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prostate cancer logoWhat is Prostate Cancer?

The prostate gland is a walnut-sized gland situated below the urinary bladder. It produces semen and its development depends on testosterone, a male sex hormone. Prostate cancer develops when cells in the prostate gland undergo uncontrolled growth and become malignant, forming a lump and invading surrounding tissue such as the seminal vesicles and bladder neck. Prostate cancer is the third most common cancer among men in Singapore.*

Many elderly men are affected by small prostate cancers which do not cause any symptoms and are clinically insignificant. However, prostate cancer may spread through the lymphatic system to other parts of the body such as the lungs. It can also spread to lymph glands in the pelvis or to the backbone. 

* Singapore Cancer Registry, Interim Annual Registry Report, Trends in Cancer Incidence in Singapore 2015

 

Overview

 

 

Risk Factors

prostate anatomy

A definitive cause of prostate cancer has not been established. However, the risk of getting prostate cancer is affected by age and family history, as reflected in the prostate health of male relatives such as fathers, brothers, and uncles. Smokers and workers exposed to cadmium are also at a higher risk of prostate cancer, as are men who have undergone a vasectomy. Other risk factors include a diet high in animal fat but low in fibre. High circulating levels of testosterone have also been noted in those with prostate cancer.

Sexual activity is not a risk factor.

 

 

Signs & Symptoms

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prostate 3

 
 

prostate 2

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Early detection and consultation with your doctor will help to determine the best course of treatment. In addition to the above the signs and symptoms, please take note of the following:

  1. Weakness or swelling of the lower limbs
  2. Lumps on the prostate gland
  3. Difficulty in urinating
  4. Back pain

Points 3 & 4 are symptoms of advanced prostate cancer. However, when taken alone, these signs are not specific to prostate cancer and may be missed. Men who display any of these symptoms are advised to seek medical advice to exclude other causes of these symptoms such as urinary tract infection, benign prostate hyperplasia, urinary stones, etc.

Screening

 

Cover Uncle 

At present, there is a lack of evidence to support population-based screening for prostate cancer in Singapore.

Patient should seek medical attention should there be symptoms as suggested above.  You should go for screening if you are male, above 50 years of age and have a family history of prostate cancer diagnosed below 60 years of age.

To help you decide whether you should be tested for prostate cancer, read our Should I Be Tested For Prostate Cancer 

 

Diagnosis

old patient

The growth rate of prostate cancer varies among men. In some men, prostate cancer develops slowly and may not cause any problems in their lifetimes.

In others, it develops quickly and may cause severe pain and other complications – even death. A large prostate cancer may obstruct the ureter and cause kidney failure.


Digital rectal examination: This is the first step in diagnosing prostate cancer. The doctor inserts a gloved finger into the rectum and feels the prostate for hard, lumpy, or abnormal areas.

 

Prostate-specific Antigen (PSA) Test: PSA is a substance produced by both normal and malignant prostate cells. The presence of elevated levels of PSA in the blood is another test that helps to detect prostate cancer. Please consult your doctors on benefits and limitations of using PSA blood test for early detection.

 

Transrectal or transperineal ultrasound guided biopsy: A procedure in which an ultrasound probe about the size of a finger is inserted into the rectum to check the prostate. Images from the ultrasound probe guided the doctor in taking systematic sampling of the prostate. Tissue samples of the prostate are removed by a thin needle under a local anaesthetic and viewed under a microscope by a pathologist.

 

MRI Scan of the pelvis: A detailed scan of the pelvis that helps to identify the extent of cancer involvement in the prostate gland or surrounding lymph nodes.

 

Bone Scan: It helps to detect if the cancer has spread outside the prostate to the bone. When prostate cancer spreads, bone is the most common place it goes to. A small amount of safe radioactive dye is injected into a vein and then the scan is taken after 2-3 hrs to pick up the “hot spots”, where the radioactive dye has been collected. These hot spots can show if the cancer has spread to the bone.
 

 

Treatment

Treatment options depend on the extent of the cancer as well as the patient’s age and fitness.

Active Surveillance or Watchful Waiting
As some prostate cancers grow very slowly and may take many years to show symptoms or spread, certain men diagnosed with prostate cancer may not need immediate treatment. Active surveillance refers to the strategy of closely observing patients with low-risk localised prostate cancer, while keeping the option of deferred curative treatment open.

Watchful waiting is advocated as a reasonable approach for certain men with prostate cancer (especially elderly men without symptoms who have a short life expectancy due to advanced age or the presence of multiple illnesses). Watchful waiting involves a less intensive follow-up schedule compared to active surveillance, with a view towards treatment only when symptoms occur. Watchful waiting is generally suitable for men with other health problems who may not be able to cope with treatments like surgery or radiotherapy.

 

Surgery
An open or robot-assisted radical prostatectomy may be recommended if the tumour is localised at the prostate. It involves the complete removal of the prostate, which often includes the pelvic lymph nodes. This procedure is commonly used to treat prostate cancer in its early stages. The possible side effects of radical prostatectomy include incontinence (not being able to control urination) and impotence (not being able to have an erection). These side effects may also occur with other forms of treatment for prostate cancer.

 

Radiotherapy
Radiotherapy uses high-energy beams to kill cancer cells or prevent them from growing.

There are 3 main forms of radiotherapy used:

  • External beam radiotherapy (EBRT) focuses radiation on an area affected by cancer. EBRT techniques may include Three-Dimensional Conformal Radiation Therapy (3D-CRT) where radiation beams are pointed at the tumour from several different directions.
  • Stereotactic Body Radiation Therapy (SBRT) points highly focused beams of high-dose radiation to the prostate over a day or several days.
  • Brachytherapy involves the surgical placement of permanent or temporary implants to deliver radiation to the prostate.

 

Hormone (Androgen Deprivation) Therapy
Hormonal therapy is commonly used to treat prostate cancer when it has spread or is used in combination with radiotherapy when the cancer is locally advanced or at high-risk. Hormonal therapy can slow or stop the growth and spread of prostate cancer by interfering with the effects of male hormones on prostate cancer.

There are two forms of hormonal therapy:

  • Prescribing drugs that prevent the release or counter the action of male hormones
  • Carrying out surgery to remove the testes, which are a major source of male hormones

Hot flashes, impaired sexual function, and loss of desire for sex may occur in men treated with hormone therapy.

 

Chemotherapy
Chemotherapy uses drugs to stop the growth of cancer cells either by killing them or stopping them from dividing. Chemotherapy is generally given to patients at an advanced or metastatic stage of prostate cancer when they are no longer responsive to hormonal treatment. It won’t cure prostate cancer but it will shrink and slow its growth. Chemotherapy may cause side effects such as nausea, hair loss (alopecia), inflammation of the cheeks, gums, tongue, lips, and roof or floor of the mouth (stomatitis), and an abnormal blood profile that could increase the risk of infection.

 

Support Group


The Walnut Warriors is a support group that reaches out to men who have been diagnosed with prostate cancer, providing physical and psychosocial support to members through therapeutic and enrichment programmes. The support group also organises the Man Plan Programme for prostate cancer patients undergoing hormone therapy. Membership is free.

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