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THE SILENT KILLER: PROSTATE CANCER

Prostate cancer usually does not show symptoms in the early stage. While its causes are still unknown, there are ways to detect the disease early.


Prostate cancer is the second most common cancer in men in Singapore, making up 14.8% of cancer cases from 2014 to 2018, according to the Cancer Registry Annual Report 2018. Dr Thomas Chan, Associate Consultant, Department of Urology, shares what you need to know about prostate cancer.

A history of prostate cancer puts you at risk

Those with a family history of prostate cancer are at a higher risk. Recently, certain germline mutations have been reported in prostate cancer cases, suggesting that genetics are linked to the risk of prostate cancer.

According to Dr Chan, there are no known preventive or dietary measures that can reduce the risk.

As the disease does not show early symptoms, the Singapore Cancer Society recommends that men with family history of prostate cancer discuss with their doctor the pros and cons of prostate-specific antigen (PSA) screening — especially if a close relative like the father or brother has had prostate cancer before 65 years old.


Initial evaluation is usually done through a clinical examination (digital rectal examination) of the prostate or a PSA blood test, followed by a magnetic resonance imaging (MRI) scan. A sure way to find out if one has prostate cancer is through a prostate biopsy.

Treatment involves a multidisciplinary approach

Treatment options for various stages of prostate cancer involve a riskstratification and multi-disciplinary approach, which helps to personalise treatment options for each patient.

"In general, treatments include watchful waiting, active surveillance, radiation therapy, hormonal therapy, surgery, chemotherapy or a combination of these methods," shares Dr Chan.




And what is Prostatic Hyperplasia?

While BPH also affects the prostate gland, it is not linked to prostate cancer, nor does it increase the risk of getting prostate cancer. Here’s how to tell the difference.

Men being diagnosed with BPH in Singapore is on the rise, with cases increasing from 14% in 2005 to 16.5% in 2012. "While its exact causes are unknown and it cannot be prevented, an enlarged prostate or BPH can be considered part of the normal ageing process in men," explains Dr Lim Yong Wei, Consultant, Department of Urology, SKH.

The good news is, BPH is not an indication of prostate cancer as they are not related. Although both conditions affect the same organ, they are separate conditions.


Unlike prostate cancer, BPH has symptoms

Unlike early-stage prostate cancer which usually does not have symptoms, BPH shows up through a collection of lower urinary tract symptoms (LUTS). LUTS consist of voiding (obstructive) and storage (irritative) symptoms.

• Voiding symptoms: Weak urine stream, straining to void, sensation of incomplete voiding, experiencing a delay before being able to pass urine, intermittent urine flow

• Storage symptoms: Increased frequency to pass urine (more than once every 2 hours), difficulty in postponing or delaying the need to urinate, disturbed sleep due to waking up to pass urine

Less common symptoms include male urinary tract infection, inability to urinate and blood in the urine.


Not all urinary symptoms are caused by BPH

Although urinary symptoms are more common in men aged 65 and older—and those above 60 are 50% more likely to develop BPH—their symptoms may not always be due to BPH. "All men have to be correctly evaluated starting with a detailed history, a physical examination and some tests," says Dr Lim. It helps to have an ultrasound of the prostate, bladder and kidneys too.


Surgical treatments are possible for older patients with BPH 

According to Dr Lim, the patient’s age is a common concern when discussing surgical treatments such as Transurethral Resection of Prostate (TURP), which involves inserting a scope into the urethra, with the obstructing part of the prostate removed to allow free passage of urine from the bladder.

"When an elderly patient has Stage 4 BPH, his relatives might think that a life with a long-term catheter provides better quality of life than TURP. The truth is, although TURP and similar surgeries have their risks, such surgeries can be managed safely with adequate preparation and optimisation," assures Dr Lim.



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