Prostate Cancer & Screening

 Prostate Cancer

In Singapore, Prostate Cancer is the 3rd most common cancer in men, after colorectal and lung cancer. Prostate Cancer tends to affect older men, with the incidence of prostate cancer increasing progressively with age above 50.

What is the prostate gland?

Prostate is a gland located just beneath the bladder which surrounds the urethra. It functions to produce seminal fluid that will be mixed together with the sperm.

What are the Symptoms of Prostate Cancer?

You can have no symptoms from prostate cancer for many years.

When symptoms surface, you may experience:

  • Increased need or urge to urinate
  • Urinating more frequently
  • Having difficulty and straining to start urination
  • Dribbling when completing urination
  • Feeling of your bladder being not completely empty
  • Urine flow that is weak and interrupted
  • Blood in urine
  • Blood in semen
  • Painful ejaculation
  • Difficulty in maintaining erection

What do I expect when I see my doctor?

Aside from taking relevant medical histories and examining you physically, there are few important points that your doctor will emphasize on:

  1. Family history. Those who have family members with prostate cancer have a higher risk of developing similar conditions themselves.
  2. Rectal examination. This is part of the physical examination where your doctor will feel the surface of the prostate gland with a gloved lubricated finger when placing it in the back passage (rectum). In prostate cancer, there can be a palpable abnormal lump felt over the wall of the prostate.
  3. Blood test Prostate-Specific Antigen (PSA). This is a blood test to look for a protein that is released by the prostate gland. In a normal healthy person, the PSA level should be less than 4ng/ml. Higher concentration can be seen in benign prostate hyperplasia, prostatitis or prostate cancer. Having said that, PSA is not used as a screening tool on its own for prostate cancer, as 15% of prostate cancer can have a normal PSA level.
  4. Prostate Biopsy (TRUS biopsy). This is usually performed by your urologist with the guidance of an ultrasound probe under local anesthesia. A biopsy is taken from suspicious lesions on the prostate gland. This is to obtain a tissue sample for further confirmation of diagnosis under microscope reading.
  5. Imaging (MRI prostate and Bone scan). MRI prostate may be offered by your doctor to visualize the prostate and surrounding organs in the pelvis to explore the extent of cancer disease. In cases where there are concerns of spreading of cancer cells to the bones, a bone scan will be offered by your doctor.

What Are the Treatments Available for Prostate Cancer?

The decision on treatment options depends on the patient’s preference, patient’s age, patient’s existing medical conditions and the aggressiveness of the cancer itself.

Treatment options include

  1. Active surveillance. In this treatment option, one is closely followed up with blood tests and repeat biopsies. Active treatment will be considered when there are concerns about the progression of cancer. This is suited for either more elderly men, or men with early-stage prostate cancer, and those who are compliant to follow-up. Unfortunately, 30% of men who are in active surveillance will eventually need treatment.
  2. Radical prostatectomy surgery. This is a surgical procedure to remove the prostate and surrounding tissues that may be affected.
  3. Radiotherapy and Chemotherapy. Radiation therapy works by delivering high energy X-rays onto the affected organ to kill cancer cells. Chemotherapy, on the other hand, involves delivering drugs through the veins to kill cancer cells or stop cancer cells from growing.
  4. Newer oral medications. There are new approved cancer pills on the market that may help advanced prostate cancer.

Am I at Risk of Prostate Cancer? Should I go for Prostate Cancer Screening?

The actual cause of prostate cancer remains unknown.

Risks factors associated with Prostate Cancer:

  • Increases with age, especially men after the age of 50
  • More common in African American ethnicity
  • Family history of prostate cancer in brothers or father (risk increases by 2-3 times)
  • Family history of breast or ovarian cancer in sisters or mother
  • Obesity and sedentary lifestyle
  • History of Sexually Transmitted Infections (STIs)

The 5-year survival rate of localized early staged Prostate Cancer treatment is more than 95%. This highlights the importance of screening for Prostate Cancer. Prostate Cancer Screening aims to find cancers that may be at high risk of spreading if left untreated and to detect them early and treat them before spreading.

Although there are no standard guidelines to screen for Prostate Cancer, Prostate Cancer Screening is recommended for men between age 50-70 years old, or those with risk factors. While the PSA tumor marker blood test is useful in assisting the diagnosis of Prostate Cancer, it needs to be correlated with the patient’s profile, risk factors, symptoms, imaging and biopsy findings.

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