Prostate cancer can be treated successfully especially when detected early.

Choice of prostate cancer treatment is dependent on factors such as:

  • Age and expected actuarial survival

  • Underlying medical health and the presence of co-existing illnesses, such as heart attack (myocardial infarction), strokes, diabetes, etc.

  • PSA (prostate-specific antigen) level

  • Gleason Score (derived from the pathologist’s assessment of the prostate biopsy)

  • Status of DRE (digital rectal examination)

  • Stage of disease (extent of prostate gland, lymph nodes or other distant organ involvement)

"An individual with prostate cancer needs to be assessed by a multi-disciplinary team of specialists to determine which modality of treatment is best for him," explained the Department of Urology from Singapore General Hospital (SGH), a member of the SingHealth group.

Prostate cancer treatment requires the involvement of different specialists such as urologists, interventional radiologists, nuclear medicine physicians, medical oncologists, radiation oncologists and palliative medicine specialists.

Types of prostate cancer treatments

1. Active surveillance of prostate cancer

This modality of management is usually used in older men with significant concurrent medical illness, or healthy men with early-stage, low-risk cancer who are willing to comply with the follow-up protocol.

In such cases, doctors may advise waiting and observing to see if the cancer progresses before starting any treatment. Active surveillance may include regular bloods tests for prostate-specific antigen (PSA), digital rectal examination, imaging investigations and repeat biopsies if required. 

The rationale for active surveillance is based on a calculated probability that the cancer is unlikely to be life-threatening in the next 5-10 years.

In patients with a life expectancy beyond 10 years or with high-risk disease posing a threat, treatment in the form of surgery or radiation is considered.

Selected persons may be closely monitored by blood tests and repeat biopsies. Treatment may be initiated when there is evidence of a change in the cancer parameters.

2. Surgery for prostate cancer

Those in good health are usually offered surgery as treatment for prostate cancer. 

Known as radical prostatectomy, this procedure involves removing all or part of the prostate gland. Surgery is usually offered to men with early-stage disease or cancer that is confined to the prostate, who do not have other serious health problems.

  • In radical prostatectomy, the entire prostate gland and other nearby tissues (e.g. surrounding structures and lymph nodes) are surgically removed.

  • Another approach is the robotic-assisted laparoscopic radical prostatectomy. This is a minimally invasive surgical technique, where the surgeon makes several small incisions in the lower abdomen and uses instruments attached to a mechanical device, known as “robotic arms”, to perform the surgery.

Tissues that have been surgically removed are sent to the pathology lab to be examined to determine how advanced the prostate cancer is, the risk of cancer recurrence and if additional treatment is necessary.

Care after prostate cancer surgery

After recovering from surgery, the patient will be given regular outpatient appointments to see a team of doctors. These visits may include blood tests and scans to monitor and check if prostate cancer recurs.

It is important to follow the doctor's advice, keep to scheduled clinic visits and do the prescribed tests so that timely treatment can be administered if prostate cancer or other problems arise. 

a) Hormone therapy 

Hormone therapy, known as androgen deprivation therapy, works by preventing prostate cancer cells from receiving testosterone, this causes the prostate cancer cells to die or grow more slowly. 

Hormone therapy for prostate cancer usually involves the use of drugs, given as injections or tablets. Another less common form of hormone therapy is the surgical removal of the testes which produce testosterone. 

b) Radiotherapy

Radiotherapy, also known as radiation therapy, is the use of high-energy radiation (rays or particles) to kill or damage the prostate cancer cells. Radiation affects both normal and prostate cancer cells. 

Generally, more cancer cells are killed compared to normal cells, which are able to repair themselves after radiotherapy.

Radiotherapy can be delivered in two main ways, external beam radiotherapy (EBRT) or internal radiotherapy:

  • During EBRT (external beam radiotherapy), radiation beams are generated from a machine and directed at the prostate. 

  • For Internal Radiation Therapy, also known as Brachytherapy, radiation is delivered to the prostate by placing radioactive materials in the prostate to kill the cancer cells.

The type of radiation therapy the doctor recommends depends on the stage of the prostate cancer and the patient’s underlying health condition.

c) Proton therapy

Proton therapy is an advanced type of radiation treatment that targets cancer cells using positively charged subatomic particles called protons. 

The unique physical properties of protons enable tumours to be more precisely targeted compared to the x-rays used in conventional radiotherapy. This minimises damage to nearby healthy tissues and organs and therefore results in fewer radiation-related side effects.

For more on proton beam therapy in treating prostate cancer, click on the "Watch on YouTube" link below to play the video!

 

d) Chemotherapy

Chemotherapy is the use of anti-cancer drugs to eradicate prostate cancer cells or prevent their growth. Chemotherapy can also help to relieve or delay symptoms like pain.

Chemotherapy is usually offered to men with advanced or metastatic prostate cancer, which has spread beyond the prostate to other parts of the body.

Ref: H24 (ed)

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