Dr. Chong Kian Tai, consultant urologist from Surgi-TEN Specialists talks about focal therapy for early prostate cancer.
Prostate cancer occurs when cells in the prostate gland grow out of control. In Singapore, it is now the third most common cancer among men, heightening interest in the various treatment options in early stage prostate cancer that can reduce possible treatment-related side effects1.
Prostate cancer, especially in the early stages, often does not cause changes in the urinary or sexual function.
“Men may not have any urination problems or blood in the urine. In fact, most of them feel perfectly well, so unfortunately, prostate cancer may be detected much later,” said Dr. Chong. In Singapore Cancer Registry data for year 2017, as much as 30.7 percent of Singapore patients are already in late Stage 4 cancer when they are first diagnosed2.
Testing men with no noticeable symptoms is one practical approach to detect prostate cancer in the early stages. This is done either through a blood test that looks for a protein called Prostate Specific Antigen (PSA), or a digital rectal exam, where a urologist feels the prostate gland for any unusual hard lumps or nodules.
Dr. Chong advised that screening is not universally recommended in Singapore.
“PSA itself is not a 100 percent marker for cancer because the PSA blood test can show high levels even in a normal prostate that is growing larger or when there is a urinary tract infection, like an infection of the prostate. So it doesn’t mean that someone with high PSA has prostate cancer,” he explained.
As the risk of developing prostate cancer increases with age, Dr. Chong advises that men above the age of 50, especially those with a family history of such incidences, should test their PSA level.
“I recommend doing PSA blood test at least once when you are more than 50 years old. If the PSA is higher than normal, it is best to check with a specialist to find out if there is any necessity to continue checking for prostate cancer.”
Surgery and radiotherapy are well established ways to treat prostate cancer. However, these two options frequently come with a range of side effects including difficulty in erection and urinary leakage that needs diapers, which will impact a man’s quality of life.
Another commonly prescribed option is active surveillance, which means monitoring the cancer growth and intervening when necessary. This, however, does not treat the cancer and therapeutic action is needed if the cancer worsens.
Focal therapy for prostate cancer is another option to consider for Stage 1 and Stage 2 prostate cancer. One method of focal therapy uses high intensity focused ultrasound (HIFU) to heat up and kill cancer cells in the prostate by directing ultrasound waves to destroy the cancerous areas, while at the same time preserving the healthy part of the prostate3.
Although HIFU has been available for more than 20 years, technological advancements with newer machines are more accurate and effective, which result in better outcomes and fewer side effects.
For HIFU, patients will be placed under general anesthesia between one to two hours. Some patients who are suitable for day surgery can even go home on the same day.
“After treatment, most patients have a bit of discomfort when they pass urine, and some blood in the urine due to the treatment's effects. But generally after about two to four weeks, most patients recover fully,” Dr. Chong added.
According to medium-term studies, 80 to 90 percent of recovered patients remain cancer-free in the next five years. For the minority who relapses, focal therapy can be repeated. Otherwise, they can opt for surgery or radiotherapy.
Follow-up tests using PSA and magnetic resonance imaging (MRI) prostate scan will be done so that the medical specialist can monitor treatment outcome. Majority of patients should expect a good prognosis.
According to Dr. Chong, focal therapy is not necessarily suitable for all patients with early stage prostate cancer. Important factors to consider are the cancer stage, area and volume of tumor. Usually, more localized or smaller areas of cancer are suitable to get better outcome prognosis.
“Whether it is active surveillance, robotic surgery, radiotherapy or focal therapy, the most important step is to discuss with your specialist to find out which of these four treatment choices are suitable for you,” Dr. Chong advised.
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1 Straits Times. 2017. Breast, prostate cancers rising sharply in Singapore. Retrieved from: https://www.straitstimes.com/singapore/health/breast-prostate-cancers-rising-sharply-in-spore
2 Singapore Cancer Registry. November 2019. 50 Years of Cancer Registration. Retrieved from: https://www.nrdo.gov.sg/publications/cancer
3 Focused Ultrasound Foundation. 2020. Prostate cancer. Retrieved from: https://www.fusfoundation.org/diseases-and-conditions/oncological/prostate-cancer
Dr. Chong Kian Tai