Dr Chong Kian Tai, Consultant Urologist from Surgi-TEN Specialists talks about
prostate cancer in Singapore.
Prostate Cancer – Symptoms and Treatments:
(1) Most prostate cancer patients do not have symptoms:
Prostate cancer usually affects men older than 50 years old. Majority of prostate cancer patients, especially in the early stages, have no symptoms and do not have urinary problems. Unfortunately 30.2% of Singapore men already have devastating Stage 4 prostate cancer when it is first detected, based on data from Singapore Cancer Registry Annual Report 20221.
Mortality number, crude and age-standardised mortality rate (per 100,000 population) of cancer, 1968-20221
Ten most frequent incident cancers, lifetime risk, and cancer deaths, 2018-20221
In fact, the first possible suspicion of prostate cancer is an abnormal blood test called total prostate specific antigen (total PSA).
Some patients may have urinary symptoms from enlarged prostate. It is important to check with your doctor on whether prostate cancer is also present in the prostate gland at the same time.
(2) If prostate cancer causes symptoms or signs, it is usually diagnosed in a later stage. These symptoms and signs may include:
- Frequent urination
- Weak or interrupted urine flow or the need to strain to empty the bladder
- The urge to urinate frequently at night
- Blood in the urine
- Blood in the seminal fluid
- New onset of erectile dysfunction
- Pain or burning during urination, which is much less common
- Discomfort or pain when sitting, caused by an enlarged prostate
- Sometimes men with prostate cancer do not experience any of these changes. Non-cancerous conditions of the prostate, such as BPH (Benign prostatic hyperplasia) or an enlarged prostate, can cause similar symptoms. The cause of a symptom may be a different medical condition that is not cancer. Urinary symptoms also can be caused by an infection of the bladder or other conditions.
(3) If cancer has spread outside of the prostate gland, a man may experience:
- Pain in the back, hips, thighs, shoulders, or other bones
- Swelling or fluid buildup in the legs or feet
- Unexplained weight loss
Fatigue - Change in bowel habits
- If you experience any of these symptoms, please see a doctor now for an appointment.
Investigations for Prostate Cancer
(1) Total PSA (Prostate-Specific Antigen)
Blood test to check possible prostate cancer. Please noted that total PSA can be high in different prostate diseases, including infection or enlargement in size.
(2) MRI prostate scan
Determines the internal structure of prostate to look for suspicious prostate lesions.
(3) Prostate biopsy
Takes some prostate tissues to check under microscope to look for abnormal or cancer cells. Using the latest MRI-ultrasound fusion guided techniques will give more accurate targeting to detect the location of cancer cells within the prostate gland.
Treatments for Prostate Cancer
(1) Active surveillance
Prostate cancers that are considered low-risk and not aggressive may not need to do surgery or radiotherapy immediately. We can closely monitor the nature of the cancer and reduce unnecessary side effects from aggressive treatments.
(2) Robotic-assisted radical prostatectomy
The entire prostate gland can be removed by surgery with the use of daVinci Robotic Surgery operating system. This is a minimally-invasive surgery with less pain, faster recovery and smaller surgical wounds.
(3) Radiotherapy
Prostate cancer cells can be killed with radiotherapy, which can be given from outside the body or from internally within the prostate. Examples include stereotactic body radiation therapy (SBRT), intensity-modulated radiation therapy (IMRT), proton
beam therapy, and brachytherapy.
Treats only the areas with significant prostate cancer, and not the entire prostate gland. It is suitable for patients who have prostate cancer that is still localised within the prostate gland.
Focal therapy aims to have less side effects when compared to major radical treatment. It reduces urine leak, decreases erectile dysfunction, and avoids unnecessary damage to surrounding healthy areas. Examples include Focal One high-intensity focused ultrasound (HIFU), Nanoknife irreversible electroporation (IRE), and cryotherapy of prostate cancer.
(5) Hormone therapy
Used in locally advanced prostate cancer, or patients with metastases having distant cancer spread. It reduces one source of the food supply of prostate cancer cells.
(6) Chemotherapy
Used in patients with metastases having distant cancer spread.
Reference:
- Singapore Cancer Registry Annual Report 2022, Health Promotion Board, National Registry of Diseases Office, published in September 2024.