Prostate cancer usually occurs in the epithelial cells of the glandular tissue. This type of cancer is known as adenocarcinoma.
Understanding your treatment options is important when planning care. Prostate cancer treatment is determined by the cancer’s stage and overall health status. Common approaches include hormone therapy, surgery, radiotherapy, chemotherapy, or active surveillance in cases where the cancer is slow growing. In certain situations, a combination of these treatments may be recommended.
Early-stage prostate cancer may not show symptoms. Individuals with risk factors are highly encouraged to seek medical advice if concerns arise. Diagnosis typically involves physical examination, blood tests (such as Prostate-specific Antigen), imaging studies, and biopsy.
At NUH, our specialists will guide you through each step, from diagnosis to treatment planning, in a manner that supports informed decisions and tailored care.
The prostate is a gland found exclusively in males. Located in front of the rectum and below the urinary bladder, the prostate is about the size of a walnut. The prostate reaches nearly full-size during puberty but may continue to grow slightly more in older men and it produces some of the fluid that protects and nourishes sperm cells in semen. Glands called seminal vesicles that make most of this fluid are found behind the prostate.
The prostate gland is a crucial component of the male reproductive system, encircling the urethra just below the bladder. This walnut-sized organ plays several vital roles in male health and reproduction:
Understanding prostate function is essential for men's health, as changes in the prostate can indicate various conditions, including benign prostatic hyperplasia (BPH) or prostate cancer. Regular prostate exams and PSA tests, especially for men over 50 or those with risk factors, are crucial for early detection and treatment of prostate-related issues.
Prostate cancer develops when cells in the prostate gland divide abnormally, forming malignant tumours. While our bodies constantly produce new cells, cancer occurs when this process goes awry. It is important to note that not all tumours are cancerous; some can be benign (non-cancerous).
Prostate cancer is a significant health concern, ranked as the most common cancer among men in Singapore. Early detection and understanding of the disease are crucial for effective treatment and management.
Cancer staging is a vital tool in communicating the size and extent of cancer spread. For prostate cancer, the stages are:
The tumour is confined within the prostate, often too small to be detected during a physical examination.
The tumour extends beyond the prostate to nearby areas, such as the seminal vesicles or surrounding the bladder or rectum. The cancer has not yet spread to other parts of the body.
The cancer spreads to other areas, such as lymph nodes, bones or organs like the liver, lungs and brain. Node-positive disease, where cancer spreads to lymph nodes, may still be treatable with robot-assisted radical prostatectomy or radiotherapy. When the cancer has spread to the bones or other organs, hormonal therapy is typically employed.
Understanding these stages is crucial for determining the most appropriate prostate cancer treatment plan. Regular prostate cancer screening, including PSA tests and digital rectal exams, can help detect the disease in its early, more treatable stages.
Prostate cancer is the most common cancers among men in Singapore. While any man can develop prostate cancer, certain factors can increase the risk. Understanding these risk factors is crucial for early detection and prevention. Over the age of 50; the risk increases with age. Younger males can also be affected.
High-risk groups for prostate cancer include:
It is crucial to discuss your individual risk factors with your healthcare provider. They can help determine if you need prostate cancer screening.
While early-stage prostate cancer often has no noticeable symptoms, it is important to be aware of potential warning signs. Please seek immediate medical attention if you experience any of the following symptoms:
It is important to note that these symptoms can also be indicative of other prostate conditions, such as benign prostatic hyperplasia (BPH) or prostatitis. However, early detection is key in prostate cancer treatment, so it is always better to err on the side of caution.
The growth rate of prostate cancer varies among men. In some men, prostate cancer develops slowly and does not cause any problem. Yet, it grows faster in some others and can result in severe pain or other problems, even death. Screening tests can help to detect prostate cancer early.
This is the first step in diagnosing prostate cancer. The doctor uses a gloved finger to examine the rectum.
PSA is a substance produced by both normal and malignant prostate cells. The presence of elevated levels of PSA in the blood is another test that helps to detect prostate cancer.
TRUS is the use of soundwaves to create an image of the prostate. It is used to guide a biopsy of the prostate.
This procedure removes some sample tissue for analysis. If the biopsy is positive for cancer, imaging such as bone scan, Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) scanning of the pelvis may be needed to help determine the extent of the cancer.
A procedure called radical prostatectomy may be recommended if the tumour is localised at the prostate. It involves the complete removal of the prostate and often includes the pelvic lymph nodes. This procedure is commonly used to treat early stages of prostate cancer. Some possible side effects of radical prostatectomy include incontinence (not being able to control urine) and impotence (not being able to have erections). These side effects can also happen with other forms of treatment for prostate cancer.
Radiation therapy uses high-energy beams to kill the cancer cells. External beam radiotherapy (EBRT) focuses radiation from outside the body on the cancer. EBRT techniques involved may include Three-dimensional Conformal Radiation Therapy (3D-CRT) where radiation beams are shaped and aimed at the tumour from several directions. Stereotactic Body Radiation Therapy (SBRT) uses highly focused beams of high-dose radiation given on one day or over several days. Brachytherapy is another form of radiotherapy that involves the surgical placement of permanent or temporary implants to deliver radiation to the prostate.
Hormonal therapy is commonly used to treat prostate cancer when it has spread or in combination with radiotherapy when the cancer is locally advanced or high risk. Hormonal therapy can slow the cancer growth as it interferes with the growth stimulatory effects of male hormones on prostate cancer. There are two forms of hormonal therapy:
Though uncommon, chemotherapy plays a role in improving symptoms of prostate cancer if hormone therapy is ineffective. It is generally well-tolerated and can alleviate bone pain for most patients. Chemotherapy is usually given in cycles with each cycle lasting for a few weeks. The body is given time to recover during a rest period that follows each cycle of treatment.
As some prostate cancers grow very slowly and may take many years to cause symptoms or spread, some men with diagnosed prostate cancer may not need immediate treatment. Active surveillance refers to a protocol that allows patients with localised prostate cancer to be observed safely for a period of time, and then for deferred treatment when necessary. Watchful waiting is also advocated as a reasonable approach for some men with prostate cancer (especially asymptomatic men with a limited life expectancy) who are observed and treated only when symptoms or spread occurs.
Energy ablative therapies such as cryotherapy have been offered as minimally invasive therapy options for highly selected men with localized prostate cancer. Cryotherapy involves placing cryoneedles into the prostate through the perineal skin and uses controlled freezing and thawing to destroy prostate cancer cells. This form of treatment is sometimes used in men whose prostate cancer has returned following other treatments.
While there is no guaranteed way to prevent prostate cancer, research suggests that certain lifestyle choices may lower your risk. Here are key strategies for prostate cancer prevention:
