What is Prostate Cancer?
Prostate cancer is the most common form of cancer among men in Singapore, contributing to 16.8% of all cancer cases. The mortality rate from prostate cancer is comparatively low (6.7%) compared to other types of cancer. The progression of prostate cancer is typically classified by the following stages:
- Stage I: slow-growing cancer in which the tumour is not palpable with low prostate-specific antigen (PSA) marker levels. Cancer cells cannot be differentiated significantly from healthy cells.
- Stage II: tumour found in the prostate, with a possibility of palpability at half of one side of the prostate. Medium PSA levels with the probability of differentiating cancer cells from healthy cells.
- Stage III: high PSA levels with an indication of cancer growth. At this stage, the chances of spread (metastasis) are high. Spread of cancer to neighbouring structures such as the bladder and rectum may occur.
- Stage IV: metastasis is in progress. The cancer spreads to regional or distant lymph nodes and bones.
The prostate gland is a crucial part of the male reproductive system. It is responsible for producing semen that nourishes and transports sperm. When cancer occurs in the prostate gland, various sexual and excretory disruptions arise, particularly in its latent stages.
What causes Prostate Cancer?
Prostate cancer develops when a mutation of specific genes occurs in the prostate gland. Subsequently, prostate cells multiply abnormally until a tumour is formed. A tumour may be benign (non-cancerous) or malignant (cancerous). The causes of the cancerous tumour depend upon the stage at which it is identified. If a tumour is detected during prostate screening, a biopsy will be required to diagnose prostate cancer definitively.
What are the symptoms of Prostate Cancer?
Prostate cancer is usually elusive; therefore, many of its symptoms tend to manifest in the latent stages when the tumour places pressure on the surrounding structures, such as the urethra. Symptoms of prostate cancer include:
- Urinary changes: frequent urination (especially at night), difficulty starting or stopping urination, weak urine flow, and inability to empty the bladder completely.
- Blood in urine or semen: blood may be visible in the urine (known as haematuria) or semen (known as haematospermia).
- Pain and discomfort: pain and discomfort may be felt in the pelvic area, lower back, hips or upper thighs. Individuals may also experience painful ejaculations.
- Lethargy and weight loss: typically prevalent in latent stages of prostate cancer.
Is Prostate Cancer painful?
Prostate cancer itself is not typically painful in its early stages. It often develops silently, causing no noticeable symptoms or discomfort. This is one of the reasons why screenings, such as the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE), are essential for early detection.
However, as prostate cancer advances and grows, it can lead to various symptoms and, in some cases, pain or discomfort. It is important to understand that not all individuals with prostate cancer will experience pain, and the severity of symptoms may vary widely.
Who is at risk of Prostate Cancer in Singapore?
The exact cause of prostate cells developing into cancer is not fully understood. However, several factors can increase an individual’s risk of prostate cancer; these include:
- Age: prostate cancer is common in older men. Your risk increases as you age, with most cases occurring in men over 65 (6 in 10 men).
- Family history: patients with three or more first-degree relatives with prostate cancer, three generations of diagnosis on the same side of the family, or two or more close relatives on the same side of the family are considered to have hereditary prostate cancer.
- Genetic mutations: inherited gene mutations, such as those associated with the BRCA1 and BRCA2 genes, can increase the risk of prostate cancer.
- Diet: some studies suggest that a diet high in meat, fat, eggs, and dairy products may be associated with a higher risk of prostate cancer.
- Lifestyle factors: smoking, obesity, and a lack of physical activity may also contribute to an increased risk.
While these factors can contribute to an increased risk of prostate cancer, it is important to remember that they do not guarantee that you will develop the disease.
How is Prostate Cancer diagnosed in Singapore?
The current recommendation for screening is 45 years for men in high-risk groups and 50 and above for non-risk individuals. Prostate cancer is commonly detected during regular screening, as patients are usually asymptomatic. If suspected of prostate cancer, a series of medical assessments and tests will be conducted in the following order:
- Medical history and physical examination: to determine the level of risk for prostate cancer.
- Prostate-specific antigen (PSA) test: a blood test to detect a protein produced by prostate gland cells. PSA are typically higher in cases of prostate cancer, inflammation, or an enlarged prostate.
- Digital rectal examination (DRE): to detect abnormal mass in the anus or rectum.
- Biopsy: a small sample is collected from prostate tissue to determine if cancerous cells are present.
- Imaging tests: magnetic resonance imaging (MRI) or ultrasound would be recommended if your urologist deems it necessary to gain a better visualisation of your prostate.
- Gleason score and staging: if diagnosed with prostate cancer, your urologist will assign a score or stage to determine the best treatment path moving forward.
Based on the results of these diagnostic tests, your urologist will discuss the most appropriate treatment options and recommendations with you.
What are the treatment options for Prostate Cancer in Singapore?
In Singapore, treatment options for prostate cancer depend on various factors, including the stage of the cancer, your overall health, and individual preferences. Unlike other types of cancer, prostate cancer rarely causes significant disruption in quality of life. In such cases, treatment is rarely introduced as non-intervention outweighs the benefits of treatment.
Depending on your condition, the treatment pathway suggested may include:
- Active surveillance: monitoring cancer progression if the spread is deemed non-aggressive.
- Surgery: to resect the tumour, particularly if symptoms of urinary dysfunction are present.
- Radiation therapy: utilising high-energy beams, such as X-rays or protons, to kill cancer cells.
- Hormone therapy: to block testosterone that expedites the growth of prostate cancer cells.
- Chemotherapy: reserved for cases where cancer has metastasised to lymph nodes or bones.
- Immunotherapy: strengthens the patient’s immune system to destroy cancer cells.
- Targeted therapy: a therapy customised to genetic makeup if cancer is resistant to other forms of treatment.
- Palliative care: focused on reducing the burden of symptoms or treatment.
Treatment decisions should be made in consultation with your urologist. Regular follow-ups and discussions are crucial for effective prostate cancer management.
Frequently asked questions
Prostate cancer is often curable, especially when detected at an early stage. The curability depends on factors such as the cancer stage and treatment approach.
Generally, radiation therapy for prostate cancer is not painful. You may experience some mild discomfort or side effects, but it is not typically a painful procedure.
There is no guaranteed method to prevent prostate cancer. One can, however, reduce their risk by consuming diets with improved nutrition. Observing a more active lifestyle and closely monitoring your health status, particularly if you are at risk, will also be advantageous.