About the Condition
The prostate is a small gland found only in men and is located below the bladder and surrounding the urethra. The prostate’s primary function is to produce seminal fluid to nourish and transport sperm. The cells that make up the outermost part of the prostate can become cancerous and give rise to prostate cancer. This is a slow growing cancer that can spread to other organs, particularly the skeleton. Patients who are diagnosed early have a very high survival rate.

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Symptoms and Detection

Early stage prostate cancer is usually without symptoms and may be detected during a routine examination of the anus and rectum. Symptoms usually show up at later stages of the disease as the tumour grows and narrows the urethra and, when the cancer spreads to other organs.

The symptoms include:-

• weak or interrupted urine flow
• frequent urination (especially at night)
• difficulty in urination
• pain or burning sensation during urination
• blood in the urine or semen
• persistent pain in the back, hips or pelvis
• painful ejaculation

These symptoms are non-specific and may also be caused by benign (non-cancerous) conditions such as benign prostatic hyperplasia and prostatitis.

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Screening and Testing

Prostate cancer can be diagnosed through the following clinical findings and laboratory tests.

1. Digital rectal examination
Your doctor will examine the prostate through the rectum to determine if there are any abnormalities.

2. Prostate Specific Antigen (PSA) level
A blood test for PSA, a substance produced by the prostate to liquefy semen, is carried out. A higher than normal level may indicate cancer.

3. Transrectal ultrasound guided biopsy
Tissue samples from the prostate are taken and tested for the presence of cancer cells

Once prostate cancer has been diagnosed, your doctor may perform scans of the abdomen and a bone scan to determine if the cancer has spread.

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Risk Factors and Causes

Very little is known about the cause of prostate cancer although some risk factors have been identified.

These risk factors include:-

• Age (over 55 years old)
• Race (higher risk in African Americans and Scandinavians)
• Family history of prostate cancer
• Diet (high in animal fat and red meat)
• Previous vasectomy

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Prevention

As the exact cause of prostate cancer is not known, it is not possible to prevent the disease from occurring. However, you can take steps to maintain prostate health by having a balanced diet comprising more fruits, vegetables and fibre, be physically active and have regular check-ups.

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Stages

The stages of prostate cancer are:-

Stage 1:	The tumour cannot be detected by routine tests, but was found during a surgery for another prostate disorder or found through a biopsy performed because of high PSA levels.
Stage 2:	The tumour can be felt during a rectal examination but has not spread beyond the prostate.
Stage 3:	The prostate cancer has spread beyond the prostate to nearby organs.
Stage 4:	The cancer has spread to the pelvic lymph nodes or distant organs such as the bones.

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Treatment Options

The choice of treatment would depend on the prostate cancer profile, including:-

• age and life expectancy
• medical condition and risk factors
• presence of significant illnesses, such as heart problem, stroke, diabetes and so on
• Prostate Specific Antigen (PSA) level
• Gleason score (derived from the pathologist’s assessment of the prostate biopsy)
• presence of metastasis (extensive spread of disease)
• status of digital rectal examination

Your doctor will assess your cancer profile and recommend one of the following treatment options:-

1. Watchful waiting
Watchful waiting is close monitoring of the disease without active treatment until symptoms appear or change. This is usually recommended for older men above the age of 70 with early stage disease and other medical problems.

As prostate cancer is a slow growing tumour, patients with shorter life expectancy are unlikely to die from the disease and may not benefit from the treatment.

Furthermore, they may have other medical problems that lower the body’s ability to respond to treatment complications.

2. Surgery
This involves the removal of the entire prostate gland with the attached seminal vesicles and vas deferens, which are organs used for storage and transport of the seminal fluid. The pelvic lymph nodes around the prostate may also be removed depending on the cancer profile.

Patients younger than 70 years old, who have early stage prostate cancer and no other medical problems, may be offered this option.

Besides conventional surgery, the Urology Centre is the first in Southeast Asia to offer the surgical technique of operating through 5 to 6 keyhole-sized incisions in the abdomen. This technique allows faster recovery and less post-operative pain.

3. Radiotherapy
This treatment option employs high energy x-rays to destroy cancer cells.

• One method involves directing the x-rays onto the area affected by the cancer. This requires an initial evaluation followed by approximately 7 weeks of treatment. During the treatment, the x-rays will affect nearby healthy tissue.
• The other method focuses the x-ray beams very precisely on the cancer, with less effect on surrounding organs.

4. Hormonal Therapy
Studies have shown that male hormones aid the growth of prostate cancer. Hormonal therapy is offered mainly for advanced prostate cancer and works by removing the source of male hormones or opposing its action on the tumour cells. The treatment may be administered via injections or through oral medications.

In some cases, the testes, which are the main sources of male hormones, may be surgically removed.

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