What is the prostate and what does it do?
The prostate is a gland of the male reproductive system. It is located in front of the rectum and just below the bladder. Its main function is to produce fluid for semen, which transports sperms.
Who gets prostate cancer?
Most men who get prostate cancer are 50 years or older, and the risk increases with age. Men with family members who had prostate cancer are also at increased risk.
Detecting prostate cancer
When prostate cancer is in its early stage, there are usually no symptoms. Tumour detected at this stage is highly treatable. When the tumour becomes more advanced, urinary symptoms may develop. These symptoms can include frequent urination, weak urinary stream, inability to urinate, blood in the urine and bone pain.
Your doctor may be able to feel a hard lump or growth in the prostate when he performs a digital rectal examination for you. This examination should be part of a regular health checkup for all men over the age of 40.
A more sensitive test is to check the level of Prostate Specific Antigen (PSA) in the blood. PSA levels can be elevated in cancer, although some men with non-cancerous conditions such as benign prostate enlargement or prostatitis (inflammed prostate) will also have increased PSA.
If the biopsy confirms prostate cancer, further radiological scans may be needed to determine the extent of the cancer.
If the clinical evaluation suggests the likelihood of prostate cancer, a biopsy of the prostate gland is usually recommended to confirm the diagnosis. Prostate biopsy is usually performed as an outpatient procedure under local anaesthetic with low risks and minimal discomfort.
What are the stages of prostate cancer?
- Organ-confined prostate cancer: The tumour has not spread beyond the prostate gland.
- Locally-advanced prostate cancer: The cancer has spread beyond the prostate gland to nearby organs such as rectum or bladder, or to the regional lymph nodes.
- Metastatic prostate cancer: The cancer has spread to distant parts of the body, most commonly to the bones.
How is prostate cancer treated?
Your doctor may use one or more of the following methods: surgery, radiation therapy, active surveillance, hormone treatment and chemotherapy.
Surgery is generally reserved for organ-confined prostate cancer, although it can be performed for locally advanced prostate cancer in selected patients. The operation is radical prostatectomy, which removes the entire prostate gland, followed by joining the bladder to the urethra. Radical prostatectomy is most commonly performed with robotic assistance nowadays. This gives patients the benefits of minimally invasive surgery. The operation can also be performed with laparoscopy (key-hole surgery) or the open technique.
Surgery for prostate cancer may result in impotence. For some men, this may be temporary, but in others this can be permanent. In addition, urinary incontinence can also occur but the majority of men will regain continence progressively.
Radiation therapy utilises high-energy radiation to kill cancer cells. Radiation may be given from a machine located outside the body (external beam radiation therapy), or from a radioactive substance introduced directly into the prostate (brachytherapy). Radiation therapy may be used to treat orgain-confined or locally advanced cancer. If the cancer is locally advanced, hormone therapy may be added.
Patients may notice a number of side effects, which usually disappear when treatment ends. For examples, patients may have skin reactions (redness, dryness or wetness) in the area being treated. Patients may also develop diarrhoea and frequent or uncomfortable urination. Some patients become impotent after radiation therapy.
Not all men diagnosed with prostate cancer require immediate treatment. Selected patients with slow-growing localised prostate cancer can be offered active surveillance, where they are kept under close observation and treatment is only instituted if their cancer progresses. This avoids the side-effects associated with treatment.
Prostate cancer growth is stimulated by the male hormone testosterone. Hormonal therapy slows the growth of prostate cancer by lowering the testosterone level in the body. Hormonal therapy is generally used when the cancer has spread beyond the prostate. It can be instituted in 2 ways:
- Medication that prevent the release or counter the action of testosterone
- Surgery to remove the testes, which are the sites of testesterone production.
Hormone therapy can also cause side effects. These include loss of sexual desire, impotence, breast enlargement, increased risk of metabolic syndrome (including diabetes) and increased risk of osteoporosis (weakening of the bones).
In patients with advanced metastatic prostate cancer, they may be referred to a medical oncologist for chemotherapy. Chemotherapy suppresses the growth of cancer cells throughout the body and therefore slows the progression of the disease. Patients may benefit from reduced symptoms like pain and improved overall quality of life and well-being.
Which treatment is suitable for me?
Every patient is unique and the factors considered in the treatment decision include age, cancer aggressiveness, stage of disease and patient’s health status. With so many treatment options and factors to consider, it is important for every patient to have a detailed discussion with his urologist. Your urologist will be able to individualise the treatment which is best suited for you.
Your future after treatment for prostate cancer
After treatment for prostate cancer, you should continue to visit your urologist for regular check-ups. At various times after your treatment, your doctor will examine you and perform various tests to determine whether any further treatment is necessary. The PSA blood test is most commonly used for monitoring response of prostate cancer to treatment.
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.
You may download the PDF version from: Patient materials – Prostate Cancer.