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Dr. James Tan
Consultant Urologist and
Kidney Transplant Surgeon
Laparoscopic, Robotic & Cancer Surgeon
MBBS, M Med, FRCS
For Treatment, Call us at
+ 65 6735 0369
Prostate Cancer

 

The prostate is part of a man's reproductive system. It is located in front of the rectum and under the bladder. It surrounds the urethra, the tube through which urine flows. A healthy prostate is about the size of a walnut. It produces a fluid that forms part of the semen. The prostatic fluid provides nourichment to the sperms and protect them with anti-bacterial properties. It is an essential part of the male reproductive system. However, once a man has completed his family, he can actually do without the prostate. 

Prostate cancer occurs when cells in the prostate grow and multiply uncontrollably. The nodular tumour mass invades the surrounding tissues and eventually spread to the lymph nodes, skeletal bones and other regions of the body. 

Prostate cancer is ranked the third most frequently diagnosed cancer in Singapore males. Based on the Singapore Cancer Registry Annual Report 2008 – 2012, the incidence of prostate cancer among male resident population was 3305 (12%) out of a total 27456 cases of cancers. It is slightly behind colorectal cancer (4810, 17.5%) and lung cancer (4197, 15.3%).

The age-standardized rate of prostate cancer incidence was 28.3 per 100 000 person and the age-standardized mortality rate was 5.6 per 100 000 persons, ranking prostate cancer the sixth highest cancer mortality (male) in Singapore. About one in five newly diagnosed prostate cancer patients will eventually die from prostate cancer.

Over the last forty years, the prostate cancer incidence has risen rapidly compared to other cancers. This is partly due to the advent of PSA testing. As a regional medical hub, many more unreported prostate cancer patients come to Singapore for second opinion, confirmation of diagnosis, staging, and treatment.

Twenty years ago, up to half of newly diagnosed prostate cancer in Singapore are metastatic late stage disease. They present with urinary retention, bone pain or cord compression. The percentage of metastatic disease at presentation has now dropped to about 20%. Majority of newly diagnosed prostate cancers are organ-confined (stage 1 and 2) disease.

 

While population mass screening is not advocated at the moment, many men have their PSA tested annually (some even more frequently) as part of their regular health screening package or routine blood testing for other non-related conditions. 

Early prostate cancer often has no symptoms. If symptoms are present, they vary from man to man, and may include:

  • frequent, difficult or painful urination
  • not being able to urinate
  • weak or interrupted urine flow
  • blood in the urine
  • blood in the semen
  • painful ejaculation
  • frequent pain or stiffness in the lower back, hips or upper thighs

Many of these symptoms are not cancer, but if you notice one or more of them for more than two weeks, see your doctor.

In advanced metastatic prostate cancers, patient may present with urinary retention, backache, pain in the pelvic bone, paraplegia, and loss of weight and appetite.

 

Many factors may influence the development of prostate cancer, including:

  • Age:  Men 50 or older are at the greatest risk. Age is the most influential risk factor.
  • Family history:  Your risk is higher with a family history of prostate cancer (especially father, brother, son)
  • Diet:  A high-fat diet, particularly animal fats, may increase your risk. Diets high in fruits and vegetables are thought to decrease your risk.

You can take action to reduce your risk of developing prostate cancer.:

  • reduce diet rich in animal fat
  • increase diet rich in lycopene (tomatoes), selenium (seafood), vitamin E, isoflavonoids (soy products)
  • eating at least five servings of fruits and vegetables per day
  • exercising regularly
  • maintaining your ideal weight

The diagnosis of prostate cancer is made by histologic confirmation of cancer in prostatic biopsies. The decision to perform a prostate biopsy is guided by digital rectal examination and the PSA level. An abnormally raised PSA may be due to prostate cancer, benign prostatic hyperplasia or prostatitis. The current challenge is in making sense of the PSA test result and deciding who needs a biopsy, thereby reducing unnecessary biopsies and yet avoid missing clinically significant cancers when it is still in the curative stage.

Your best chance for surviving prostate cancer is detecting it early. When prostate cancer is found early and treated appropriately, there is nearly a 100% chance for cure.

Prostate cancer detection should begin at age 50. Men with positive family history (father, uncle or brother has prostate cancer) may begin screening at age 40. Doctors use 2 tests to detect prostate cancer – PSA blood test and DRE.

  • Digital Rectal Exam (DRE) : The physician inserts a lubricated, gloved finger into the rectum to assess the size, shape, symmetry and consistency of the prostate. If the prostate gland is irregularly enlarged and hard, it is suspicious of cancer.
  • Prostate Specific Antigen (PSA) Test: This simple blood test measures the level of PSA - a protein produced by the prostate. Normal PSA values vary with age and size of prostate. Generally, the higher the level of PSA, the greater the risk for prostate cancer. Benign prostate enlargement, urinary tract infection and prostatitis may also cause a rise in PSA. About 5 to 10% of prostate cancer have normal PSA at diagnosis. While PSA test is not perfect, it is still the best available at this point in time.

    Normal PSA: Age 40 -49 ( less than 2.5 ug/L), 50 – 59 ( less than 3 ug/L), 60-69 ( less than 4 ug/L)
  • To schedule a prostate cancer screening test, call (65) 6735 0369.

What's next after screening ?

If the digital rectal exam or the PSA test is abnormal, a prostate biopsy is necessary. Only a biopsy can confirm the presence of prostate cancer. This is a clinic procedure whereby under ultrasound guidance, the doctor uses special needles to remove small strips of prostate tissue from different areas of the prostate. The prostate tissue samples are viewed under a microscope to see if cancer calls are present.

What if the biopsy is positive ?

If your biopsy results are positive for prostate cancer, more tests including MRI scan of the prostate and bone scan may be required. These tests help to describe the stage or extent of the cancer.

Treatment options include surgery, radiation, hormonal therapy, chemotherapy or “watchful waiting” (not treating the cancer and monitoring it closely). 

The treatment option will depend very much on the stage and grade of the disease as well as patient's age and co-morbid factors. For organ-confined prostate cancer, the aim of treatment is curative. These treatment options include radical surgery and radiation. For advanced metastatic disease, hormonal and chemotherapy are used as palliative treatment.

Over the last decade, one of the major developments in prostate cancer treatment that has made a huge impact in clinical practice worldwide is the da Vinci robotic radical prostatectomy. The two most feared complications of urinary incontinence and erectile dysfunction are now minimized by the precise dissection and water-tight suturing of the vesico-urethral anastomosis as well as bilateral nerve-sparing of the neurovascular bundle.

The Da Vinci robotic system (Intuitive Surgical, Inc., CA, USA) allows the surgeon to sit comfortably at a console to control robotic arms with10-fold magnified and 3-dimensional vision. The robot hand fine-scales the surgeon’s endowrist hand motions, thereby reducing tremors.  The highly magnified three dimensional vision plus fine hand movement allows surgery to be done at great precision and ease.

Early detection of prostate cancer with appropriate treatment results in improved cancer survival. Robotic radical prostatectomy is an established form of treatment for early organ-confined prostate cancer. It is both safe and effective.

For Treatment, Call Us at
+ 65 6735 0369
Mount Elizabeth Medical #17-14,
3 Mount Elizabeth Singapore 228510
Tel: +65 6735 0369
Fax: +65 6735 1317
24 Hours Hotline: +65 6535 8833
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