No one likes to discuss the ‘C’ word.
Yes, we are talking about cancer, which is also topical as the month of November focuses on important men’s health problems. Movember continues to raise awareness of men’s health problems, including mental health and testicular and prostate cancer. We address the latter here with advice from an expert in the field – Dr. Lincoln Tan, urologist, Gleneagles Hospital Singapore.
If you did not know, prostate cancer is one of the most common cancers among men globally. In Singapore, it is the third most common cancer in men here, accounting for 14.1% of cancer diagnoses.
Although prostate cancer is a common cause of cancer in men, it has a 5-year survival rate of more than 95% if diagnosed early. It is important to note that the risk of getting prostate cancer increases beyond the age of 50, especially for those who have a family history of it. To find out more, we talk to Dr. Tan to get you updated on prostate cancer, from early detection to treatments as well as preventative care.
What is prostate cancer in the layman’s sense?
Cancer is the uncontrolled growth of cells in the body. Cells in almost any part of the body can turn into cancer cells, which can then spread to other areas of the body. Prostate cancer is cancer of the prostate gland that is only found in men. The prostate is located below the bladder and in front of the rectum. The prostate produces fluid that nourishes sperm and is part of a man’s sperm.
What are the warning signs and / or symptoms that men should keep an eye on?
Early prostate cancer may have no symptoms. Common urination problems such as difficulty urinating, having to urinate to urinate, having to urinate more frequently or urgently, or waking up more than once a night to urinate are usually symptoms of a benign enlarged prostate. Both benign prostate enlargement (BPH) and prostate cancer are common conditions in men over the age of 50, and prostate cancer is sometimes found during the assessment of a man with urinary tract symptoms – so urinary tract symptoms should not be ignored!
Advanced prostate cancer can manifest itself with blood in the urine, urinary tract symptoms as described above, kidney failure or with bone pain or fracture due to the spread of the cancer to the bones. Although urinary tract symptoms are not specific to prostate cancer, assessment of these symptoms by a doctor with a prostate physical examination and PSA blood test can lead to the detection of early cancer, which increases the chance of being cured.
The important thing to note is that since early prostate cancer is often asymptomatic – men at risk (age over 50 or with a family history of prostate cancer) should discuss prostate cancer testing with a PSA (Prostate Specific Antigen) blood test and prostate examination with their doctor.
There is a misconception that prostate cancer only affects older men. Based on statistics, which groups are at risk of getting it?
Based on the latest data from the Singapore Cancer Registry – prostate cancer is the second most common cancer in local men. The risk of developing prostate cancer increases sharply with age, especially after the age of 50. Just over half of the cases occurred among people aged 70 years and over. On the other hand, about 49% of prostate cancers have been diagnosed in younger men between the ages of 50 and 70 years.
Unfortunately, more than 30% of men with prostate cancer in Singapore are diagnosed in the last stage IV with distant spread. By comparison, in the United States, less than 8% of men with prostate cancer are diagnosed with stage IV cancer. The difference is that more men in the United States go for early detection of prostate cancer.
How is the course of treatment?
Treatment depends on how advanced the disease is when it is diagnosed, and the degree (or predicted aggressiveness) of the cancer. Active surveillance is a treatment option for men who are considered to have a low risk of prostate cancer death, especially in older men. This group may not need immediate treatment and can be carefully observed by their urologist with repeated PSA blood tests / MRIs as well as prostate biopsies.
If there is evidence that the cancer has developed into a higher risk disease, immediate treatment may be offered. This potentially spares patients with prostate cancer who are at low risk for their lives from the side effects of surgery or radiation therapy, while preserving the possibility of curative treatment if necessary.
For patients at higher risk for disease that may cause damage from non-prostate cancer spread or a previous death, treatment options include surgical removal of the prostate (radical prostatectomy) or radiation therapy to the prostate.
Prostate removal is most often done using a surgical robot. This allows removal of the prostate with greater precision through keyhole surgery. Since there is minimal pain and blood loss, most patients can go home on the first or second day after surgery. Radiation therapy for prostate cancer uses high-energy X-rays to kill cancer cells by destroying the genetic material that controls how cells grow and divide.
Healthy cells in the path of the radiation are also affected by the radiation and can result in side effects. The goal of the treatment is to destroy the cancer cells and at the same time spare as much of the normal surrounding tissue as possible. Radiation therapy is typically given outpatient five days a week over 6-8 weeks. Each treatment session usually lasts less than an hour. Most of it is preparation time. The radiation treatment itself only takes a few minutes.
Advanced cancer is treated with medication or surgical removal of the testicles to reduce the man’s testosterone level and can be combined with chemotherapy.
Will a person’s quality of life be affected after treatment?
Treatment side effects may include changes in urination such as incontinence, frequency of urination and urgency, as well as sexual dysfunction from erectile dysfunction or loss of libido. Many of these side effects are temporary and most men recover from them.
The reported quality of life score is the best in patients where the cancer is detected at an early, curable stage. Therefore, efforts against early detection and awareness are crucial to avoid unnecessary deterioration of their quality of life.
How expensive is it to treat this type of cancer?
The cost of treating prostate cancer varies depending on the type of treatment required. In general, the cost of treating advanced cancer may be greater than that of treating localized cancer, without the benefit of cure. The good news is that for patients with Integrated Shield plans, most of the costs can be covered by health insurance with minimal outlay.
What is the survival rate?
This in turn depends on the stage of the disease when it is diagnosed. Men with treated early prostate cancer who have not spread beyond the prostate have 5-year survival rates close to 100% and 10-year survival rates of more than 90%. On the other hand, men diagnosed in the advanced stages with cancer spread across the prostate may have a 5-year (not 10-year as above) survival rate of as low as 30%.
How often should men, according to your expert assessment, go for their check?
Men should consider studies for prostate cancer from the age of 50. If they have a family history of prostate cancer, they can discuss with their doctors about previous tests. The frequency of the check depends on their risk factors and their PSA levels, and – varies from once a year to every 2-3. year.
Is there anything we can do in terms of diet / lifestyle to protect ourselves against prostate cancer?
It has been seen that while prostate cancer is less common in Asian men compared to men from Western countries, when Asian men migrate to Western countries, the risk of prostate cancer increases over time. This indicates that the biggest risk factor explaining this is diet – foods that produce oxidative damage to DNA.
Here are some tips on how to reduce your risk of prostate cancer:
- Obesity is associated with a higher risk of more aggressive prostate cancer. Eat fewer calories and do regular aerobic and muscle-strengthening exercises to maintain a healthy weight.
- Minimize the amount of fat you get from red meat and dairy products.
- Keep an eye on your calcium intake. Avoid taking more than 1,200 mg a day.
- Eat more fatty fish such as sardines, salmon, tuna, which are rich in omega-3 fatty acids. Non-fish sources of omega-3 fatty acids include flaxseed, soy products and walnuts. Avoid trans fatty acids (eg in margarine).
- Incorporate more lycopene-rich foods into your diet. This can be found in boiled tomatoes, cruciferous vegetables (like broccoli and cauliflower) and fruits like watermelon, papaya, guava and pink grapefruit.
- Soy-based foods and green tea are also potential dietary components that can be helpful.
- Avoid smoking.
- For men 50 years or older (younger for those with a family history of prostate cancer) – discuss the risks and benefits of screening with a PSA test and a rectal exam with your doctor.
(Main image and highlighted image: Anna Tarazevich / Pexels)