Prostate Cancer

Prostate cancer is the third most common cancer among Singaporean men. Tests can be done for men with symptoms suggestive of prostate cancer, and for those at high risk of developing the disease.

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What is Prostate Cancer?

Prostate cancer is a disease in which malignant cancer cells form in the tissues of the prostate. The prostate is a gland in the male reproductive system located just below the bladder and in front of the rectum. It is about the size of a walnut and surrounds the urethra (the tube that empties urine from the bladder). The prostate gland produces fluid that is one of the components of semen.

Due to greater public awareness, early detection of prostate cancer is on the rise and mortality rates are declining. Additionally, new advances in medical technology are enabling cancer patients to go on to live active and productive lives after their treatment. 

Prostate Cancer Causes 

The cause of prostate cancer is not clear. A combination of factors may play a role, such as family history, ethnicity, hormones, diet and the environment.

Prostate Cancer Risk Factors

The main risk factors include:
Age — the risk of prostate cancer increases after the age of 50 years
Race or ethnicity — dark-skinned men have a higher risk of developing and dying of prostate cancer
Family history of prostate cancer — this increases the risk of prostate cancer
Diet — a high-fat diet and obesity  may increase your risk of prostate cancer
High testosterone levels in men who use testosterone therapy

Managing the Risk of Prostate Cancer

Men aged over 50 years with a normal risk of prostate cancer should discuss with their doctors the risks and benefits of prostate cancer screening. Men who have a strong family history — for example, a brother or father with prostate cancer — should be aware of the symptoms and discuss management options with their doctor.

Prostate cancer cannot be prevented. In general, men are advised to make choices that benefit their overall health, such as regular exercise , avoiding high-fat diets  and consuming fruit and vegetables  rich in antioxidants.

Prostate Cancer Symptoms 

In the early stages of prostate cancer, there may be no symptoms. In the later stages, symptoms of prostate cancer may include:
Frequent urination, especially at night
Difficulty passing urine or slowing of the flow of urine to a trickle
Pain or burning sensation during urination
Decreased force in the stream of urine
Blood in the urine or semen
Bone pain
Loss of appetite
Weight loss 

Advanced prostate cancer which has spread to bones may cause bone pain, fractures and compression of the spine, and if it has spread to the lymph nodes, it may cause swelling or discomfort of the leg.

You should consult your doctor if these symptoms occur.

Prostate Cancer Diagnosis 

This can include:
Digital rectal examination (DRE) to detect any abnormalities in the texture, shape or size of the prostate gland
Prostate-specific antigen (PSA) test, which involves taking a blood sample from a vein and testing for PSA, a substance that is naturally produced by the prostate gland to help liquefy semen. High levels will warrant further investigation
Transrectal ultrasound to detect any abnormalities in the prostate gland
Prostate biopsy, which involves taking thin sections of tissue from the prostate gland

Additional tests include:
Bone scan
Ultrasound
Computerised tomography (CT) scan
Magnetic resonance imaging (MRI)
Lymph node biopsy

Prostate Cancer Complications 

Typical complications of prostate cancer include:
Spread of the cancer to nearby organs or the cancer travelling through the bloodstream or lymphatic system, affecting bones or other organs
Excruciating pain when the cancer spreads to bones 
Difficulty urinating (urinary incontinence)
Erectile dysfunction (ED) or impotence
Depression after a diagnosis of prostate cancer or after trying to cope with the side effects of treatment

Prostate Cancer Treatment 

The most common treatments for prostate cancer include the following: 

External Beam Radiation Therapy 

This uses high-powered X-rays to kill cancer cells.

Radioactive Seed Implants 

Also known as brachytherapy, these deliver a higher dose of radiation than external beams.

Hormone Therapy 

This involves using drugs to stop the body from producing the male sex hormone testosterone, which can stimulate the growth of cancer cells. There are two forms of hormonal therapy: 
Drugs that prevent the release or counter the action of male hormones 
Surgical removal of the testicles, which are a major source of male hormones

Radical Prostatectomy 

Surgical removal of the prostate gland is used to treat cancer that is confined to the prostate gland. Possible side effects include incontinence (not being able to control urine) and impotence (not being able to have erections). These side effects can also occur with other forms of treatment for prostate cancer. 

The Da Vinci Surgical System of radical prostatectomy is designed to provide surgeons with enhanced capabilities, including latest high-definition 3D vision and a magnified view. The surgeon controls the Da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body and allows the performance of complex procedures through just a few tiny openings. As a result, you may be able to get back to your normal activities faster — without the long recovery that usually follows open surgery.

Chemotherapy 

This uses drugs to destroy rapidly-growing cancer cells. This treatment is not common, but may improve symptoms of prostate cancer if hormone therapy is ineffective. It is generally well-tolerated and can alleviate bone pain for most patients. Chemotherapy is usually given in cycles lasting a few weeks, with periods for the body to recover in between. 

Active Surveillance or Watchful Waiting 

As some prostate cancers grow very slowly and may take many years to cause symptoms or spread, some men with diagnosed prostate cancer may not need immediate treatment.

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