Improving Prostate Cancer Care in Cambodia: A Personal and Professional Journey

နောက်ဆုံး ပြင်ဆင်သည် မေ ၃၊ ၂၀၂၆

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Greetings to all my colleagues, patients, and friends. I am sharing a significant milestone in my professional journey. On January 3, 2020, I had the distinct honor of serving as an International Faculty member at the 3rd Asian Urological Oncology Forum in Kaohsiung, Taiwan, held in conjunction with the 12th Annual Meeting of the Taiwan Urological Oncology Association (TUOA).

Representing the Urology Department of Royal Phnom Penh Hospital, I was privileged to present the current landscape of prostate cancer management in Cambodia. It was a momentous occasion, marking a key milestone in my career as I shared the challenges and triumphs of practicing urology in Cambodia with international colleagues.

In the spirit of that presentation, this article walks through the “current situation” of prostate cancer in Cambodia — distilling complex medical data into a narrative that highlights where we are and, more importantly, where we are headed.

Understanding the Cambodian Context

To understand the state of cancer care, one must first understand the demographics of the nation. Cambodia is home to approximately 16 million citizens. Within this population, there is a growing group of elderly citizens — specifically, there are over 850,000 people over the age of 65, including approximately 330,000 elderly males who are at the primary age risk for prostate cancer.

Located in the heart of Southeast Asia, bordered by Thailand, Laos, and Vietnam, Cambodia is a developing nation working tirelessly to modernize its healthcare infrastructure.

The Numbers: A Hidden Challenge

According to 2018–2019 data from the World Health Organization (WHO) and Globocan, prostate cancer is recorded as the 19th most frequently diagnosed cancer in Cambodia.

• Incidence: Approximately 1.15 per 100,000 population.
• Mortality: Approximately 0.75 per 100,000 population.

At first glance, these numbers seem low compared to the worldwide incidence of 33 per 100,000. However, as I discussed with my colleagues in Taiwan, these figures likely represent a significant underestimation. The reality is that many cases go undiagnosed due to a lack of public awareness and limited screening programs. Furthermore, the Mortality-to-Incidence Ratio is high (0.65), suggesting that when the cancer is found, it is often in its later, more dangerous stages.

The Public Healthcare Landscape

One of the greatest hurdles in managing prostate cancer in Cambodia is the lack of a centralized, digital National Cancer Registry. Currently, most government hospitals still rely on paper-based documentation, making it difficult to track long-term patient outcomes or form a comprehensive national strategy.

To get a clearer picture for my presentation, I reached out to the heads of the urology departments at the “Top 3” public institutes in Phnom Penh:

1. Calmette Hospital
2. Khmer-Soviet Hospital
3. Kossamak Hospital

Urology Resources in Cambodia

While the medical community is dedicated, the resources are spread thin. Across the entire country, there are only 65 registered urologists. Through a special France-Cambodian medical agreement, about 30 of these specialists received their training in France.

Currently, only 135 hospital beds are dedicated to urology services for the entire nation. This scarcity of resources highlights why international collaboration and private-sector support are so vital.

The Reality of Diagnosis and Management

In Cambodia, the way prostate cancer is discovered differs significantly from Western countries. In the West, many cases are caught early through routine PSA (Prostate-Specific Antigen) blood tests. In Cambodia, approximately 200 new cases are diagnosed annually across the major public hospitals — but the presentation is often late.

Late-Stage Presentation

Sadly, 90% of patients arrive at the hospital already suffering from symptomatic metastatic prostate cancer (mPCA). These patients often present with chronic difficulty urinating (dysuria), urinary retention, and severe bone pain (a sign that the cancer has spread).

For those few caught in the “early stage,” the diagnosis is often an incidental finding — meaning the cancer was discovered during a surgery (such as a TUR-P) intended to treat a non-cancerous enlarged prostate.

Barriers to Early Detection

A major challenge we face is patient hesitation. Even when a screening test shows a high PSA level, many patients refuse a TRUS biopsy (the standard procedure to confirm cancer) due to fear or a lack of understanding of the procedure.

Treatment Options in Cambodia

The treatment path often depends on the stage of the disease and the patient’s financial resources. The contrast between localized and metastatic disease management is stark:

Stage	Available Treatment Options
Localized (Early Stage)	Open surgery is the primary surgical option in public institutes, with only about 15 cases performed annually across the major centers. External Beam Radiation Therapy (EBRT) is even more limited — there is currently only one EBRT machine in the entire country, located at Khmer-Soviet Hospital.
Metastatic (Advanced Stage)	Management focuses on androgen deprivation therapy (ADT) — reducing the testosterone that fuels cancer growth. Surgical castration is the most common approach because it is covered by national insurance. Medical castration (e.g., Goserelin or Bicalutamide) is typically self-pay at roughly 33 USD per month, which can be a significant barrier for many Cambodian families.

