Prostate cancer is one the most common cancers among males. In fact, it’s the third most common cancer in men in Singapore. Here, two doctors answer all our questions about prostate cancer symptoms, screening methods such as the PSA test, risk factors and prostate cancer treatment options.
What is a prostate?
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 that produces secretions to protect sperm, explains DR LEE JANG FANN, Senior Consultant and urologist at StarMed Specialist Centre (12 Farrer Park Station Road).
Prostate cancer, he says, occurs when cells grow abnormally in the prostate. Most incidences of this type of cancer occur after the age of 50; the average age of men diagnosed with prostate cancer is 66. However, it’s important that all men are aware of the risk factors and warning signs, no matter their age.
How common is this type of cancer?
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). Luckily, this type of cancer can grow slowly, and most men diagnosed with it do not die from it. 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.”
What are the risk factors?
“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.”
Additionally, Dr Lee says eating excessive amounts of red meat can have an increased risk of prostate cancer. A healthy lifestyle, with lower meat consumption can therefore go a long way in helping to lower the risk.
What are the symptoms of prostate cancer?
Early prostate cancer is usually asymptomatic. However, more advanced prostate cancers can sometimes 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. So, it’s important not to panic; discuss things with your doctor first.
Should all men be screened for prostate cancer?
Because this type of cancer can be “silent” in the early stages, 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 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. In fact, 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.
What does a prostate check involve?
In addition to a discussion with your doctor, it involves 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.
However, 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. So, 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.
Additionally, 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 biopsy to confirm the presence of cancer. Then, various prostate cancer treatment options can be discussed.
What are the options for prostate cancer treatment?
In some cases, because 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, Dr Lee says that both radiotherapy and the surgical removal of the prostate and surrounding structures are good treatment options with comparable cure rates. 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 customised to the individual. All screening and treatment options should be discussed with a healthcare professional.
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