Prostate cancer is the most common cancer among older men in Singapore. Globally, it remains a major public health issue, as about one in every six men may be diagnosed with prostate cancer. According to the Global Cancer Statistics 2020, it caused 375,304 deaths among men worldwide of all ages.
It occurs in the prostate, a small walnut-shaped gland in males that produces the seminal fluid that nourishes and transports the sperm.
Early prostate cancer is usually asymptomatic, while more advanced prostate cancer shares similar symptoms to Benign Prostatic Hyperplasia (BPH). According to urologist Dr. Lee Fang Jann, having BPH will not directly increase your risk of developing prostate cancer, although the two conditions can coexist, making it essential for men with BPH to stay vigilant about their prostate health.
With regard to BPH, symptoms are typically related to obstructed urine flow and are not usually associated with pain or involve blood in the urine. That is not the case for prostate cancer.
“Prostate cancer symptoms may include not only urinary issues but also pain or discomfort, especially in the lower back, hips, or pelvis,” Dr. Lee stated. “Additionally, blood in the urine or semen can be a warning sign.”
Some other common symptoms of prostate cancer include:
The exact cause of prostate cancer is unknown, but there are several risk factors that can increase one’s risk of developing prostate cancer, including:
The risk of getting prostate cancer increases with age, with most sufferers aged 50 or older. Dr. Lee shared that this could be due to either age-related genetic changes that happen at random or environmental factors, and that older men have been exposed to cancer-causing risk factors longer.
If you have a relative with prostate cancer, your risk of getting it increases. Aside from that, having family members with breast or ovarian cancer also increases a man’s risk for prostate cancer.
People who are overweight will have a higher risk of prostate cancer compared to people with a healthy weight. In obese people, the cancer is more likely to be aggressive and more likely to return after it has been treated.
According to the International Agency for Research on Cancer (IARC), more than 60% of chemicals in a cigarette are Class I and Class II carcinogens, such as polycyclic aromatic hydrocarbons (PAH). PAHs are hydrocarbons highly linked to several cancers. It can be genotoxic and bind to DNA-inducing mutations that enhance cancer proliferation.
The best way to reduce your risk of getting prostate cancer is to live a healthy lifestyle with a diet full of fruits and vegetables and regular exercise. If you happen to have a high risk for prostate cancer, be it through factors such as age or genetics, you are advised to consult with your doctor about possible medications or treatments that can be done to lower the risk.
Screening is also recommended for men aged 55 and older. This can help find cancer at an early stage. Abnormal tissue or cancer detected early may offer patients a higher chance of survival. PSMA test is a test that measures the level of prostate-specific antigen in the blood. PSA is a substance that is primarily made in the prostate and may be found in increased amounts in men with prostate cancer.
Treatment options for prostate cancer will depend on several factors, including the stage of the cancer, the patient’s age and current health condition, whether the cancer is new or recurrent, and the patient's wishes.
Different types of treatment are available for different patients.
For older men who do not exhibit any signs or symptoms or men whose prostate cancer is found during a prostate test, doctors might recommend watchful waiting or active surveillance. Watchful waiting involves closely monitoring a patient’s condition without giving any treatment until signs or symptoms change or appear. Treatment is then given to improve the patient’s quality of life. Meanwhile, active surveillance involves closely following a patient’s condition without giving any treatment unless there are changes in the test results. When the cancer begins to grow, treatment will be given to cure it.
According to urologist Dr. Png Keng Siang, surgery is the most established form of treatment for prostate cancer. Surgery is typically offered to patients who are in good health and whose tumor is located only in the prostate gland. Dr. Png adds that surgery also offers the best chance of a complete cure for aggressive cancers. A type of surgery that could be performed is radical prostatectomy which involves the surgical removal of the prostate, seminal vesicles, and vas deferens.
Radiation therapy makes use of high-energy x-rays to damage cancer cell DNA beyond repair, this stops the tumor from dividing and kills it, with effects typically seen weeks to months after the radiotherapy session. Radiation oncologist Dr. Jonathan Teh shares that radiotherapy is typically painless, with patients experiencing no sensation at all, and only takes a few minutes. The way the radiotherapy is administered will depend on the type and stage of the cancer being treated. However, radiation therapy may cause impotence and urinary problems that get worse with age.
Hormone therapy is a cancer treatment that tries to stop the growth of cancer cells through hormones. In prostate cancer, testosterone can cause prostate cancer to grow and proliferate, thus, as medical oncologist Dr. Toh Chee Keong shares, shutting down the production of testosterone in prostate cancer patients is desirable. This can be done through Androgen Deprivation Therapy (ADT), where drugs, surgery, or other hormones are used to reduce the amount of male hormones or block them from working.