Улучшение ухода при раке предстательной железы в Камбодже: личный и профессиональный путь

Последнее обновление: Август 17, 2026

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Приветствую всех моих коллег, пациентов и друзей. Я делюсь значительной вехой в моем профессиональном пути. На 3 января 2020 года, я имел честь служить в качестве Член Международного факультета на 3-й Азиатский форум по урологической онкологии в Каосюне, Тайвань, совместно с 12-е ежегодное собрание Тайваньской ассоциации урологической онкологии (TUOA).

Представляя урологическое отделение Королевской больницы Пномпеня, я имел честь представить текущую ситуацию с Лечение рака предстательной железы в Камбодже. Это было знаменательное событие, ознаменовавшее важный этап в моей карьере, поскольку я поделился трудностями и триумфами практика урологии в Камбодже вместе с зарубежными коллегами.

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.
• Полная неспособность мочиться 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.

Понимание ситуации в Камбодже

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 16 миллионов граждан. 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.

Камбоджа, расположенная в самом сердце Юго-Восточной Азии, граничащая с Таиландом, Лаосом и Вьетнамом, является развивающейся страной, неустанно работающей над модернизацией своей инфраструктуры здравоохранения.

Цифры: скрытая проблема

According to the 2018–2019 World Health Organization and Globocan data available at the time, prostate cancer was recorded as the 19-е место среди наиболее часто диагностируемых видов рака в Камбодже.

• Заболеваемость approximately 1.15 per 100,000 population.
• Смертность 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.

Обзор системы государственного здравоохранения

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 бумажная документация, 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. Больница Кальметта
2. Кхмерско-советская больница
3. Больница «Коссамак»

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.

Ресурсы в области урологии в Камбодже

While the medical community was dedicated, resources were spread thin. Across the entire country there were only 65 зарегистрированных урологов. Through a France-Cambodia medical agreement, about 30 of them had trained in France.

Only 135 больничных коек 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.

Реальность диагностики и лечения

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.

Презентация на поздней стадии

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 случайная находка — cancer discovered in tissue removed during surgery such as TUR-P, performed to treat a non-cancerous enlarged prostate.

Препятствия на пути ранней диагностики

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.

Варианты лечения в Камбодже

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:

Сцена	Available options at the time (2020)
Localized (early stage)	Open radical prostatectomy was the main surgical option in public institutes, with only about 15 случаев ежегодно 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. Хирургическая кастрация 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.

Роль частного международного здравоохранения

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 единственное учреждение в Камбодже, аккредитованное JCI и крупнейшая частная больница в стране.

Быть частью Сеть BDMS 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.

Взгляд в будущее: мои главные выводы

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. Сотрудничество 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 и robotic radical prostatectomy у Головной офис Бангкокской больницы, and consults at Samitivej Sriracha Hospital, Chonburi — 088-022-1445.

Телемедицина больницы Бангкока доступна для пациентов, которые не могут прийти лично, включая иностранных пациентов — организуйте это заранее по электронной почте в отделении урологии bhquro@bdms.co.th. Samitivej Sriracha is in-person only. For any enquiry about the cost of consultation or treatment, please contact the hospital directly — Bangkok Hospital at bhquro@bdms.co.th, or Samitivej Sriracha on 088-022-1445.

Часто задаваемые вопросы об уходе при раке предстательной железы в Камбодже

Насколько распространено рак предстательной железы в Камбодже по сравнению с западными странами?

In the 2018–2019 data used for this presentation, the recorded incidence in Cambodia was approximately 1.15 per 100,000 population, against a worldwide rate of around 33 per 100,000. That gap almost certainly reflects underdiagnosis rather than genuinely low disease — the consequence of limited PSA testing, low public awareness, and the absence of a centralized cancer registry. These are figures from that period, not current national statistics.

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

Around 90% were diagnosed only after developing symptoms of metastatic disease, such as urinary retention or bone pain. Limited routine PSA testing, patient hesitation around biopsy, and a paper-based health system together meant early-stage detection was uncommon outside incidental findings during surgery for benign prostate enlargement.

What is the difference between surgical and medical castration?

Both lower testosterone, which is what drives prostate cancer growth. Surgical castration removes the testicular tissue that produces it and is permanent. Medical castration uses an injected LHRH agonist such as goserelin or leuprorelin to switch off production, and is reversible if stopped. Anti-androgens such as bicalutamide are a different class — they block testosterone’s effect at the receptor rather than reducing the hormone itself, so they are not castration and are used alongside or after it rather than as a substitute.

What prostate cancer treatments were available in Cambodia?

Localized disease was treated primarily with open surgery in public institutes, at about 15 cases per year across the major centres. External beam radiotherapy was severely limited, with one machine nationwide. For metastatic disease, surgical castration was the most common option because national insurance covered it, while medical castration was largely self-pay and often unaffordable. This describes the position in 2020 and may well have changed since.

Когда мужчинам следует начинать скрининг на рак предстательной железы?

Major urology guidelines suggest beginning a conversation about baseline PSA at around age 50 for men at average risk, and earlier — typically 40 to 45 — for those with a family history or other risk factors. It should be a shared decision rather than an automatic test, because PSA screening reduces prostate cancer deaths but also detects cancers that would never have caused harm, and treating those can cause lasting incontinence and erectile dysfunction. MRI before biopsy and active surveillance for low-risk disease exist to keep the benefit while limiting that harm.

Which symptoms of prostate cancer need urgent care?

New or worsening back pain with leg weakness, numbness or loss of bladder or bowel control may indicate spinal cord compression, an emergency in which treatment within hours protects the ability to walk. Complete inability to pass urine, fever with urinary symptoms particularly after a prostate biopsy, and visible blood in the urine with clots also need same-day assessment. In Thailand the emergency number is 1669.

Отказ от ответственности: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. The epidemiological and health-system figures described here date from a January 2020 presentation and describe Cambodia at that time. No diagnosis, advice or prescription is provided through personal messaging channels or social media. Always consult a qualified healthcare professional before starting, stopping or changing any medical treatment.