Prostate cancer cases rising amongst Western men

Prostate cancer is the most common malignancy affecting men in much of the Western world. “Its incidence surpasses the prevalence of any other male cancer in America, Europe and Australia,” says Dr Gerald Tan, a senior consultant urological specialist at Mount Elizabeth Novena Hospital in Singapore. “It ranks third in Singapore.”

“It is widely believed that prostate cancer is a disease of affluence,” he says. A Western diet is suspected to play a big role in triggering the disease, with the probable culprits being an excessive intake of red meat, dairy products and gluten – a protein present in cereal grains – that are staple foods in the West.

Dr Tan notes that in Japan and South Korea, where people consume less of these foods, morbidity from prostate cancer is much lower, but he stresses that eating habits are not the sole risk factor for prostate cancer.

“The other big risk factor is a positive family history of prostate cancer,” he says. For instance, the US National Cancer Institute reports that 5 to 10 percent of prostate cancer cases are due to inherited genes.

How to screen for prostate cancer

In recent years several types of blood-based tests have come into widespread use to screen asymptomatic patients for prostate cancers.

This array of examinations measures the amount of prostate-specific antigen (PSA) – a protein produced by the prostate gland – in the bloodstream.

“The PSA test is now universally used as a marker to predict the likelihood of having prostate cancer,” says Dr Tan. “However, the test cannot confirm if you do or do not have prostate cancer.”

The larger the PSA level is, the higher the risk of having prostate cancer. Dr Tan says that a PSA quantity exceeding 10 ng/mL of blood is associated with a 50 percent chance of prostate cancer.

If a high level of PSA is detected, further examinations may be required, such as a transrectal ultrasound-guided biopsy – where a sample of the prostate is extracted through a needle.

Treatment modality: from surveillance to surgery

The basic message patients should be aware of, according to Dr Tan, is that prostate cancer is a very curable disease.

For instance, early-stage patients usually don’t need to be treated at all but have to simply engage in active surveillance. 

“For these patients, the risk of the cancer spreading outside the prostate is very low,” says Dr Tan. “So, they just need to do the PSA test once every few months and a biopsy every year to make sure the cancer is not turning more malignant.” With active surveillance, many patients with low-risk prostate cancer can enjoy a normal life for many years before undergoing definitive treatment for prostate cancer.

Once prostate cancer reaches a stage requiring treatment, surgery is often the most effective approach.

“Surgery alone or in combination with radiation or hormone therapy is the bedrock of treatment for prostate cancer because it offers the best survival rates in the long term,” says Dr Tan.

He adds that robotic-assisted surgery is often the treatment of choice since it outperforms both minimally invasive surgery and open surgery in terms of blood loss, transfusion rate and degree of pain.

Robotic instruments are superior at visualising the fine tissues surrounding the prostate and can twist or turn in all sorts of ways, notes Dr Tan.

As a result, surgeons are able to minimise damage to the surrounding nerves that are responsible for urine control and erectile function. By doing so patients can recover much faster from urinary incontinence and erectile dysfunction, which are common side effects associated with prostate surgery.

Active surveillance also plays a role in reducing these types of side effects.

“The earlier we find the cancer, the more nerves we are able to preserve,” explains Dr Tan.

Dr Gerald Tan is a senior consultant urologist at Mount Elizabeth Novena Hospital in Singapore. His field of expertise is in minimally invasive and robotic-assisted surgery to treat prostate, kidney and bladder cancers. Dr Tan has received numerous international honours and awards. In 2012, he was named the Outstanding Young Urologist of Asia by the Urological Associations of Asia. He may be contacted at www.drgeraldtan.com.sg

Mount Elizabeth Novena Hospital
38 Irrawaddy Road, Singapore 329563
Tel: (+65) 6735 5000
www.mountelizabeth.com.sg

Gerald Tan Urology + Robotics
Mount Elizabeth Novena Specialist Centre #07-40
38 Irrawaddy Road, Singapore 329563
Tel: (+65) 6694 1838