Prostate cancer is the fifth most common cancer in Singaporean men. It is usually curable when detected early, but can kill if diagnosed late or not treated effectively.
The prostate is a gland of the male reproductive system. It is located in front of the rectum and just below the bladder. It's main function is to produce fluid for semen, which transports sperm.
Prostate cancer is a malignant tumor that begins most often in the outer part of the prostate and beyond the prostate to other parts of the body.
Most men who get prostate cancer are 50 years of age or older, and the risk increases with age.
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.
Cancer screening involves performing medical tests to diagnose early cancer before the onset of symptoms. Prostate cancer screening should begin at age 50. Men with positive family history (father, uncle or brother has prostate cancer) may begin screening at age 45. Doctors use 2 tests to screen for 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 likely to be cancerous
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 race. 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. A small percentage of prostate cancer can have normal level PSA. As such, while this PSA test is not perfect, it is 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)
A man should understand the risks and benefits of prostate cancer screening. Screening may miss cancer that is present. Screening may result in unnecessary anxiety.
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.
In the early stages, when prostate cancer is a small, treatable tumor, there are usually no symptoms. When the growth becomes more advanced, urinary symptoms may develop. These include:
Rectal examination is the first step in diagnosing prostate cancer. Using a gloved finger to examine inside the rectum, the doctor may be able to feel a hard lump or growth in the prostate. This examination should be part of a regular checkup for all me over the age of 40.
Another test that helps to detect prostate cancer is the presence of elevated levels of Prostate-Specific Antigen (PSA) in the blood. PSA is a substance produced by both normal and malignant prostate cells. Some men with BPH or prostatitis (inflamed prostate) have increased levels of PSA without cancer also.
If initial clinical evaluation suggests the presence of prostate cancer, a biopsy of the prostate is usually recommended. A biopsy of the prostate causes no more discomfort than a visit to the dentist.
If the biopsy is positive, then a bone scan and/or computer scanning may be needed to help determine the extent of the cancer.
Your doctor may use one or more of the following methods - surgery, hormone treatment, radiation and anti-cancer drugs. The choice depends on the stage of the cancer, your age and health.
Radical prostatectomy is used to treat cancer localized in the prostate and involves complete removal of the prostate. Often the pelvic lymph nodes are removed as well.
Radiation therapy uses high energy x-ray to kill cancer cells. Radiation may be given from a machine located outside the body (external radiation therapy), or from a radioactive substance introduced directly into the tumor. Sometimes a combination of these methods is used.
Both surgery and radiation provide excellent 10-year survival rates. Your doctor can help advise you about the best treatment for your cancer.
Hormonal therapy is used to treat prostate cancer which has spread. The 2 basic techniques involve:
Watchful waiting has also been advocated as a reasonable approach for some men with prostate cancer. Not all men diagnosed with the disease require immediate treatment. Some cancers grow slowly and may take 10 years or more to cause problems or to spread. Immediate treatment may not be necessary for men with an early-stage cancer whose age or general health make it unlikely that they will live at least 8 to 10 years.
Surgical treatment of prostate cancer raises many questions about a man's ability to remain sexually active. For some men, changes including impotence, may be temporary but for others, these problems may be permanent. Urinary incontinence may be present.
During radiation therapy, patients may notice a number of side effects, which usually disappear when treatment ends. For example, patients may have skin reactions (redness, dryness or wetness) in the area being treated, and they may feel unusually tired. Patients also may have diarrhea and frequent and uncomfortable urination. Some patients are impotent after radiation therapy.
Hormone therapy also may cause side effects. Female hormones (estrogen) may cause breast tenderness and enlargement, nausea, vomiting and water retention. High doses of estrogen also increase the risk of heart problems. Sexual problems commonly caused by hormone therapy include loss of sexual desire and impotence.
The side effects of chemotherapy depend on the drugs given and the response of the individual patient. Chemotherapy commonly affects hair cells, blood-forming cells, and cells lining the digestive tract. As a result, patient may have side effects such as hair loss, lowered blood counts, nausea, or vomiting. Most side effects end after the treatment is over.
After treatment for prostate cancer, you should continue to visit your urologist for regular checkups. At various times after your treatment, your doctor will examine whether any further treatment is necessary. The PSA test has proved to be particularly useful in monitoring the response of prostate cancer to treatment.