Medical Care , Health & Wellness , Oncology (Cancer)
As per Singapore Cancer Annual Registry report 2019, prostate cancer was the second most common cancer diagnosed in men in the period from 2015 till 2019. It accounted for 5875 new cases or 15.4 percent of all cancers diagnosed in men during that time-period. Prostate cancer more commonly affects older men, but can be diagnosed in younger men as well.
Early-stage prostate cancer has few or no symptoms as the cancer develops relatively slowly. If symptoms appear, they may include difficulty in passing urine, slow urine flow, frequent urination and blood in urine.
There is currently no established screening programme for the early detection of prostate cancer in Singapore. Screening usually utilises the prostate specific antigen (PSA) blood test to determine the risk of having prostate cancer. Men who may benefit from screening after counselling include those at elevated risk of having prostate cancer:
• Men from 50 years or age.
• Men from 45 years of ageanda family history of prostate cancer;
• Men of African descent from 45 years of age;
• Men carrying BRCA2 mutations from 40 years of age.
In early-stage prostate cancer, or cancer localised to the prostate, the treatment options are mainly influenced by the grade (or aggressiveness) of the cancer.
In active surveillance, patients are monitored closely and treatment such as surgery or radiation therapy is deferred unless there is growth or progression of cancer. This approach is only applicable to a small proportion of low-grade cancers.
Surgery involves removing the prostate and the surrounding tissues completely. This includes removal of the surrounding lymph nodes, especially for high-grade cancers. The gold standard surgical option nowadays is robot-assisted radical prostatectomy. Two of the main long-term side effects of surgery are erectile dysfunction and urinary incontinence.
Radiation therapy involves utilising high doses of radiation to kill prostate cancer cells. The most commonly used type of radiation therapy for prostate cancer is called external beam radiation therapy (EBRT), in which a machine aims radiation at the cancer from outside the body. It is considered as effective as surgery for the treatment of localised prostate cancer, and is the standard alternative in all the prostate cancer treatment guidelines. Potential downsides to radiation therapyinclude longer treatment duration and risk of damage to surrounding organs.
With the advent of more accurate MRI-targeted prostate biopsies in the last few years, some patients are diagnosed with cancer only involving a small proportion of the prostate. In these men, the logical thought is whether treatment can be focused only on these areas of cancer without needing whole gland treatment.
This is also known as focal therapy as only the region of the prostate where the cancer is located is treated. This approach can potentially improve the functional outcomes of treatment (i.e., lower the risk of urine incontinence and erectile dysfunction) without sacrificing control of the cancer that is achieved with whole gland treatment. Focal therapy is a new approach to treating prostate cancer, and as such the studies have follow up of less than 10 years after treatment. However, it is still not considered standard of care and more information is needed about long term outcomes from this approach.
Dr Akhil Chopra is a senior consultant in medical oncology practicing at the OncoCare Cancer Centre (Singapore). He has a special interest in Genitourinary oncology, especially prostate cancer.
Dr Tan Teck Wei is a Senior Consultant Urologist at Urohealth Medical Clinic (Singapore). He has a special interest in the management of urological cancers, and completed a fellowship in Robotic surgery and Uro-oncology at Guy’s and St Thomas’ Hospitals in London, United Kingdom.
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