By 2040, Malaysia’s demographic will include an almost equal share of young (18.6%) and older populations (14.5%), with the elderly population surpassing six million—a key milestone in the country’s transition to an ageing nation.

As this demographic shift unfolds, managing MetS in men will be crucial to promoting healthy ageing and supporting men’s resilience throughout life’s stages.

Decoding MetS – Not only a male issue

So, what is MetS? As shared by Sunway Medical Centre Velocity (SMCV) Consultant
Nephrologist and Internal Medicine Physician, Dr Radzi Rodzlan, it is characterised by at
least three of the following five risk factors, such as central obesity, high serum triglycerides (having too much fats in your blood), low high-density lipoprotein cholesterol (HDL-C) or when a person does not have enough good cholesterol in their blood, raised blood pressure and raised fasting blood sugar levels.

MetS is not only a male issue. This condition affects both men and women, according to Dr Rodzlan. Studies showed that the overall prevalence of MetS among adults in Malaysia lies between 25-40%. Risk factors most closely tied to MetS include age – you are more likely to have it the older you are.

Personal or family history of diabetes where women who have had diabetes during pregnancy (gestational diabetes) or people who have a family member with type 2 diabetes are at greater risk for MetS. Other risk factors include unhealthy eating habits, smoking, history of heavy drinking, stress, being past menopause, high-fat diet and sedentary lifestyle, Dr Radzi added.

Having MetS can increase one’s risk of developing Type 2 diabetes, and can cause heart and blood vessel disease – eventually leading to heart attack or stroke.

Urinary problems

MetS is also linked to several urological conditions including kidney stones, benign prostatic hyperplasia (BPH) or enlarged prostate, lower urinary tract symptoms (LUTS), erectile dysfunction, male infertility, and prostate cancer 1

According to SMCV’s Consultant Urologist and Robotic Surgeon, DatoDr Selvalingam Sothilingam, there has been increasing evidence that men with MetS are at an increased risk of experiencing moderate to severe urinary symptoms as they age

Lower urinary tract symptoms or collectively referred to as LUTS are frequently caused by BPH. The symptoms include delay in initiating voiding (hesitancy), poor urinary flow, incomplete bladder emptying, urinary urgency or frequent urination and disturbed sleep due to avoiding (nocturia), Dato’ Dr Selvalingam explained.

Patients with these symptoms are urged to seek medical attention as soon as possible, especially those with an elevated Prostate Specific Antigen (PSA) level. If left untreated, BPH can be associated with complications such as urinary tract infection, blood in the urine, acute urinary obstruction, urinary incontinence, renal impairment and bed wetting.

BPH may also cause obstruction to the kidney leading to kidney swelling (hydronephrosis) and in severe cases, it may result in kidney failure. This condition is often referred to as chronic obstruction and men will experience hypertension, bilateral leg swelling and often complain of bedwetting (nocturnal enuresis).

Dato’ Dr Selvalingam stressed the importance of going for health screenings, as early detection is key in preventing further complications. He said that 80% of men with BPH can be successfully treated with medication. However, these medications need to be taken long term. Men with complications from BPH may require surgery such as TURP (Transurethral Resection of Prostate), or minimally invasive treatments such as REZUM (Water Vapour Therapy of Prostate).

Impact on kidney health
MetS can result in significant changes to renal structure and function. Dr Radzi intoned that these changes include decreased glomerular filtration rate (GFR) which is a calculation to measure how well a person’s kidneys are working in filtering out waste and extra fluid from their blood and increased urinary microalbumin which indicates protein leakage from the kidneys.

Such alterations in kidney function can lead to chronic kidney disease (CKD), which may progress to severe health issues, including end-stage renal disease that requires dialysis or kidney transplantation.

Dr Radzi further emphasised that early symptoms and signs of kidney problems associated with MetS can include leg swelling, frothy urine, and abnormality results in blood and urine tests.

To prevent the progression of CKD, he highlighted the importance of regular health screenings, as early detection is vital for avoiding further complications related to MetS.

Additionally, both consultants encourage lifestyle changes such as regular exercise to combat insulin resistance and adopting a heart-healthy diet by avoiding excessive amounts of carbohydrates that stimulate excess insulin production. These proactive measures can significantly improve overall health and reduce the risk of developing kidney-related issues.

