1. How common is prostate cancer? (and why is it so common?)
Prostate cancer is the 3rd commonest cancer among men in Singapore, with an incidence of 23.9 cases per 100,000 per year (Singapore Cancer Registry).
It is the 6th leading cause of cancer deaths in Singaporean men.
The prostate is a walnut-sized gland situated below the urinary bladder.
2. What are the risk factors?
Prostate cancer increases with age. Smokers and workers exposed to cadmium are also at a higher risk.
Men with a family history of prostate cancer are at a higher risk of developing prostate cancer.
Sexual activity is not a risk factor.
3. Who should get screened and when? And how often?
This is a controversial issue, the pros and cons of which are best discussed in detail with your doctor, who will then adopt a shared approach to decision -making.
In the absence of strong family history, routine prostate cancer screening should not be offered to men younger than 50 years of age.
Men, who are between 50 and 75 years of age may be offered screening for prostate cancer after a discussion of both the benefits and harms associated with screening.
High-risk men with a strong family history of prostate cancer i.e one or more first-degree relatives (father, brothers) diagnosed before the age of 60 years, may be offered screening at an earlier age.
The optimal screening interval has yet to be determined, however, in general, a blood test called prostate-specific antigen (PSA) screening is done on an annual basis.
This screening may be done once every 2 years in low-risk men.
4. Are enough men getting themselves screened?
The incidence of prostate cancer has been increasing. Locally, Malay and Indian men appear to have a lower risk of prostate cancer as compared to the Chinese.
Discuss the options of screening with your healthcare professional during your next medical examination.
5. What symptoms should men look out for?
Early prostate cancer may not cause any symptoms. Some of the symptoms are the presence of blood in the urine, frequent passing of urine with poor stream, terminal dribbling of urine, waking up in the night more often to pass urine, swelling of the lower limbs and back pain. The last two symptoms are more common in advanced disease.
6. What does a prostate screening involve?
Digital rectal examination is the first step in diagnosing prostate cancer. The doctor inserts a gloved finger into the rectum and feels the prostate for hard, lumpy or abnormal areas.
Elevated blood PSA levels may help to detect prostate cancer, do consult your doctor on benefits and limitations of using PSA blood test for early detection.
If cancer is suspected, further evaluation may be done via an ultrasound-guided biopsy, whereby a small probe is inserted into the rectum to check the prostate and to take samples of the prostate gland.
7. How treatable is prostate cancer?
Treatment depends on the type and extent of cancer as well as the patient’s age and fitness. As some prostate cancers grow very slowly and may take many years to show symptoms or spread, certain men diagnosed with prostate cancer may not even need immediate treatment.
Some of the treatment options include radiation, hormonal therapy, chemotherapy and surgery.
8. Is prostate cancer preventable in any way?
There is no sure way to prevent prostate cancer. You may reduce your risk by choosing a low-fat diet, increasing the amount of fruits and vegetables you eat each day, maintaining a healthy weight, exercising and avoiding smoking.
Treatment for prostate cancer has made leaps and bounds over the years, resulting in a very good prognosis.
9. Do lifestyle factors play a role or is it just luck?
Other risk factors include smoking and a diet high in animal fat but low in fibre. Sexual activity is not a risk factor.
What would you say to someone who is reluctant to have his prostate checked?
A prostate check is highly recommended in men who are at high risk. Consult a doctor early if you experience problems affecting your urinary system.
1.Ministry of Health Clinical Practice Guidelines: Prostate Cancer and Cancer Screening
2.Singapore Cancer Society: Prostate Cancer
Contributed by: Dr Sharon Kaur Minhas