The prostate gland is part of the male reproductive system. Prostate cancer is a disease which develops from the tissues of the prostate, a gland located below the bladder and in front of the rectum.
In most cases, prostate cancer is slow-growing and is confined to the prostate gland. It typically takes a number of years to become large enough to detect, and even longer to spread beyond the prostate. However, there are some aggressive forms of prostate cancer that can spread quickly.
Prostate cancer is the second most common cancer in men in Singapore. During a period of five years, from 2014-2018, 5368 cases of prostate cancer were diagnosed in Singapore.
Prostate cancer usually occurs in men over the age of 50 and is mostly seen in those over the age of 70.
There are usually no symptoms in the early stages of prostate cancer. As most prostate cancers are slow growing, many men reach old age or pass away without knowing that they have prostate cancer. Most men discover they have prostate cancer during routine medical check-ups or through blood tests.
Symptoms, which typically occur in more advanced prostate cancer may include:
The symptoms above can be caused by a number of reasons and may not indicate the presence of prostate cancer. However, make an appointment with your doctor if you have any signs or symptoms that worry you.
At present there is a lack of evidence to support population-based screening for prostate cancer in Singapore. Individuals should seek medical attention if they have any of the above symptoms.
Currently there are no proven preventive strategies. However, adopting a healthy lifestyle can help prevent the risk of prostate cancer. This includes:
The exact causes of prostate cancer are still unknown and are being studied through research. Some of the risk factors that are known to increase the risk of developing prostate cancer are:
Several different tests can be used to diagnose prostate cancer, including:
Treatment for prostate cancer depends on several factors including the patient’s age, medical conditions, significant illnesses, prostate-specific antigen level, digital rectal examination results, aggressiveness of the cancer and spread of disease.
An individual with prostate cancer should be assessed by a multi-disciplinary team of specialists to determine which modality of treatment is best suited for them. Prostate cancer treatment requires the involvement of different specialists – urologists, interventional radiologists, nuclear medicine physicians, medical oncologists, radiation oncologists and palliative medicine specialists. Such multi-disciplinary care is available at SingHealth healthcare institutions. It is important to discuss all the possible treatment choices, including what to expect and possible side effects, to help you make an informed decision.
Men with early-stage prostate cancer, that is slow-growing and causing little or no symptoms, may not need immediate treatment. In such cases, their doctors may advise waiting and observing to see if the cancer progresses before starting any treatment. Active surveillance may include regular tests such as prostate-specific antigen level blood test or digital rectal examination.
This is a minimally invasive approach to treating prostate cancer using ablative energy to target just the area of cancer in the prostate gland for destruction. The non-cancerous part of the prostate as well as surrounding critical structures are preserved thus maintaining sexual and urinary function. This treatment may be suggested if your cancer is early stage and limited to just 1 or, maximally, 2 areas within the prostate.
The surgical approach to treating prostate cancer is known as prostatectomy. It involves removing all or part of the prostate gland. Surgery is usually offered to men with early-stage disease or cancer that is confined to the prostate, who do not have other serious health problems.
In radical prostatectomy, the entire prostate gland and other nearby tissues (e.g. surrounding structures and lymph nodes) are surgically removed.
Another approach is the robotic-assisted laparoscopic radical prostatectomy, where the urologist makes several small incisions in the lower abdomen and uses instruments attached to a mechanical device, known as “robotic arms”, to perform the surgery.
Tissues that have been surgically removed will be examined to indicate how advanced the prostate cancer is, the risk of cancer recurrence and if additional treatment is necessary.
Hormone therapy, known as androgen deprivation therapy, works by preventing prostate cancer cells from receiving testosterone, causing the prostate cancer cells to die or grow more slowly. Hormone therapy for prostate cancer usually involves the use of drugs, given as injections or tablets. Another less common form of hormone therapy is the surgical removal of the testicles or the parts of the testicles that produce testosterone.
Radiotherapy, also known as radiation therapy, is the use of high-energy radiation (rays or particles) to kill or damage the prostate cancer cells. Radiation affects both normal and prostate cancer cells. Generally, prostate cancer cells are more sensitive to radiation and more cancer cells are killed compared to normal cells. Normal cells are also better able to repair themselves after radiotherapy.
Radiotherapy can be delivered in two main ways; external beam radiotherapy (EBRT) or internal radiotherapy. In EBRT, radiation beams are generated from a machine outside the body and directed at the prostate. For Internal Radiation Therapy, also known as Brachytherapy, radiation is delivered to the prostate by placing radioactive materials in the prostate.
The type of radiotherapy the doctor would recommend depends on the stage of the prostate cancer and the patient’s underlying health condition.
Chemotherapy is the use of anti-cancer drugs to eradicate prostate cancer cells or prevent their growth. Chemotherapy can also help to relieve or delay symptoms like pain. Early stage prostate cancer is not usually treated with chemotherapy. Chemotherapy is mostly offered to men with advanced or metastatic prostate cancer, which has spread beyond the prostate to other parts of the body. It is commonly given to those who have not responded to hormone therapy.
Your urologist will perform a comprehensive medical work-up including blood tests, exams and scans to see if you are suitable for surgery and advise you on the risks involved. This treatment recommendation is often based on consensus by a group of different specialists' opinions (tumour board) which weighs the pros and cons of every treatment strategy.
Before surgery, the anaesthesia team will also assess your fitness for surgery and advise you on various aspects of general anaesthesia and pain control after surgery.
Specialist nurses will also provide pre-surgery counselling.
After recovering from surgery, you will be given regular outpatient appointments to see your team of doctors. These visits may include blood tests and scans to monitor and check if prostate cancer recurs.
It is important to follow your doctor's advice, keep to scheduled clinic visits and do the prescribed tests so that timely treatment can be administered if prostate cancer or other problems arise.