Detecting prostate cancer early can boost survival

The detection, treatment, and outcomes for prostate cancer are significantly better than for other cancers, which is fortunate considering that it is one of the most common male cancers.

That’s according to Dr Michael Wong, a urologist at Mount Elizabeth Hospital in Singapore, who says that, with early detection, the five-year survival rate for the cancer is more than 95 percent.

“Even in locally advanced prostate cancer, the survival rate is easily more than 80 percent, and what is surprising is that in most patients with very advanced prostate cancer, 30 percent of them would be expected to survive for at least five years.

“And if we find that the prostate cancer volume is very small, it’s not aggressive, and there is no evidence of spread beyond the prostate capsule, most doctors would just recommend that their patients only undergo monitoring to see whether they need treatment,” says Dr Wong, who is also deputy director at the Japan-based Asian School of Urology.

Treatment options

In general, when a cancer is considered to have a slightly higher risk of spreading, patients will need treatment, which could come either in the form of robotic radical prostatectomy (removal of the prostate gland) or through non-invasive therapies.

The former, which can take up to three and a half hours to perform, is carried out through 5 small incisions in the abdominal wall. Recovery should be rapid after a 2-3 night hospital stay.

Patients will return home with a urinary catheter placed in the bladder to allow the healing of the bladder neck after surgery. After its removal, most patients experience transient incontinence before full recovery, which can take up to 3-4 months.

Erectile dysfunction, another downside of the procedure, is commonly seen after a radical prostatectomy, although with adequate management, counseling, and oral therapy, recovery from this should take between 9-12 months.

“In essence, in cancer control for early prostate cancer, robotic radical prostatectomy is definitely deemed as one of the most optimal choices,” Dr Wong explains.

In certain cases, when patients are not keen for surgery, doctors might consider a seven-and-a-half week outpatient course of radiotherapy to shrink the cancer and prevent it from relapse. This would probably be performed over 20 minutes each weekday.

If a patient presents to his urologist with advanced prostate cancer, especially if it has spread to the lymph nodes or also to the bones, then the treatment options are “very straightforward,” he says, and responsive in almost three quarters of patients. In this case, patients would normally undergo hormonal therapy to shrink the cancer in the prostate gland and other affected areas. This might be followed up with radiation therapy to further reduce the chance of relapse.

While the international average response rate using this therapy is roughly 2-3 years, eventually prostate cancer could relapse and no longer be sensitive to hormonal therapy.

“Thereafter, the search is now on across the world for other forms of oral therapy that can manage the relapse of advanced prostate cancer,” Dr Wong says.

Risk factors

Based on what is understood about prostate cancer, several factors can increase one’s chances of developing it, including age, race, and family history.

For example, the older a patient, the more likely he is to develop the disease, making it one of the most common cancers among males today.

In studies in the United States, it was found that African-Americans were at twice the risk of developing prostate cancer than white Caucasian males, while the risk factor for Asian-Americans and Latino-Americans was slightly lower.

Another factor is family history. It is well documented that men who have a father, brother, or even uncle diagnosed with prostate cancer have double the chance of developing it.

“Therefore, if you have risk factors you need to make sure that you are screened for prostate cancer on a regular basis after the age of 45,” says Dr Wong.

A possible link between the BRCA1 and BRCA2 genes and prostate cancer is currently being investigated, though this has not yet been identified.

Symptoms and detection

Patients who have difficulty passing urine, who do so more often during the night, or who have blood in their semen should see a urologist to investigate the possibility of an enlarged prostate and the presence of cancer cells in it.

Some tests to improve the detection of prostate cancer are currently being evaluated beyond the prostate-specific antigen (PSA) test, which is the most commonly used method to differentiate between the possibility of having benign prostate enlargement, prostatitis (swelling), and prostate cancer.

For the last two years, the free and total PSA, PHI, and the 4Kscore tests have been investigated as a means to make the PSA test more accurate before performing a biopsy.

“Currently we still rely on the standard total PSA with free and total PSA ratio being a little bit of help in finding out the need for a biopsy to detect prostate cancer.

“Of course we know that blood tests are never totally accurate for the diagnosis of prostate cancer, so it’s very important that you see a urologist if your prostate blood test PSA is elevated to confirm that there is no presence of prostate cancer,” explains Dr Wong.

If cancer is identified, Dr Wong advises patients to stay calm and recognize that the chances of remission are high, especially for early-stage cancers.

“So the good news is that once you find the right urologist, you must stick to the treatment protocols, which are very well defined, then the outcome will be much better than you expect,” he advises.

Dr Michael Wong Yuet Chen is a US Fellowship-trained urologist who practices at Mount Elizabeth Hospital in Singapore. He specialises in minimally invasive surgery in endourology, female urology and male fertility. In addition to his practice, Dr Wong is associate editor of the British Journal of Urology, and through his deep interest in education, currently holds the position of deputy director at the Asian School of Urology.