No one likes to discuss the ‘C’ word.
Yes, we’re talking about cancer, which is timely too as the month of November focuses on important men’s health issues. Movember continues to raise awareness of men’s health issues including mental health aa well as testicular and prostate cancer. We’re addressing the latter here with advice from an expert in the field – Dr Lincoln Tan, Urologist, Gleneagles Hospital Singapore.
In case you didn’t 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 and accounts for 14.1% of cancer diagnoses.
Even though prostate cancer is a common cause of cancer among 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 speak to Dr Tan to get you up to speed on prostate cancer, from early detection to treatments as well as preventive care.
In layman terms, what exactly is prostate cancer?
Cancer is the uncontrolled growth of cells in the body. Cells in nearly any part of the body can become cancer cells, which can then spread to other areas of the body. Prostate cancer is cancer of the prostate gland, which 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 forms part of a man’s semen.
What are the warning signs/or symptoms, men should keep a look out for?
Early prostate cancer may not have any symptoms. Common urinary complaints such as difficulty to pass urine, needing to strain to pass urine, having to go pass urine more frequently or urgently, or waking up more than once per night to pass urine, are usually symptoms of a benign enlarged prostate. Both benign enlargement of the prostate (BPH) and prostate cancer are common conditions in men who are over 50 years old, and prostate cancer is sometimes found during the assessment of a man with urinary symptoms – so urinary symptoms should not be ignored!
Advanced prostate cancer may present with blood in the urine, urinary symptoms as described above, kidney failure, or with bone pain or fracture as a result of the cancer spreading to the bones. Although urinary symptoms are not specific to prostate cancer, assessment of these symptoms by a doctor with a prostate physical exam and PSA blood test may lead to detection of early cancer, thus increasing the chance of being cured.
The important thing to note is that since early prostate cancer is often symptomless – men at risk (age more than 50 years old 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 effects older men. Based on statistics, which groups are at risk of getting it?
Based on the latest Singapore Cancer Registry data – prostate cancer is the second most common cancer in local men. The risk of developing prostate cancer increases sharply with age, especially after 50 years of age. Just over half of the cases occurred among those aged 70 years and above. On the other hand, about 49% of prostate cancer have been diagnosed in younger men aged between 50 and 70 years old.
Unfortunately, in Singapore, more than 30% of men with prostate cancer are diagnosed in the final stage IV with distant spread. In comparison, in the USA, less than 8% of men with prostate cancer are diagnosed with stage IV cancer. The difference is that more men in the USA go for early prostate cancer detection.
What is the treatment process like?
Treatment depends on how advanced the disease is when it is diagnosed, and the grade (or predicted aggressiveness) of the cancer. Active surveillance is a treatment option for men assessed to have a low risk of prostate cancer death, especially in older men. This group may not need immediate treatment and can be observed carefully by their urologist with repeat PSA blood tests/MRIs as well as prostate biopsies.
If there are signs that the cancer has progressed to a higher risk disease, immediate treatment may then be offered. This potentially spares patients, with prostate cancer that is of low risk to their lives, the side effects of surgery or radiation therapy, while maintaining the option of curative treatment if required.
For patients with higher risk disease, which can cause harm from cancer spread outside of the prostate or an earlier death, the treatment options are surgical removal of the prostate (radical prostatectomy) or radiation therapy to the prostate.
Removal of the prostate is most commonly done with the assistance of a surgical robot. This allows the removal of the prostate with greater precision through keyhole surgery. As 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-ray beams to kill cancer cells by destroying the genetic material that controls how cells grow and divide.
Healthy cells in the beam’s path are also affected by the radiation and may result in side effects. The goal of treatment is to destroy the cancerous cells while sparing as much of the normal surrounding tissue as possible. Radiation therapy is typically given on an outpatient basis, five days a week over 6-8 weeks. Each treatment session usually lasts less than an hour. Most of that is preparation time. The actual radiation treatment only takes a few minutes.
Advanced cancer is treated with medications or the surgical removal of the testicles to reduce the man’s testosterone level and may be combined with chemotherapy.
Will a person’s quality of life be affected after treatment?
Treatment side effects can include changes in urination such as incontinence, urinary frequency, and urgency, as well as sexual dysfunction from erectile dysfunction or loss of libido. Many of these side effects are temporary, and most men do recover from them.
Reported quality of life scores are the best in patients where the cancer is discovered in an early, curable stage. Hence, efforts towards early detection and awareness are essential to avoid unnecessary deterioration in their quality of life.
How expensive is it to treat this form of cancer?
Costs of treating prostate cancer vary depending on the type of treatment required. In general, the cost of treating advanced cancer can be greater than that of treating localised 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 out-of-pocket outlay.
What’s the survivability rate like?
This again depends on the stage of disease when diagnosed. Men with treated early prostate cancer which has 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 at the advanced stages with cancer spread beyond the prostate can have 5-year (not 10-year as above) survival rate of as low as 30%.
In your expert opinion, how often should men go for their check-ups?
Men should consider check-ups for prostate cancer from age 50. If they have a family history of prostate cancer, they can discuss with their doctors on earlier testing. The frequency of the check-up depends on their risk factors and their PSA levels, and – range from once a year to every 2-3 years.
Is there anything we can do in terms of diet/lifestyle to safeguard 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 major risk factor that accounts for this is diet – foods that produce oxidative damage to DNA.
Here is some advice on how to reduce your risk of prostate cancer:
- Obesity is associated with a higher risk of more aggressive prostate cancer. Consume fewer calories and do regular aerobic and muscle strengthening exercises so that you maintain a healthy weight.
- Minimise the amount of fat you get from red meat and dairy products.
- Watch your calcium intake. Avoid taking more than 1,200 mg per 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 flax seed, soy products and walnuts. Avoid trans fatty acids (for example, in margarine).
- Incorporate more lycopene rich foods into your diet. This can be found in cooked 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 may be helpful.
- Avoid smoking.
- For men who are 50 years old 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 examination, with your doctor.
(Main and featured image: Anna Tarazevich/Pexels)