The Role of Private International Healthcare

As a practitioner at Royal Phnom Penh Hospital, I was proud to offer an alternative that bridged the gap between local limitations and international standards. Royal Phnom Penh is the only JCI-accredited facility in Cambodia and the largest private hospital in the country.

Being part of the BDMS network — the largest hospital network in Thailand — allowed us to provide a level of care that would otherwise require traveling abroad:

• Advanced Surgery: We offered both open and laparoscopic (minimally invasive) prostatectomy.
• Advanced Radiation: Patients requiring specialized EBRT could be seamlessly transferred to BDMS headquarters in Bangkok.
• Modern Therapeutics: Access to newer hormonal agents like Leuprorelin and Abiraterone, with support for patients undergoing immunotherapy.

Our patient base was truly international, reflecting the trust placed in our facility by locals (47%), as well as expatriates from Asia, North America, and Europe.

Looking Forward: My Take-Home Message

My presentation in Kaohsiung was not just about sharing data — it was a call to action. The journey of practicing urology in Cambodia since 2016 has taught me that we have much work to do. The take-home messages I shared with the international faculty remain true today:

1. Data Gaps: We need better registry systems to understand the true scale of the problem.
2. Education is Key: We must invest in patient education to remove the stigma surrounding biopsies and screenings.
3. Early Detection: Catching cancer early is the only way to lower that high mortality rate.
4. Collaboration: Cambodia’s prostate cancer management needs the continued help and expertise of the global medical community.

That meeting in Taiwan was a milestone because it gave Cambodia a voice in the regional conversation about cancer. I am committed to ensuring that the “current situation” we discussed becomes a history of how we transformed urological care for the better. Thank you for being part of this journey with me. Together, we can improve the lives of fathers, grandfathers, and brothers across Cambodia.

If you or a loved one have concerns about prostate health, an elevated PSA, or a prostate cancer diagnosis, Dr. Soarawee Weerasopone offers specialist consultations in urological oncology at Bangkok Hospital Headquarters. တိုင်ပင်ဆွေးနွေးမှု ကြိုတင်မှာယူရန်.

Frequently Asked Questions About Prostate Cancer Care in Cambodia

How common is prostate cancer in Cambodia compared to Western countries?

The recorded incidence in Cambodia is approximately 1.15 per 100,000 population, far lower than the worldwide rate of 33 per 100,000. However, this likely reflects significant underdiagnosis rather than a true low incidence — the result of limited PSA screening, lack of public awareness, and the absence of a centralized cancer registry.

Why are most Cambodian prostate cancer patients diagnosed at a late stage?

Approximately 90% of patients in Cambodia are diagnosed only after developing symptoms of metastatic disease, such as urinary retention or bone pain. The combination of limited routine PSA screening, patient hesitation around TRUS biopsy, and a paper-based health system means early-stage detection is uncommon outside of incidental findings during BPH surgery.

What prostate cancer treatments are available in Cambodia?

Localized disease is treated primarily with open surgery in public institutes (about 15 cases per year). External beam radiation is severely limited, with only one EBRT machine nationwide. For metastatic disease, surgical castration is the most common option due to insurance coverage, while medical castration agents (Goserelin, Bicalutamide) are available but typically self-pay.

How does international private healthcare help Cambodian prostate cancer patients?

JCI-accredited private hospitals in the BDMS network offer access to laparoscopic prostatectomy, advanced radiation therapy through transfer to Bangkok, and modern hormonal agents like Leuprorelin and Abiraterone. This bridges the gap between local limitations and international treatment standards without requiring patients to independently arrange care abroad.

When should men start screening for prostate cancer?

Major urology guidelines recommend a baseline PSA discussion starting at age 50 for average-risk men, or earlier (age 40–45) for those with a family history of prostate cancer or other risk factors. Screening decisions should be individualized in consultation with a urologist, weighing personal risk factors against the benefits and limitations of PSA testing.

ရှောင်ကြဉ်ချက်: ဤအကြောင်းအရာကို ဘန်ကောက်ဆေးရုံဌာနချုပ်ရှိ ဘုတ်လက်မှတ်ရ ဆီးလမ်းကြောင်းနှင့် ဆီးအိမ်အထူးကု ဆရာဝန် ဒေါက်တာ ဆိုရာဝီ ဝီရာဆိုပွန်က ဆေးဘက်ဆိုင်ရာအရ ရေးသားပြီး ပြန်လည်သုံးသပ်ထားပါသည်။ ဤအကြောင်းအရာသည် ပညာရေးဆိုင်ရာ ရည်ရွယ်ချက်အတွက်သာ ရည်ရွယ်ထားပြီး ဆေးဘက်ဆိုင်ရာ အကြံဉာဏ် မဟုတ်ပါ။ မည်သည့် ဆေးကုသမှုကိုမဆို စတင်မပြုမီ အရည်အချင်းပြည့်မီသော ကျန်းမာရေးပညာရှင်တစ်ဦးနှင့် အမြဲတမ်း ဆွေးနွေးတိုင်ပင်ပါ။.