Prostate cancer: what to know

The prostate is a walnut-sized gland located directly below the bladder and in front of the rectum. It’s part of the male reproductive system, responsible for producing secretions that protect sperm. DR LEE JANG FANN, Senior Consultant and urologist at HMI (12 Farrer Park Station Road) explains.

Prostate cancer, he says, occurs when cells grow abnormally in the prostate. Most incidences occur after the age of 50; the average age of men diagnosed with prostate cancer is 66.

However, all men must be aware of the risk factors and warning signs.

About one in nine men will be diagnosed with prostate cancer during his lifetime, explains DR TY HO, Deputy Medical Director of International Medical Clinic’s (IMC) Camden Medical Centre clinic (#14-05/06/07, 1 Orchard Boulevard).

Fortunately, this type of cancer grows slowly and does not cause death in most men. In fact, according to the American Cancer Society (ACS), it has the best survival rate among all cancers.

“The five-year survival rate for most men with local or regional prostate cancer is nearly 100 percent,” says Dr Ho. “For men diagnosed with prostate cancer that has spread to other parts of the body, the five-year survival rate is 30 percent.”

“Prostate cancer is unusual, as there are no definitively proven preventable risk factors,” says Dr Ho. “Increasing age, Afro- Caribbean ethnicity and family history are the main risks. There is also some evidence to suggest higher rates in those who are overweight or smokers.”

Dr Lee mentions that eating excessive amounts of red meat can cause an increased risk of prostate cancer. A healthy lifestyle and a low-meat diet can go a long way in helping to lower the risk.

Early prostate cancer usually doesn't show any symptoms (asymptomatic). However, more advanced prostate cancers can cause symptoms such as:

• A painful or burning sensation during urination or ejaculation;
• frequent urination, especially at night;
• difficulty starting and maintaining a steady flow of urine;
• blood in one’s urine; and
• sudden onset of erectile dysfunction.

Some of these symptoms can also be due to benign enlargement of the prostate. Which is very common but not associated with cancer.

It’s important to discuss things with your doctor first before making any judgments.

Yes, it’s important to get checked– even if you have no symptoms, says Dr Lee. He recommends screening from the age of 45 for men. Especially for men with a family history of prostate cancer.

But, because this type of cancer is usually slow-growing and treatable, some men feel that they don’t need to get screened.

Dr Ho says uptake is poor in general, as many men are very reluctant to discuss this issue. However, it’s an issue that needs to be discussed. Dr Ho feels it’s a good idea for men to discuss screening with their doctors from the age of 50 to be safe.

Besides discussing with your doctor, you’ll go through a digital rectal examination. This allows your doctor to feel the surface of the prostate and look for any suspicious bumps or nodules. “While this may sound unpleasant, it is very quick, safe and could save your life,” says Dr Ho.

Sometimes, a blood test is also done. This is usually the prostate-specific antigen (PSA) test, which allows for detection in the early stages while the disease is still asymptomatic, says Dr Lee; an elevated PSA level is often the first sign of prostate cancer.

He adds that the prostate-specific antigen test can be affected by certain medical procedures and medications. It can also be affected by an enlarged prostate or a prostate infection. A high PSA level doesn’t necessarily mean cancer.

If the PSA test is abnormal, a newer test called Prostate Health Index (PHI) can be done to see if a biopsy is needed. “The PHI test allows us to reduce unneeded biopsies,” explains Dr Ho.

If cancer is suspected, further investigation may be warranted, says Dr Lee. This may include a multiparametric prostate MRI, which is a non-invasive method of looking for suspicious lesions in the prostate.

It may also include a biopsy to confirm if there is cancer. Then, various prostate cancer treatment options can be discussed.

In some cases, prostate cancer can take many years to progress. Doctors may choose to simply monitor the tumour rather than treat it immediately. This is because treatment depends on factors including the stage of the cancer, symptoms, age and the general health of the patient.

“There are good treatments available including surgery, radiotherapy and hormonal medication,” says Dr Ho. “The big challenge is that not all cases are aggressive or require treatment and much current research is focused on deciding between which men need aggressive therapy and those who can be safely monitored.”

If the cancer is confined to the prostate, radiotherapy and the surgical removal of the prostate and surrounding structures are good treatment options with comparable cure rates, says Dr Lee.

He says hormone therapy is often used as an adjunct in locally advanced cancer too. And, if the cancer has spread to other organs, hormone therapy and chemotherapy are plausible treatment options.

Of course, every case is distinct, and treatment options must be relevant to the individual. All screening and treatment options should be discussed with a healthcare professional.

Dr Lee Fang Jann is a Urology and Renal Transplant Specialist who has received numerous awards for service excellence, including the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016). Having served in the public sector for 16 years before entering private practice, Dr Lee Fang Jann was the Director of the Andrology and Male Subfertility Services at Singapore General Hospital (SGH), where he led the Renal Transplant Program and Laparoscopic Donor Nephrectomy Service as the Surgical Director.