Gentlemen, don't ignore your health down there!

According to the recent Singapore Cancer Registry Annual Report 2022, prostate cancer is now the most common cancer affecting Singapore men. 

Prostate cancer develops in the cells of the prostate, a gland in the male reproductive tract located below the bladder and in front of the rectum. 

Usually occurring in men over the age of 50, prostate cancer is often diagnosed in the early-stage where it is confined to the prostate gland, although more aggressive forms of the disease are sometimes diagnosed in later stages.

Prostate cancer symptoms

Common symptoms of prostate cancer include:

• Difficulty passing urine

• Burning or pain during urination

• Increased urinary frequency, especially at night (nocturia)

• Blood in urine

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

• Weakness or numbness in the legs and difficulty walking

Another cancer affecting men in that "region" is testicular cancer.

Testicular cancer occurs when healthy cells in the testicles develop changes in their DNA, leading to abnormal growth and the formation of a tumour which may be malignant. 

Despite only representing about 1-2% of all cancers in males, testicular cancer occurs predominantly in younger men aged 20 - 40 years.

Testicular cancer symptoms

Common symptoms of testicular cancer include:

• A lump or swelling in either testicle

• A dull ache in the lower belly or groin

• Pain or discomfort in a testicle or the scrotum

• Enlargement or tenderness of the breast tissue

• Back pain

Fortunately, prostate cancer and testicular cancer are curable if diagnosed and treated early.

So take this opportunity to learn more about prostate and testicular cancers by participating in this ‘Ask the Specialist’ Q&A forum. After all, the first step on the journey to better health starts with knowing what to do and what to look out for.

Related articles:

6 Tips for a Healthy Prostate

Coping with Prostate Cancer Treatment

Testicular Cancer: Causes, Symptoms and Treatment

Did you know?

 Movember participants typically grow a moustache to raise awareness about the importance of early detection and diagnosis, as well as advocate for a healthier lifestyle for men!

About Clin Asst Prof Yam Wai Loon

Dr Yam obtained his medical degree at Yong Loo Lin School of Medicine, National University of Singapore in 2008. He completed his residency training in Urology from 2013 to 2017, and was awarded the SingHealth Outstanding Resident Award in 2014.  He passed the specialist board examination in 2017 and was the top scorer in the European Board of Urology assessment in 2017.

With keen interests in metastatic prostate cancer, prostate cancer and urothelial cancer, Dr Yam initiated CGH Department of Urology’s metastatic prostate cancer clinic as well as intravesical gemcitabine for bladder cancer. He has organised, as well as has been invited as speaker, at various workshops, courses, and conferences for fellow urologists and residents in Singapore and across the region.

Questions and answers on prostate cancer

1. Question by Jeff

Dear Doctor Yam,

Most of the cancer prevention advice I am aware of revolves around adopting a healthy lifestyle – incorporating more vegetables in your daily diet, cutting down on meat consumption, avoiding smoking, maintaining a healthy weight, exercising regularly and keeping stress in check – apart from these, is there anything else specifically I can do to lower my risk of prostate cancer?

Oh yes, going for screening is just as important. Is there anything else that I had missed

Thank you for your advice.

Answer by Clin Asst Prof Yam Wai Loon

Hi Mr Jeff, thank you for the question. You have summarised most of the healthy lifestyle advice for most cancers as well as chronic diseases.

Unfortunately, the risk factors of prostate cancer are unmodifiable, meaning they cannot be controlled or changed. These risk factors include age, race, and having a family history of prostate cancer and breast cancer. Furthermore, no medications have been proven to reduce the risk of prostate cancer thus far.

2. Question by Tan KC

Hi Prof Yam,

Is frequent urination at night an early sign of prostate cancer? But an enlarged prostate could also be the cause of this, correct? Is there any way to tell the difference between early-stage prostate cancer and an enlarged prostate?

Are there specific symptoms that one should look out for that gives clear indication that a person is likely having prostate cancer? Appreciate your advice.

Answer by Clin Asst Prof Yam Wai Loon

Hi Mr Tan, thank you for the question. Night urination is a common occurrence among the elderly, and you are right that an enlarged prostate may be a cause for this.

The best way to be able to diagnose prostate cancer in its early stages is to go for regular screening. 

This includes a blood test to test for the levels of Prostate-Specific Antigen (PSA) in the blood, a rectal examination by your doctor, and an MRI scan of the prostate. 

When there are specific symptoms that likely indicate prostate cancer e.g. bone pain or severe blood in the urine, the prostate cancer may already be at an advanced stage, hence regular screening is important for early diagnosis and treatment for better outcomes.

3. Question by Yong KK

Hi Doctor,

This happened for more than a year, the top portion of my penis slightly curved to the right hand side, no pain, but the sperm ejection is slightly slower than before.

What are the possible causes and what should I do? Thank you in advance.

Answer by Clin Asst Prof Yam Wai Loon

Hi Mr Yong, your symptoms might be related to a condition called Peyronie disease, in which plaque (scar tissue) forms and builds up underneath the penis. This may be what is causing the curvature, and this is not harmful to health. 

While it is unlikely to be related to prostate cancer or testicular cancer, do consult a healthcare professional if you have any concerns.

4. Question by Clifford

Hi Dr,

Is surgery the mainstay of treatment for prostate cancer? What are the other treatment options? Thank you.

Answer by Clin Asst Prof Yam Wai Loon

Hi Mr Clifford, thank you for the question.

The treatment options for prostate cancer depends on the stage of the disease. 

For a selective group of very early-stage prostate cancer, active surveillance is a viable option. This refers to an approach where the individual's care team proactively monitors a patient's signs, symptoms, and other indicators of the condition, and defers treatment until the patient shows signs of cancer progression.

Treatment options for early-stage prostate cancer include surgery, which potentially involves surgically removing the prostate gland and/or surrounding tissues and lymph nodes, or radiotherapy, a type of cancer treatment which uses high doses of radiation to kill cancer cells and shrink tumours. 

At more advanced stages of prostate cancer, the patient may require treatments such as hormonal therapy or chemotherapy.

There are pros and cons of each treatment, and the choice of treatment recommended may vary depending on the individual's condition. A multi-disciplinary care team approach is also best for the patient and their family, in order to discuss comprehensive treatment and care management options.  

As each patient also has his own concerns and expectations, it is advisable to consult a urology specialist or radiation oncologist to discuss treatment options before making any decisions.

Ref: H24