When it comes to common cancers in men, many might think about lung or colorectal cancer. But in recent years, prostate cancer cases have risen and now it sits as the most common cancer among men in Singapore, according to the Singapore Cancer Society.
Urologist Dr. Png Keng Siang shares more about the condition, treatment options, and management of its side effects.
Dr. Png attributes the rise of prostate cancer to two main factors – an increased awareness of the disease, and the lifestyle choices of Singaporeans.
An increased awareness of prostate cancer means there is a bigger push for increased prostate cancer screening, from efforts being made to raise awareness about the disease such as Prostate Cancer Awareness Month every November, which in turn leads to an increased detection of prostate cancers.
According to a Ministry of Health spokesperson, some prostate cancers detected during screening may have remained silent throughout the lifetime of an individual if screening had not been conducted.
Prostate cancer is a cancer of the prostate gland, a male reproductive organ located below the bladder. The prostate is responsible for producing fluid that mixes with sperm to create semen.
However, though the rates of prostate cancer have risen in tandem with the number of people screened, the Singapore Cancer Registry notes that the number of cases detected at an early stage has declined, from 63.5% (2003-2007) to 51.7% (2013-2017). This may be a sign that men are only testing for prostate cancer when symptoms become apparent. The registry also showed that 30.2% of prostate cancers detected from 2018-2022 were already in stage 4.
“I think the majority of the cancers that are detected now are clinically significant and therefore need to be treated,” Dr. Png shares. “I pick up very few low-risk cancers these days.”
Another reason for the rise in prostate cancer cases in Singapore, according to Dr. Png, is the modern lifestyle habits among Singaporean men. This extends to dietary choices, with unhealthy food such as processed and preserved foods, and refined sugar being linked to an increased risk of prostate cancer.
Age is another major risk factor for prostate cancer. In fact, it is the strongest risk factor for nearly all chronic diseases, including every major cancer type. As the global population’s life expectancy increases, more people reach ages at which the body’s maintenance system naturally declines. This leads to a large number of changes such as higher rates of DNA mutations, epigenetic alterations, metabolic changes, reduced immune surveillance, and impaired capacity for repair.
“I can safely say that prostate cancer increases as men grow older,” Dr. Png states. “This is why we advocate for PSA testing or prostate cancer screening for men aged 50 and above.”
One of the biggest advancements in prostate cancer care has been the improvement in imaging technology, particularly the use of multiparametric MRI scans.
According to Dr. Png, the multiparametric MRI captures multiple images of the prostate using different imaging modes, helping doctors identify suspicious areas more accurately.
“With modern MRI techniques, we can better determine which areas are likely to be clinically significant cancers,” Dr. Png says.
This has also helped reduce unnecessary biopsies. Rather than automatically proceeding to a biopsy after a raised PSA blood test, doctors now consider several factors together, including physical examination findings, PSA levels, and MRI results.
“We do not want to subject men to unnecessary biopsies,” Dr. Png explains. “We combine all the information and discuss it carefully with the patient before deciding whether a biopsy is necessary.”
The goal is not simply to detect any prostate cancer, but to identify cancers that are likely to become dangerous if left untreated.
If there is not a high likelihood of prostate cancer, the patient will typically be asked to monitor their condition.
Should prostate cancer be detected, there are several treatment options to consider. These options range from watchful waiting to surgery.
Choosing the right option for you will depend on several factors. If you have early-stage prostate cancer, factors such as your age and overall health will be considered. Watchful waiting is an option that focuses on monitoring prostate cancer that is not causing any symptoms or problems. The aim of this treatment method is to keep an eye on the cancer long term, and avoid further treatment unless there are signs and symptoms that the cancer is growing.
“The treatment I recommend would mainly depend on the patient,” Dr. Png elaborates. “Is he fit? Can he go onto the surgical table? Does he have any other medical conditions that make him a bad candidate for surgery? Most importantly, how old is he, and what are his expectations?”
Some patients could be very active well into their 70s and 80s, and wish to enjoy their retirement. Dr. Png will consider these factors to decide whether the patient should undergo surgery or whether a less invasive option would be more suitable.
“Not all prostate cancers behave the same way,” Dr. Png explains. “Some cancers can safely be monitored, while others require treatment because they are likely to cause problems later.”
Today, most prostate cancer surgeries are performed using robotic-assisted techniques. Despite the name, Dr. Png stresses that the robot does not perform the surgery independently.
“The surgeon controls the robot, and the robotic instruments move exactly as the surgeon’s hands move,” Dr. Png explains.
Robotic prostatectomy, one such robot-assisted surgery performed to treat prostate cancer, involves a surgeon using surgical tools attached to robotic arms to remove the prostate.
Due to its minimally invasive approach, patients experience shorter recovery time. Dr. Png shares that his patients are usually able to go home after a three-night stay in the hospital and if the patient is younger or active, they are typically able to return to work and physical activity within the month.
One of the major concerns surrounding prostate cancer surgery involves the risk of urinary incontinence and erectile dysfunction, as the prostate gland is located near important nerves and structures controlling bladder and sexual function.
Robotic-assisted surgery has significantly improved surgical precision, helping surgeons better preserve surrounding tissues. However, Dr. Png notes that temporary side effects may still occur even in the best hands.
“There will definitely be some temporary changes,” Dr. Png says. “I would always tell the patient to expect a bit of incontinence.”
Recovery often involves physiotherapy, pelvic floor exercises, medications, and rehabilitation programmes. Many patients are able to regain most of their urinary and sexual function with proper recovery and follow-up care.
Over the years, Dr. Png has noticed a significant shift in how men approach prostate cancer screening and treatment.
“Awareness has definitely improved,” he says. “Patients are much more informed now. Many come in already knowing about robotic surgery or asking about specific treatment options.”
Family members also play an important role in encouraging men to seek medical attention earlier.
“Often, it is the spouse or children encouraging them to get checked,” Dr. Png shares.
With continued advancements in imaging, robotic surgery, and cancer treatments, prostate cancer is increasingly becoming a condition that can be effectively managed, especially when detected early.
“Even if surgery is not suitable, there are still many excellent treatment options available,” Dr. Png says. “The important thing is early detection, proper assessment, and choosing the treatment approach that best fits the patient.”
