous. That is itself part of the finding.

ကမ္ဘောဒီးယားနိုင်ငံရှိ ဆီးလမ်းကြောင်းဆိုင်ရာ ဆေးဘက်ဆိုင်ရာ အရင်းအမြစ်များ

While the medical community was dedicated, resources were spread thin. Across the entire country there were only မှတ်ပုံတင်ထားသော ဆီးလမ်းကြောင်းနှင့် ကျောက်ကပ်ဆိုင်ရာ အထူးကုဆရာဝန် ၆၅ ဦး. Through a France-Cambodia medical agreement, about 30 of them had trained in France.

Only ဆေးရုံ ကုတင် ၁၃၅ လုံး nationwide were dedicated to urology. Set that against 330,000 men in the at-risk age group and the scale of the gap becomes clear — and with it, why international collaboration and private-sector capacity mattered so much.

ရောဂါရှာဖွေခြင်းနှင့် ကုသစီမံခန့်ခွဲခြင်းဆိုင်ရာ လက်တွေ့အမှန်တရား

In Cambodia, the way prostate cancer was discovered differed sharply from Western countries. In the West, many cases are caught early through PSA blood testing. In Cambodia, approximately 200 new cases were diagnosed annually across the major public hospitals — but usually late.

ရောဂါအဆင့်နှောင်းပိုင်းတွင် ပြသခြင်း

Around 90% of patients arrived already suffering from symptomatic metastatic prostate cancer, typically with long-standing difficulty passing urine, urinary retention, or severe bone pain signalling spread to the skeleton. By that point the aim of treatment is control and comfort rather than cure, which is the whole reason late presentation matters so much.

For the few caught at an early stage, the diagnosis was usually an မတော်တဆ တွေ့ရှိချက် — cancer discovered in tissue removed during surgery such as TUR-P, performed to treat a non-cancerous enlarged prostate.

စောစီးစွာ စစ်ဆေးတွေ့ရှိမှုကို အတားအဆီးဖြစ်စေသော အကြောင်းရင်းများ

A major challenge was patient hesitation. Even when a PSA result was clearly raised, many men declined the biopsy needed to confirm or exclude cancer, out of fear or because nobody had explained what the procedure involved. That is a failure of communication as much as of resources, and it is fixable without buying a single machine.

It is worth noting how much the biopsy itself has changed since that presentation. The transrectal ultrasound-guided approach described then has largely given way, where resources allow, to MRI before biopsy and a transperineal route, which lowers the risk of infection and improves the detection of clinically significant disease while missing more of the harmless kind. Patients who refused a biopsy in 2020 were declining a different, less appealing procedure than the one available today.

ကမ္ဘောဒီးယားနိုင်ငံရှိ ကုသမှုဆိုင်ရာ ရွေးချယ်စရာများ

The treatment path depended on the stage of disease and on what the family could afford. The contrast between localized and metastatic management was stark:

စင်မြင့်	Available options at the time (2020)
Localized (early stage)	Open radical prostatectomy was the main surgical option in public institutes, with only about တစ်နှစ်လျှင် အမှုပေါင်း (၁၅) မှု ဆောင်ရွက်ခဲ့သည် across the major centres. External beam radiotherapy was scarcer still — one EBRT machine in the entire country, at Khmer-Soviet Hospital.
Metastatic (advanced stage)	Management centred on androgen deprivation therapy — removing the testosterone that drives the cancer. ခွဲစိတ်၍ မျိုးအောင်ခြင်းဖျက်ဆီးခြင်း was the most common route because it was covered by national insurance. Medical castration with an LHRH agonist such as goserelin was largely self-pay, and the monthly out-of-pocket cost put it beyond many families. Bicalutamide, an anti-androgen, was also in use — it blocks the effect of testosterone rather than lowering it, so it is not castration and is generally used alongside or after it rather than instead of it.

That last row is the sentence I still think about. Whether a Cambodian man had his testicles removed or received an injection was determined not by which suited him better, but by which one insurance paid for.

ပုဂ္ဂလိက နိုင်ငံတကာ ကျန်းမာရေးစောင့်ရှောက်မှု၏ အခန်းကဏ္ဍ

As a practitioner at Royal Phnom Penh Hospital, I was able to offer an alternative that bridged the gap between local limitations and international standards. At that time, Royal Phnom Penh was the ကမ္ဘောဒီးယားနိုင်ငံရှိ JCI အသိအမှတ်ပြု လက်မှတ်ရရှိထားသည့် တစ်ခုတည်းသော ဆေးရုံ/ကျန်းမာရေးစောင့်ရှောက်မှုဌာန နှင့် နိုင်ငံ၏ အကြီးဆုံး ပုဂ္ဂလိကဆေးရုံလည်း ဖြစ်သည်။.

၏ အစိတ်အပိုင်းတစ်ခု ဖြစ်လာခြင်း ဘီဒီအမ်အက်စ် ကွန်ရက် allowed us to provide care that would otherwise have meant a family arranging treatment abroad on their own:

• Surgery: both open and laparoscopic radical prostatectomy.
• Radiotherapy: patients needing EBRT could be transferred to BDMS hospitals in Bangkok.
• Systemic therapy: access to LHRH agonists such as leuprorelin and to abiraterone for advanced disease, with onward referral to medical oncology where further systemic treatment was needed.

Our patient base was genuinely international — Cambodian nationals made up a little under half, alongside expatriates from across Asia, North America, and Europe. I should be honest that this is also the uncomfortable part of the story: a private hospital closes the gap for the patients who reach it, and does nothing at all for the ones who do not. Private capacity is a bridge, not a health system.

A Word on Screening, Honestly

It would be easy to read all of this as an argument for testing every man’s PSA, everywhere. That is not quite what the evidence supports, and it is worth saying so on a urologist’s own website.

PSA screening reduces deaths from prostate cancer, but it also finds a great many cancers that would never have caused a man any harm in his lifetime. Treating those cancers can cause lasting incontinence and erectile dysfunction for no benefit — this is what is meant by overdiagnosis and overtreatment, and it is the reason guidelines call for a shared decision rather than a blanket policy. Much of modern practice, from MRI before biopsy to active surveillance for low-risk disease, exists precisely to keep the benefit while reducing that harm.

None of that weakens the Cambodian argument. There is a wide gulf between over-testing well men and a situation where nine in ten patients arrive with incurable disease. The case for improving detection where almost none exists is not the same as the case for maximal screening where it already does.

မျှော်လင့်ချက်ဖြင့် ရှေ့သို့: ကျွန်ုပ်၏ အဓိကသတင်းစကား

My presentation in Kaohsiung was not just about sharing data — it was a call to action. The messages I left with the international faculty were these:

1. Data gaps: better registry systems are needed to understand the true scale of the problem.
2. Education: investment in patient education to remove the fear surrounding biopsy and screening.
3. Earlier detection: where 90% present with metastatic disease, moving that figure is the single change that would save the most lives.
4. ပူးပေါင်းဆောင်ရွက်မှု Cambodian prostate cancer care benefits enormously from the continued engagement of the regional and global urological community.

That meeting in Taiwan mattered because it gave Cambodia a voice in a regional conversation about cancer. I left the country in 2024, and I hope the situation I described has already moved on — the measure of a talk like that one is whether its data becomes out of date quickly. Thank you for being part of this journey with me.

If you or a loved one have concerns about prostate health, a rising PSA, or a prostate cancer diagnosis, Dr. Soarawee Weerasopone provides prostate cancer screening and diagnosis နှင့် robotic radical prostatectomy at ဘန်ကောက်ဆေးရုံ