Stopping the condition in its tracks

As Malaysia’s ageing population continues to rise, understanding and addressing men’s health, particularly in the context of MetS, becomes increasingly important. With a significant portion of the population facing the challenges associated with MetS, including the risk of urinary and chronic kidney problems, proactive health management is crucial to adopt now.

By fostering awareness and encouraging health screenings, as advocated by both Dato’ Dr Selvalingam and Dr Radzi, men can take charge of their health, facilitating early detection and intervention that can greatly improve health outcomes. This will not only enhance the quality of life for individuals but will also contribute to the overall well-being of Malaysia’s ageing population

Source:
1. https://pmc.ncbi.nlm.nih.gov/articles/PMC3020279/#:~:
text=MetS%20has%20been%20linked%20to,
female%20incontinence%2C%20and%20prostate%20cancer

Breakthrough study

A pioneering study by Romie Angelo Azur, Kevin Christian Olarte, Weand Ybañez, Alessandria Maeve Ocampo, and Dr. Pia Bagamasbad at the University of the Philippines (UP) Diliman College of Science National Institute of Molecular Biology and Biotechnology (UPD-CS NIMBB) has identified a key protein, CYB561, that contributes to the progression of prostate cancer into its most aggressive form, NEPC. This discovery elucidates the molecular basis of the disease and opens new avenues for treatment.

According to the World Health Organization, prostate cancer is the third most common cancer type among Filipino men. In 2022, nearly 10,000 Filipino men were diagnosed with this disease. While many cases are manageable, some progress to aggressive forms, such as castration-resistant prostate cancer (CRPC) and neuroendocrine prostate cancer (NEPC). NEPC, the most fatal, resists standard treatments.

Standard treatment and limitations

Prostate cancer relies on male sex hormones, or androgens, for growth. Androgen deprivation therapy (ADT) is the standard treatment to stifle this growth. However, over time, cancer cells can mutate, growing without androgens and becoming resistant to ADT, potentially developing into neuroendocrine prostate cancer or NEPC.

A key protein identified
Dr. Bagamasbad and her team discovered that CYB561 plays a dual role in cancer progression: It activates specific growth factors and manages iron levels, enabling cancer cells to thrive even without androgens. Using publicly available data and experimental findings, they found that CYB561 is more prevalent in CRPC and NEPC cells compared to normal prostate cancer cells.

Impact of CYB561 on treatment resistance

Depleting CYB561 made prostate cancer cells more sensitive to enzalutamide, a common ADT drug, suggesting that CYB561 provides resistance to this treatment. The protein also converts iron into a more active form, essential for aggressive cancer cell growth. Knocking down CYB561 reduced active iron levels, delayed CRPC progression to NEPC, and diminished the aggressive behavior of NEPC cells.

Looking forward

The findings, published in PLOS One, could lead to new therapies targeting CYB561. “By understanding the role of CYB561 in prostate cancer,” said Dr. Bagamasbad, “we have potentially identified a new target for future treatments.” The team plans to further research on animal models and primary tumor samples, and investigate whether Filipinos have higher risks of developing CRPC and NEPC due to CYB561. They aim to establish a drug screening platform to target CYB561 activity effectively.

Source: SCIENCE – UP Diliman

Scientists at Weill Cornell Medicine have identified two new subtypes of prostate cancer. The tumour subtypes can be resistant to hormone therapy, which reduces the levels of androgens (male hormones) like testosterone that the cancer cells depend on to grow – knowing the exact subtype is nevertheless important for successful cancer treatment.

Of the four subtypes of prostate cancer, the two latest to be identified are named SCL and WNT, after the overactive signaling pathways characteristic of the respective tumours. These subtypes were determined by analysing chromatin profiles in tumour samples, as he genetic content of chromatin can lead to the development of different types of cancer.

The scientists found that the SCL type accounted for around 22-30% of cases of prostate cancer, in a patient sample of over 360 individuals; the WNT type was much rarer in the same patient sample, at just 5-7%. In SCL prostate cancers, for example, a series of proteins become too active, which changes chromatin accessibility and drives tumour growth.

Depending on which proteins are involved, existing molecules that are known to affect them could then slow the growth of SCL cancer cells, indicating new treatments could be possible.

“Once you can identify which type of tumour patients have, that’s very powerful information,” said Dr. Etka Khurana, associate professor of physiology and biophysics at Weill Cornell Medicine. “For patients that fall into this SCL group, we have found very promising drug targets, which future studies will work to validate.”

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Scientists identify new prostate cancer tumour type