The topic of prostate cancer made the news earlier this year when former US president Joe Biden revealed that he had been diagnosed with it after experiencing urinary symptoms.
Within the context of Singapore especially, when it comes to cancer in men, people might immediately think of colorectal and lung cancer — but prostate cancer sits quietly up on the list, rising steadily over the years, based on a study by the Singapore Medical Association.
It’s now the most common cancer among men, according to the Singapore Cancer Society (SCS), above colon and rectum cancer as well as lung cancer in terms of the number of cases from 2017 to 2021.
And while efforts are being made to raise awareness about the disease, like Prostate Cancer Awareness Month every November by SCS and screening campaigns by organisations in Singapore to encourage early detection, many men might still be unaware of what prostate cancer is — including its risks, symptoms and how to prevent it as much as possible.
Prostate cancer is a cancer of the prostate gland, a male reproductive organ.
Dr Wong Siew Mei, medical oncologist with Gleneagles Hospital, shared with AsiaOne that the gland is located below the bladder and near the base of the penis. It produces white-coloured fluid that mixes with sperm to create semen.
“Prostate cancer is caused by the changes in DNA of a normal prostate cell, resulting in the uncontrolled growth of abnormal prostate cells. Almost all prostate cancers are adenocarcinomas, which are cancers that start from the cells that line glands,” she explained.
Who’s most at risk?
Prostate cancer primarily affects older men, according to SCS, and the risk increases substantially after 50.
Dr Jeffrey Tuan, senior consultant and research director at the National Cancer Centre Singapore (NCCS), shared with AsiaOne that while the exact cause of prostate cancer isn’t known, there are a few risk factors to look out for, like age (especially men over 50), diet (those that are high in fat, particularly from red meats and other animal products) and ethnicity.
According to the Dr Tuan, family history and genetics also play a role.
He explained that men with a father or brother with prostate cancer are more likely to get the disease, and the risk is higher for men who have a brother with prostate cancer than for those with an affected father. Risk is also much higher for men with several affected family members, especially if they were young at the age of diagnosis.
In Singapore, Chinese men have twice the risk of getting prostate cancer compared to Malay and Indian men, according to the National Cancer Centre Singapore.
Certain genetic mutations like BRCA1/2 (linked to breast and ovarian cancer) can also raise the chances of prostate cancer.
That said, Dr Wong also shared that “the best understood risk factors for prostate cancers are not modifiable”, which means that they cannot be altered by factors such as lifestyle changes.
“These include older age, race, family history and inherited cancer predisposing genes,” she said.
Dr Wong added that the chance of prostate cancer increases after the age of 50, and that “Africans have the highest risk followed by Caucasians then Asians”.
She also noted that most prostate cancers occur in men without a family history, but “having a family history of prostate cancer more than doubles the lifetime risk” especially if their relative’s diagnosis “occurred at a younger age”.
Are more young people getting prostate cancer?
Referencing the Singapore Cancer Registry, Dr Shum Cheuk Fan, senior consultant of the Department of Surgery at Woodlands Health, told AsiaOne that prostate cancer ranks at number three below colorectal and lung cancer for males under the age of 60 and at number one for males above 60 years old.
And while he recognises that there is a pattern of doctors seeing “more and more young patients coming in with the diagnosis of prostate cancer”, it doesn’t necessarily mean that the disease is becoming more prominent in younger patients.
“I don’t think the disease has changed, but rather, more people are willing to seek medical opinions and come forward. They are more aware when they are at risk, for example, when they have family history, or when they start to have very mild symptoms,” the urologist explained.
According to Dr Shum, this is a shift from the past, where patients would often come in with severe symptoms and more advanced disease.
“When people present early, we diagnose more, but we also diagnose them at a much earlier age when the survival as well as treatment options are more readily available,” he added.
Dr John Yuen, head and senior consultant for the Department of Urology at Singapore General Hospital, also agreed that while there is an increased number of prostate cancer diagnoses in younger people, it is likely due to early screening and higher awareness instead of the disease’s demographic really shifting.
“There is a slight increase in diagnoses among younger men under 55, partly due to earlier screening and better awareness. However, true early-onset prostate cancer remains relatively uncommon. In younger cases, hereditary or genetic mutations may play a larger role,” he stated.
Symptoms of prostate cancer
According to the experts, prostate cancer often doesn’t present with symptoms in its early stages, but there are some signs to take note of.
Dr Wu Qing Hui, senior consultant at Raffles Urology Centre, explained to AsiaOne that when symptoms do appear, they can include difficulty in urination, weak urine flow, increased urinary frequency, blood in urine or semen and pain or burning during urination.
However, he said, it’s “important to note that these symptoms can also often be caused by a benign enlarged prostate”, which is a non-cancerous condition where the prostate gland increases in size.
Dr Tuan also noted frequent urination (especially at night) as a symptom for prostate cancer.
Less common symptoms also include bone pain, unexplained weight loss and erectile dysfunction, he said.
He also noted that while these may be symptoms of prostate cancer, they are not specific to it and can be caused by other conditions, so it’s important to consult a doctor if they occur.
But is there any way to prevent prostate cancer?
While there’s no guaranteed way to prevent prostate cancer, Dr Yuen shared that the risks can be lowered by adopting a healthier lifestyle.
This includes eating less red meat and more vegetables and healthy fats, exercising regularly and maintaining a healthy weight, avoiding smoking and limiting alcohol.
He also recommended early screening for those with family history or higher risk.
He also noted that aside from lifestyle changes, men can also go for regular health checks from age 50 — or earlier if they have strong family history or other risk factors.
This includes discussing prostate-specific antigen (or PSA) testing with a doctor.
Dr Yuen added that managing chronic conditions like diabetes and obesity may also reduce the risk.
Dr Wu echoed this, agreeing that while “absolute prevention is not possible” for prostate cancer, living healthily — exercising regularly, eating more fruits and vegetables, cutting down on red meat and avoiding tobacco — can “significantly lower” the risk.
He also stressed the importance of regular prostate cancer screenings after the age of 50 and early detection.
Early detection, prompt treatment crucial
And while there aren’t any guaranteed preventative measures to eliminate the risk of prostate cancer entirely, experts say that the prognosis and outlook for the disease has improved significantly over the years.
According to Dr Tuan, this is due to earlier detection and advancements in treatment.
Dr Wong emphasised that how early the cancer is detected also plays a big role in survival.
“More than 99 per cent of patients with localised disease remain alive at five years versus 37 per cent of patients with distant spread of cancer,” she said.
Dr Wong also added that in Singapore, about three in 10 cases of prostate cancer are diagnosed at stage four, which leads to a “less favourable prognosis”.
This is why early detection and prompt treatment are important.
What are the treatment options?
According to Dr Wu, treatment options vary based on the disease stage, patient health and also individual preferences.
For early-stage prostate cancer, treatment typically involves surgery, radiation or focal therapy (targeting the exact location of the tumour).
Robotic surgeries are also commonly used, such as the Da Vinci surgical system at Raffles Urology Centre, which is a minimally-invasive robotic-assisted procedure that involves removing the prostate glands.
For late-stage cancers, options may include hormone therapy, chemotherapy and immunotherapy.
Dr Yuen also added that treatments also vary based on disease stage and severity.
In addition to the treatment options mentioned, he also stated active surveillance as a possible treatment option for low risk cancer, which means closely monitoring the tumour before starting treatment immediately.
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carol.ong@asiaone.com
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