Prostate cancer is currently the most common cancer affecting Singaporean men (according to statistics from the Singapore Cancer Registry Annual Report 2021).

6 Tips to maintain a healthy prostate

As a start:

1. Include more green, leafy vegetables in your daily diet. This is a good first step towards a healthy prostate as leafy vegetables contain important vitamins and antioxidants
   

2. Avoid charred meats which is associated with a type of chemical (PhIP), which increase the risk of cancer

3. Get moderate exposure to sunlight. This ensures adequate Vitamin D, which lowers the risk of cancer

4. Maintain a healthy weight. Being overweight or obese increases risk of prostate cancer.

5. Exercise regularly. Studies have shown that exercise is beneficial for prostate health

6. Consider going for prostate cancer screening, if you are above 50 years of age. Consult your doctor regarding the pros and cons of going for prostate cancer screening. Prostate health can easily be determined with a digital rectal exam (DRE) and a simple blood test (prostate specific antigen)

Symptoms of prostate cancer

Early prostate cancer is usually asymptomatic. Symptoms of prostate cancer usually show up at later stages of the disease as the tumour grows and narrows the urethra (urine passage) and spreads to other organs.

The following symptoms are non-specific and may also be caused by benign (non-cancerous) conditions such as benign prostatic hyperplasia and prostatitis. They include:

• Weak or interrupted flow of urine

• Frequent urination (especially at night)

• Difficulty urinating

• Pain or burning during urination

• Blood in the urine or semen

• Nagging pain in the  back (spine), hips, chest (ribs), pelvis or other bony areas
  

• Weakness or numbness in the legs and difficulty walking
  

• Difficulty controlling the bladder or bowels

• Painful ejaculation

• Weight loss, loss of appetite

The symptoms above can be caused by a number of reasons and may not indicate the presence of prostate cancer. However, make an appointment with your doctor if you have any signs or symptoms that worry you.

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Factors for increased risk of prostate cancer

The exact causes of prostate cancer are still unknown and are being studied through research. Some of the risk factors that are known to increase the risk of developing prostate cancer are:

• Age − This is the strongest risk factor. Men above the age of 50 are at risk and the risk increases with age.

• Ethnicity − In Singapore, Chinese men have double the risk of getting prostate cancer compared to Malay or Indian men.

• Family history – Men with a father or brother with prostate cancer are more likely to get the disease. 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 when the prostate cancer was detected.

• Unhealthy diet − Men who consume large amounts of fat, particularly from red meat and other sources of animal fat, including dairy products.

Ways to diagnose prostate cancer

Several different tests can be used to diagnose prostate cancer including:

1. Digital rectal examination
   Often part of a routine physical examination, the doctor inserts a lubricated gloved finger into the rectum and gently feels for abnormal growths. This may be uncomfortable but should not be painful.

2. Prostate-Specific Antigen (PSA) blood test
   A blood test that measures PSA levels in the blood may indicate prostate cancer. The PSA is a substance produced by the prostate and a small amount of it is normal. Men with prostate cancer tend to have higher levels of PSA in their blood. As elevated PSA levels may be caused by other non-cancerous conditions, additional tests are needed to confirm the presence of prostate cancer.

3. Transrectal Ultrasound scan (TRUS)
   This test uses high-frequency sound waves to produce images of the prostate. It is done by inserting a small probe into the rectum. TRUS is often conducted if a man has an abnormal digital rectum exam or a high level of prostate-specific antigen (PSA). It is also commonly used during a prostate biopsy, to allow the doctor to see where to take small samples of tissue from.

4. Biopsy
   A prostate biopsy involves taking small samples of prostate tissue for further examination in the lab to determine the presence of prostate cancer cells. Prostate biopsy samples can be collected in different ways, by inserting a thin needle either through the rectum (transrectal biopsy) or through the area between the anus and scrotum (transperineal biopsy). 

5. Computer Tomography (CT) scan
   A CT scan takes X-ray images from different angles to build up a 3D picture of the inside of the body. This can identify the area of the prostate cancer and any spread to nearby structures or body parts.

6. Magnetic Resonance Imaging (MRI) scan
   An MRI scan uses magnetic fields to give detailed pictures of the pelvic area. It can help to detect prostate cancer and look for any spread to the lymph nodes.

7. Bone scan
   A bone scan can detect if cancer has spread from the prostate to the bones. A small amount of radioactive material called a tracer is injected and a scan is done to see how the tracer is absorbed, to indicate the presence of prostate cancer.

8. Positron Emission Tomography - Computed Tomography (PET-CT) scan
   A PET-CT scan combines both a CT scan and a PET scan to provide a more comprehensive view of the cancer and the extent of its spread. A CT scan uses X-rays to take images to check for any areas with abnormalities. With the PET scan, a radioactive glucose solution is injected and absorbed by cells in the body that are growing quickly, indicating the presence of prostate cancer, which can be seen with a special camera. The PET scan helps to show if areas with abnormalities seen on the CT scan are suspicious for cancerous growth.

Treating prostate cancer with SBRT (stereotactic body radiotherapy)

If you are diagnosed with early stage prostate cancer, you may be eligible for stereotactic body radiotherapy (SBRT) treatment.

Compared to traditional radiotherapy that requires daily treatments of between 37 to 39 sessions, which can last up to two months, SBRT delivers radiation over a much shorter period (2-3 times shorter) and can be completed within five sessions. This enables patients to return back to work and normal activities more quickly (in nearly half the time).

“This is due to improvement in technology that allows for better imaging of the prostate, faster and more precise radiation delivery,” said Dr Li Youquan, Consultant from the Division of Radiation Oncology at National Cancer Centre Singapore (NCCS), a member of the SingHealth group.

Recent studies also confirmed that SBRT is as effective as traditional techniques with a promise of reduced side effects such as rectal bleeding and sexual dysfunction¹.

Since 2014, over 100 patients from NCCS have been treated with SBRT with good clinical outcomes and a favorable toxicity profile. The treatment is currently being tested in two large randomised control trials in the United States and United Kingdom and could replace traditional treatments as the new standard^2,3.

References:

1. Cushman TR et al, Oncotarget. 2019 Sep 24; 10 (54) 5660-5668
2. PACE-B trial (NCT01584258)
3. NRG GU005 (NCT03367702)

Ref: K21

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Enlarged Prostate (Benign Prostate Hyperplasia): What Causes It and How to Treat

Prostate Cancer: What You Need to Know

Prostate Cancer Treatment: How to Choose the One That's Right for You

Prostate Cancer: Overview On Treatment Options

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